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Sample records for reserve base provide

  1. Protein domain architectures provide a fast, efficient and scalable alternative to sequence-based methods for comparative functional genomics [version 1; referees: 1 approved, 2 approved with reservations

    Directory of Open Access Journals (Sweden)

    Jasper J. Koehorst

    2016-08-01

    Full Text Available A functional comparative genome analysis is essential to understand the mechanisms underlying bacterial evolution and adaptation. Detection of functional orthologs using standard global sequence similarity methods faces several problems; the need for defining arbitrary acceptance thresholds for similarity and alignment length, lateral gene acquisition and the high computational cost for finding bi-directional best matches at a large scale. We investigated the use of protein domain architectures for large scale functional comparative analysis as an alternative method. The performance of both approaches was assessed through functional comparison of 446 bacterial genomes sampled at different taxonomic levels. We show that protein domain architectures provide a fast and efficient alternative to methods based on sequence similarity to identify groups of functionally equivalent proteins within and across taxonomic bounderies. As the computational cost scales linearly, and not quadratically with the number of genomes, it is suitable for large scale comparative analysis. Running both methods in parallel pinpoints potential functional adaptations that may add to bacterial fitness.

  2. 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.

  3. Providing frequency regulation reserve services using demand response scheduling

    International Nuclear Information System (INIS)

    Motalleb, Mahdi; Thornton, Matsu; Reihani, Ehsan; Ghorbani, Reza

    2016-01-01

    Highlights: • Proposing a market model for contingency reserve services using demand response. • Considering transient limitations of grid frequency for inverter-based generations. • Price-sensitive scheduling of residential batteries and water heaters using dynamic programming. • Calculating the profits of both generation companies and demand response aggregators. - Abstract: During power grid contingencies, frequency regulation is a primary concern. Historically, frequency regulation during contingency events has been the sole responsibility of the power utility. We present a practical method of using distributed demand response scheduling to provide frequency regulation during contingency events. This paper discusses the implementation of a control system model for the use of distributed energy storage systems such as battery banks and electric water heaters as a source of ancillary services. We present an algorithm which handles the optimization of demand response scheduling for normal operation and during contingency events. We use dynamic programming as an optimization tool. A price signal is developed using optimal power flow calculations to determine the locational marginal price of electricity, while sensor data for water usage is also collected. Using these inputs to dynamic programming, the optimal control signals are given as output. We assume a market model in which distributed demand response resources are sold as a commodity on the open market and profits from demand response aggregators as brokers of distributed demand response resources can be calculated. In considering control decisions for regulation of transient changes in frequency, we focus on IEEE standard 1547 in order to prevent the safety shut-off of inverter-based generation and further exacerbation of frequency droop. This method is applied to IEEE case 118 as a demonstration of the method in practice.

  4. Bilingualism provides a neural reserve for aging populations.

    Science.gov (United States)

    Abutalebi, Jubin; Guidi, Lucia; Borsa, Virginia; Canini, Matteo; Della Rosa, Pasquale A; Parris, Ben A; Weekes, Brendan S

    2015-03-01

    It has been postulated that bilingualism may act as a cognitive reserve and recent behavioral evidence shows that bilinguals are diagnosed with dementia about 4-5 years later compared to monolinguals. In the present study, we investigated the neural basis of these putative protective effects in a group of aging bilinguals as compared to a matched monolingual control group. For this purpose, participants completed the Erikson Flanker task and their performance was correlated to gray matter (GM) volume in order to investigate if cognitive performance predicts GM volume specifically in areas affected by aging. We performed an ex-Gaussian analysis on the resulting RTs and report that aging bilinguals performed better than aging monolinguals on the Flanker task. Bilingualism was overall associated with increased GM in the ACC. Likewise, aging induced effects upon performance correlated only for monolinguals to decreased gray matter in the DLPFC. Taken together, these neural regions might underlie the benefits of bilingualism and act as a neural reserve that protects against the cognitive decline that occurs during aging. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. SCPR: Secure Crowdsourcing-Based Parking Reservation System

    Directory of Open Access Journals (Sweden)

    Changsheng Wan

    2017-01-01

    Full Text Available The crowdsourcing-based parking reservation system is a new computing paradigm, where private owners can rent their parking spots out. Security is the main concern for parking reservation systems. However, current schemes cannot provide user privacy protection for drivers and have no key agreement functions, resulting in a lot of security problems. Moreover, current schemes are typically based on the time-consuming bilinear pairing and not suitable for real-time applications. To solve these security and efficiency problems, we present a novel security protocol with user privacy called SCPR. Similar to protocols of this field, SCPR can authenticate drivers involved in the parking reservation system. However, different from other well-known approaches, SCPR uses pseudonyms instead of real identities for providing user privacy protection for drivers and designs a novel pseudonym-based key agreement protocol. Finally, to reduce the time cost, SCPR designs several novel cryptographic algorithms based on the algebraic signature technique. By doing so, SCPR can satisfy a number of security requirements and enjoy high efficiency. Experimental results show SCPR is feasible for real world applications.

  6. Fundamentals of Using Battery Energy Storage Systems to Provide Primary Control Reserves in Germany

    Directory of Open Access Journals (Sweden)

    Alexander Zeh

    2016-09-01

    Full Text Available The application of stationary battery storage systems to German electrical grids can help with various storage services. This application requires controlling the charge and discharge power of such a system. For example, photovoltaic (PV home storage, uninterruptible power supply, and storage systems for providing ancillary services such as primary control reserves (PCRs represent battery applications with positive profitability. Because PCRs are essential for stabilizing grid frequency and maintaining a robust electrical grid, German transmission system operators (TSOs released strict regulations in August 2015 for providing PCRs with battery storage systems as part of regulating the International Grid Control Cooperation (IGCC region in Europe. These regulations focused on the permissible state of charge (SoC of the battery during nominal and extreme conditions. The concomitant increased capacity demand oversizing may result in a significant profitability reduction, which can be attenuated only by using an optimal parameterization of the control algorithm for energy management of the storage systems. In this paper, the sizing optimization is achieved and a recommendation for a control algorithm that includes the appropriate parameters for the requirements in the German market is given. Furthermore, the storage cost is estimated, including battery aging simulations for different aging parameter sets to allow for a realistic profitability calculation.

  7. A Multi-Period Optimization Model for Service Providers Using Online Reservation Systems: An Application to Hotels

    Science.gov (United States)

    Xu, Ming; Jiao, Yan; Li, Xiaoming; Cao, Qingfeng; Wang, Xiaoyang

    2015-01-01

    This paper presents a multi-period optimization model for high margin and zero salvage products in online distribution channels with classifying customers based on number of products required. Taking hotel customers as an example, one is regular customers who reserve rooms for one day, and the other is long term stay (LTS) customers who reserve rooms for a number of days. LTS may guarantee a specific amount of demand and generate opportunity income for a certain number of periods, meanwhile with risk of punishment incurred by overselling. By developing an operational optimization model and exploring the effects of parameters on optimal decisions, we suggest that service providers should make decisions based on the types of customers, number of products required, and duration of multi-period to reduce the loss of reputation and obtain more profit; at the same time, multi-period buying customers should buy products early. Finally, the paper conducts a numerical experiment, and the results are consistent with prevailing situations. PMID:26147663

  8. Demonstrated reserve base for coal in New Mexico. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Hoffman, G.K.

    1995-02-01

    The new demonstrated reserve base estimate of coal for the San Juan Basin, New Mexico, is 11.28 billion short tons. This compares with 4.429 billion short tons in the Energy Information Administration`s demonstrated reserve base of coal as of January 1, 1992 for all of New Mexico and 2.806 billion short tons for the San Juan Basin. The new estimate includes revised resource calculations in the San Juan Basin, in San Juan, McKinley, Sandoval, Rio Arriba, Bernalillo and Cibola counties, but does not include the Raton Basin and smaller fields in New Mexico. These estimated {open_quotes}remaining{close_quotes} coal resource quantities, however, include significant adjustments for depletion due to past mining, and adjustments for accessibility and recoverability.

  9. Documentation of the demonstrated reserve base of coal in the United States. Volume 2. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Herhal, A J; Britton, S G; Minnucci, C A

    1982-03-01

    The purpose of this report is to document the methodologies used to develop the 1979 Demonstrated Reserve Base (DRB) of coal. The main body of this report summarizes the methodological procedures used to develop each state reserve estimate. The appendices to the report provide a detailed description of the entire DRB process for each state.

  10. Network-Based Substrate of Cognitive Reserve in Alzheimer's Disease.

    Science.gov (United States)

    Serra, Laura; Mancini, Matteo; Cercignani, Mara; Di Domenico, Carlotta; Spanò, Barbara; Giulietti, Giovanni; Koch, Giacomo; Marra, Camillo; Bozzali, Marco

    2017-01-01

    Cognitive reserve (CR) is known to modulate the clinical features of Alzheimer's disease (AD). This concept may be critical for the development of non-pharmacological interventions able to slow down patients' cognitive decline in the absence of disease-modifying treatments. We aimed at identifying the neurobiological substrates of CR (i.e., neural reserve) over the transition between normal aging and AD, by assessing the underlying brain networks and their topological properties. A cohort of 154 participants (n = 68 with AD, n = 61 with amnestic mild cognitive impairment (aMCI), and 25 healthy subjects) underwent resting-state functional MRI and neuropsychological testing. Within each group, participants were classified as having high or low CR, and functional connectivity measures were compared, within group, between high and low CR individuals. Network-based statistics and topological network properties derived from graph theory were explored. Connectivity differences between high and low CR were evident only for aMCI patients, with participants with high CR showing a significant increase of connectivity in a network involving mainly fronto-parietal nodes. Conversely, they showed significantly decreased connectivity in a network involving fronto-temporo-cerebellar nodes. Consistently, changes to topological measures were observed in either direction, and were associated with measures of global cognitive function. These findings support the hypothesis that CR impacts on neurodegenerative process in the early phase of AD only. In addition, they fit with the existence of a "neural reserve", characterized by specific neural networks and their efficiency. It remains to be demonstrated whether interventions later in life can modulate this "neural reserve".

  11. Integration in MASCEM of the Joint Dispatch of Energy and Reserves Provided by Generation and Demand Resources

    DEFF Research Database (Denmark)

    Soares, Tiago; Santos, Gabriel; Faria, Pedro

    2013-01-01

    and electricity markets due to their inherent competitive environment. This paper concerns a methodology proposed by the authors, which aims to jointly and optimally dispatch both generation and demand response resources to provide the amounts of reserve required for the system operation. Virtual Power Players...... are especially important for the aggregation of small size demand response and generation resources. The proposed methodology has been implemented in MASCEM, a multi agent system also developed at the authors’ research center for the simulation of electricity markets...

  12. Dispatch of distributed energy resources to provide energy and reserve in smart grids using a particle swarm optimization approach

    DEFF Research Database (Denmark)

    Faria, Pedro; Soares, Tiago; Pinto, Tiago

    2013-01-01

    grid operation. Computational intelligence methods can be used to give a suitable solution for the resources scheduling problem considering the time constraints. This paper proposes a methodology for a joint dispatch of demand response and distributed generation to provide energy and reserve...... are recognized. The increasing integration of demand response and distributed generation resources, all of them mostly with small scale distributed characteristics, leads to the need of aggregating entities such as Virtual Power Players. The operation business models become more complex in the context of smart...

  13. Data base dictionary for the Oak Ridge Reservation Hydrology and Geology Study Groundwater Data Base

    Energy Technology Data Exchange (ETDEWEB)

    Thompson, B.K.

    1993-04-01

    The Oak Ridge Reservation Hydrology and Geology Study (ORRHAGS) Groundwater Data Base has been compiled to consolidate groundwater data from the three US Department of Energy facilities located on the Oak Ridge Reservation: the Oak Ridge K-25 Site, the Oak Ridge National Laboratory, and the Oak Ridge Y-12 Plant. Each of these facilities maintains its own groundwater and well construction data bases. Data were extracted from the existing data bases, converted to a consistent format, and integrated into the ORRHAGS Groundwater Data Base structures. This data base dictionary describes the data contained in the ORRHAGS Groundwater Data Base and contains information on data base structure, conventions, contents, and use.

  14. Community - based management in two biosphere reserves in ...

    African Journals Online (AJOL)

    The paper presents the characteristics of both sites and explores traditional natural resource use, local associations, and their role in collective action, as well as customary institutional arrangements. The results provide insight into strengthening local management capacities and cooperation. They also highlight the need to ...

  15. based management in two biosphere reserves in Madagascar

    African Journals Online (AJOL)

    N.V.M. Fritz-Vietta, C. Roettger, S. Stoll-Kleemann

    2009-12-02

    Dec 2, 2009 ... ABSTRACT. This article explores the socio - cultural aspects of community - based management of natural resources in Madagascar. The contractual devolution of management rights and responsibili- ties to local user groups constitutes an important instrument in the country's environmental policy.

  16. Derelict Fishing Line Provides a Useful Proxy for Estimating Levels of Non-Compliance with No-Take Marine Reserves

    OpenAIRE

    Williamson, David H.; Ceccarelli, Daniela M.; Evans, Richard D.; Hill, Jos K.; Russ, Garry R.

    2014-01-01

    No-take marine reserves (NTMRs) are increasingly being established to conserve or restore biodiversity and to enhance the sustainability of fisheries. Although effectively designed and protected NTMR networks can yield conservation and fishery benefits, reserve effects often fail to manifest in systems where there are high levels of non-compliance by fishers (poaching). Obtaining reliable estimates of NTMR non-compliance can be expensive and logistically challenging, particularly in areas wit...

  17. Assessment of DoD-Provided Healthcare for Members of the United States Armed Forces Reserve Components

    Science.gov (United States)

    2014-10-08

    The TRICARE Dental Program covers the following services: • exams, cleanings, fluorides, sealants , and x-rays, • fillings, including white fillings...establish that programs will be in place to support the medical and dental readiness of Reserve Component (RC) service members so they comply with... dental care to RC service members for all wounds, illnesses, and injuries incurred or aggravated in the line of duty until they have recovered. Reserve

  18. Reservation Application System Of Private Lesson At Easyspeak Denpasar Based On Web And Android

    Directory of Open Access Journals (Sweden)

    Ferry yudhitama putra

    2016-06-01

    Full Text Available Abstract— English Private lessons institutes are now widely facilitates a person to develop English skills in speaking and writing. Currently the service users private lessons English book private lessons manually, that is by coming directly to the place as well as through the telephone service, but with the operator even then still have difficulties in user validation that requires a long time. To facilitate the user in terms of the reservation, then the system will be built based on web and Android. Development of private lessons reservation application built with PHP and Java programming language using CodeIgniter framework on the web side , while on the Android using Eclipse tools , and MySQL as database storage media . Applications reservation private lessons has several functions to make a reservation time and tutor can be done by the student of Easyspeak and on the side of the tutor application can provide information about the student will be taught , as well as on the side of the operator to provide ease in setting booking private lessons because it computerized not manually as before. Applications reservation private lessons are also equipped with a reminder or reminders are made on the side of Android apps , using alarmmanager system.

  19. Derelict fishing line provides a useful proxy for estimating levels of non-compliance with no-take marine reserves.

    Science.gov (United States)

    Williamson, David H; Ceccarelli, Daniela M; Evans, Richard D; Hill, Jos K; Russ, Garry R

    2014-01-01

    No-take marine reserves (NTMRs) are increasingly being established to conserve or restore biodiversity and to enhance the sustainability of fisheries. Although effectively designed and protected NTMR networks can yield conservation and fishery benefits, reserve effects often fail to manifest in systems where there are high levels of non-compliance by fishers (poaching). Obtaining reliable estimates of NTMR non-compliance can be expensive and logistically challenging, particularly in areas with limited or non-existent resources for conducting surveillance and enforcement. Here we assess the utility of density estimates and re-accumulation rates of derelict (lost and abandoned) fishing line as a proxy for fishing effort and NTMR non-compliance on fringing coral reefs in three island groups of the Great Barrier Reef Marine Park (GBRMP), Australia. Densities of derelict fishing line were consistently lower on reefs within old (>20 year) NTMRs than on non-NTMR reefs (significantly in the Palm and Whitsunday Islands), whereas line densities did not differ significantly between reefs in new NTMRs (5 years of protection) and non-NTMR reefs. A manipulative experiment in which derelict fishing lines were removed from a subset of the monitoring sites demonstrated that lines re-accumulated on NTMR reefs at approximately one third (32.4%) of the rate observed on non-NTMR reefs over a thirty-two month period. Although these inshore NTMRs have long been considered some of the best protected within the GBRMP, evidence presented here suggests that the level of non-compliance with NTMR regulations is higher than previously assumed.

  20. Derelict fishing line provides a useful proxy for estimating levels of non-compliance with no-take marine reserves.

    Directory of Open Access Journals (Sweden)

    David H Williamson

    Full Text Available No-take marine reserves (NTMRs are increasingly being established to conserve or restore biodiversity and to enhance the sustainability of fisheries. Although effectively designed and protected NTMR networks can yield conservation and fishery benefits, reserve effects often fail to manifest in systems where there are high levels of non-compliance by fishers (poaching. Obtaining reliable estimates of NTMR non-compliance can be expensive and logistically challenging, particularly in areas with limited or non-existent resources for conducting surveillance and enforcement. Here we assess the utility of density estimates and re-accumulation rates of derelict (lost and abandoned fishing line as a proxy for fishing effort and NTMR non-compliance on fringing coral reefs in three island groups of the Great Barrier Reef Marine Park (GBRMP, Australia. Densities of derelict fishing line were consistently lower on reefs within old (>20 year NTMRs than on non-NTMR reefs (significantly in the Palm and Whitsunday Islands, whereas line densities did not differ significantly between reefs in new NTMRs (5 years of protection and non-NTMR reefs. A manipulative experiment in which derelict fishing lines were removed from a subset of the monitoring sites demonstrated that lines re-accumulated on NTMR reefs at approximately one third (32.4% of the rate observed on non-NTMR reefs over a thirty-two month period. Although these inshore NTMRs have long been considered some of the best protected within the GBRMP, evidence presented here suggests that the level of non-compliance with NTMR regulations is higher than previously assumed.

  1. 7 CFR 1412.23 - Base acres and Conservation Reserve Program.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false Base acres and Conservation Reserve Program. 1412.23... Base Acres for a Farm for Covered Commodities § 1412.23 Base acres and Conservation Reserve Program. (a... year, adjust the base acres for covered commodities and peanuts with respect to the farm by the number...

  2. Patient and provider attitudes to emergency department-based HIV ...

    African Journals Online (AJOL)

    Patient and provider attitudes to emergency department-based HIV counselling and testing in South Africa. ... We also used two previously validated survey instruments to gather data on patients' HIV knowledge and providers' stigma against patients living with HIV, as we anticipated that these may have an impact on ...

  3. Providing Base Line Data for the Treatment of Mauritian Sugar ...

    African Journals Online (AJOL)

    In that context, a pilot study was carried out to determine the performance of the UASB process in treating sugar mill effluent and to provide base-line operational and design data for the reactor on a large scale. A sugar factory wastewater was characterised and the data were used to prepare the molasses-based synthetic ...

  4. C-DAM: CONTENTION BASED DISTRIBUTED RESERVATION PROTOCOL ALLOCATION ALGORITHM FOR WIMEDIA MEDIUM ACCESS CONTROL

    Directory of Open Access Journals (Sweden)

    UMADEVI K. S.

    2017-07-01

    Full Text Available WiMedia Medium Access Control (MAC provides high rate data transfer for wireless networking thereby enables construction of high speed home networks. It facilitates data communication between the nodes through two modes namely: i Distributed Reservation Protocol (DRP for isochronous traffic and ii Prioritized Contention Access (PCA for asynchronous traffic. PCA mode enables medium access using CSMA/CA similar to IEEE 802.11e. In the presence of DRP, the throughput of PCA saturates when there is an increase in the number of devices accessing PCA channel. Researchers suggest that the better utilization of medium resolves many issues in an effective way. To demonstrate the effective utilization of the medium, Contention Based Distributed Reservation Protocol Allocation Algorithm for WiMedia Medium Access Control is proposed for reserving Medium Access Slots under DRP in the presence of PCA. The proposed algorithm provides a better medium access, reduces energy consumption and enhances the throughput when compared to the existing methodologies.

  5. Robust Allocation of Reserve Policies for a Multiple-Cell Based Power System

    DEFF Research Database (Denmark)

    Hu, Junjie; Lan, Tian; Heussen, Kai

    2018-01-01

    This paper applies a robust optimization technique for coordinating reserve allocations in multiple-cell based power systems. The linear decision rules (LDR)-based policies were implemented to achieve the reserve robustness, and consist of a nominal power schedule with a series of linear modifica...... in real time operation to make a trade off....

  6. An Enhanced Reservation-Based MAC Protocol for IEEE 802.15.4 Networks

    Science.gov (United States)

    Afonso, José A.; Silva, Helder D.; Macedo, Pedro; Rocha, Luis A.

    2011-01-01

    The IEEE 802.15.4 Medium Access Control (MAC) protocol is an enabling standard for wireless sensor networks. In order to support applications requiring dedicated bandwidth or bounded delay, it provides a reservation-based scheme named Guaranteed Time Slot (GTS). However, the GTS scheme presents some drawbacks, such as inefficient bandwidth utilization and support to a maximum of only seven devices. This paper presents eLPRT (enhanced Low Power Real Time), a new reservation-based MAC protocol that introduces several performance enhancing features in comparison to the GTS scheme. This MAC protocol builds on top of LPRT (Low Power Real Time) and includes various mechanisms designed to increase data transmission reliability against channel errors, improve bandwidth utilization and increase the number of supported devices. A motion capture system based on inertial and magnetic sensors has been used to validate the protocol. The effectiveness of the performance enhancements introduced by each of the new features is demonstrated through the provision of both simulation and experimental results. PMID:22163826

  7. Notes on the marine algae of the International Biosphere Reserve Seaflower, Caribbean Colombia VI: New records of Phaeophyceae from Old Providence and Santa Catalina.

    Directory of Open Access Journals (Sweden)

    Viviana Patricia Reyes-Gómez

    2017-05-01

    Full Text Available Two species of brown algae (Phaeophyceae, Bachelotia antilarum (Grunow Gerloff and Dictyota humifusa Hörnig, Schnetter & Coppejans, are reported for the first time for the Archipelago of San Andrés, Old Providence and Sainte Cataline, part of the International Biosphere Reserve Seaflower.

  8. A model based on stochastic dynamic programming for determining China's optimal strategic petroleum reserve policy

    International Nuclear Information System (INIS)

    Zhang Xiaobing; Fan Ying; Wei Yiming

    2009-01-01

    China's Strategic Petroleum Reserve (SPR) is currently being prepared. But how large the optimal stockpile size for China should be, what the best acquisition strategies are, how to release the reserve if a disruption occurs, and other related issues still need to be studied in detail. In this paper, we develop a stochastic dynamic programming model based on a total potential cost function of establishing SPRs to evaluate the optimal SPR policy for China. Using this model, empirical results are presented for the optimal size of China's SPR and the best acquisition and drawdown strategies for a few specific cases. The results show that with comprehensive consideration, the optimal SPR size for China is around 320 million barrels. This size is equivalent to about 90 days of net oil import amount in 2006 and should be reached in the year 2017, three years earlier than the national goal, which implies that the need for China to fill the SPR is probably more pressing; the best stockpile release action in a disruption is related to the disruption levels and expected continuation probabilities. The information provided by the results will be useful for decision makers.

  9. Research of Coal Resources Reserves Prediction Based on GM (1, 1) Model

    Science.gov (United States)

    Xiao, Jiancheng

    2018-01-01

    Based on the forecast of China’s coal reserves, this paper uses the GM (1, 1) gray forecasting theory to establish the gray forecasting model of China’s coal reserves based on the data of China’s coal reserves from 2002 to 2009, and obtained the trend of coal resources reserves with the current economic and social development situation, and the residual test model is established, so the prediction model is more accurate. The results show that China’s coal reserves can ensure the use of production at least 300 years of use. And the results are similar to the mainstream forecast results, and that are in line with objective reality.

  10. A Reserve-based Method for Mitigating the Impact of Renewable Energy

    Science.gov (United States)

    Krad, Ibrahim

    The fundamental operating paradigm of today's power systems is undergoing a significant shift. This is partially motivated by the increased desire for incorporating variable renewable energy resources into generation portfolios. While these generating technologies offer clean energy at zero marginal cost, i.e. no fuel costs, they also offer unique operating challenges for system operators. Perhaps the biggest operating challenge these resources introduce is accommodating their intermittent fuel source availability. For this reason, these generators increase the system-wide variability and uncertainty. As a result, system operators are revisiting traditional operating strategies to more efficiently incorporate these generation resources to maximize the benefit they provide while minimizing the challenges they introduce. One way system operators have accounted for system variability and uncertainty is through the use of operating reserves. Operating reserves can be simplified as excess capacity kept online during real time operations to help accommodate unforeseen fluctuations in demand. With new generation resources, a new class of operating reserves has emerged that is generally known as flexibility, or ramping, reserves. This new reserve class is meant to better position systems to mitigate severe ramping in the net load profile. The best way to define this new requirement is still under investigation. Typical requirement definitions focus on the additional uncertainty introduced by variable generation and there is room for improvement regarding explicit consideration for the variability they introduce. An exogenous reserve modification method is introduced in this report that can improve system reliability with minimal impacts on total system wide production costs. Another potential solution to this problem is to formulate the problem as a stochastic programming problem. The unit commitment and economic dispatch problems are typically formulated as deterministic

  11. The models for financial crisis detection in Indonesia based on import, export, and foreign exchange reserves

    Science.gov (United States)

    Sugiyanto; Wibowo, Supriyadi; Rizky Aristina Suwardi, Vivi

    2017-12-01

    The severity of the financial crisis that occurred in Indonesia required an early warning system of financial crisis. The financial crisis in Indonesia can be detected based on imports, exports, and foreign exchange reserves. The purpose of the research is to determine an appropriate model to detect the financial crisis in Indonesia based on imports, exports, and foreign exchange reserves. Markov switching is an alternative framework for the approach often used in financial crisis detection. Combined volatility and Markov switching model with three states assumptions can be established if an AR and volatility models have been obtained. Imports, exports, and foreign exchange reserves data from January 1990 to December 2016 have the heteroscedasticity effect so that an ARCH model is used as a volatility model. Research shows that SWARCH(3.1) model is an appropriate model for detecting financial crisis in Indonesia based on imports, exports, and foreign exchange reserves.

  12. Data base dictionary for the Oak Ridge Reservation Hydrology and Geology Study Groundwater Data Base. Environmental Restoration Program

    Energy Technology Data Exchange (ETDEWEB)

    Thompson, B.K.

    1993-04-01

    The Oak Ridge Reservation Hydrology and Geology Study (ORRHAGS) Groundwater Data Base has been compiled to consolidate groundwater data from the three US Department of Energy facilities located on the Oak Ridge Reservation: the Oak Ridge K-25 Site, the Oak Ridge National Laboratory, and the Oak Ridge Y-12 Plant. Each of these facilities maintains its own groundwater and well construction data bases. Data were extracted from the existing data bases, converted to a consistent format, and integrated into the ORRHAGS Groundwater Data Base structures. This data base dictionary describes the data contained in the ORRHAGS Groundwater Data Base and contains information on data base structure, conventions, contents, and use.

  13. Provider-based Medicare risk contracting and subcontracting: opportunities and risks for provider sponsored organizations.

    Science.gov (United States)

    Levin, H A; Zenner, P A; Kipp, R A; Whitney, E L

    1997-01-01

    Provider sponsored organizations (PSOs) are increasingly acquiring the risk for the management of Medicare Risk patients by accepting capitation directly from the Health Care Financing Administration (HCFA) or through contracts with HMOs or other organizations contracting with HCFA. The Medicare population and the requirements that the federal administration has put into place with respect to risk contracting are unique and demand specific responses on the part of the PSO for a contract to be successful. The PSO is cautioned to understand the actuarial risk, the clinical uniqueness of the Medicare beneficiary, Medicare reimbursement regulatory requirements, utilization management needs, and necessary reporting before entering into a contractual arrangement. This article attempts to describe some of the more common issues a provider organization must consider.

  14. Internet-based information system of digital geological data providing

    Science.gov (United States)

    Yuon, Egor; Soukhanov, Mikhail; Markov, Kirill

    2015-04-01

    One of the Russian Federal аgency of mineral resources problems is to provide the geological information which was delivered during the field operation for the means of federal budget. This information should be present in the current, conditional form. Before, the leading way of presenting geological information were paper geological maps, slices, borehole diagrams reports etc. Technologies of database construction, including distributed databases, technologies of construction of distributed information-analytical systems and Internet-technologies are intensively developing nowadays. Most of geological organizations create their own information systems without any possibility of integration into other systems of the same orientation. In 2012, specialists of VNIIgeosystem together with specialists of VSEGEI started the large project - creating the system of providing digital geological materials with using modern and perspective internet-technologies. The system is based on the web-server and the set of special programs, which allows users to efficiently get rasterized and vectorised geological materials. These materials are: geological maps of scale 1:1M, geological maps of scale 1:200 000 and 1:2 500 000, the fragments of seamless geological 1:1M maps, structural zoning maps inside the seamless fragments, the legends for State geological maps 1:200 000 and 1:1 000 000, full author's set of maps and also current materials for international projects «Atlas of geological maps for Circumpolar Arctic scale 1:5 000 000» and «Atlas of Geologic maps of central Asia and adjacent areas scale 1:2 500 000». The most interesting and functional block of the system - is the block of providing structured and well-formalized geological vector materials, based on Gosgeolkart database (NGKIS), managed by Oracle and the Internet-access is supported by web-subsystem NGKIS, which is currently based on MGS-Framework platform, developed by VNIIgeosystem. One of the leading elements

  15. Determination of fractional flow reserve (FFR) based on scaling laws: a simulation study

    International Nuclear Information System (INIS)

    Wong, Jerry T; Molloi, Sabee

    2008-01-01

    Fractional flow reserve (FFR) provides an objective physiological evaluation of stenosis severity. A technique that can measure FFR using only angiographic images would be a valuable tool in the cardiac catheterization laboratory. To perform this, the diseased blood flow can be measured with a first pass distribution analysis and the theoretical normal blood flow can be estimated from the total coronary arterial volume based on scaling laws. A computer simulation of the coronary arterial network was used to gain a better understanding of how hemodynamic conditions and coronary artery disease can affect blood flow, arterial volume and FFR estimation. Changes in coronary arterial flow and volume due to coronary stenosis, aortic pressure and venous pressure were examined to evaluate the potential use of flow and volume for FFR determination. This study showed that FFR can be estimated using arterial volume and a scaling coefficient corrected for aortic pressure. However, variations in venous pressure were found to introduce some error in FFR estimation. A relative form of FFR was introduced and was found to cancel out the influence of pressure on coronary flow, arterial volume and FFR estimation. The use of coronary flow and arterial volume for FFR determination appears promising

  16. Topology Optimization Design of 3D Continuum Structure with Reserved Hole Based on Variable Density Method

    Directory of Open Access Journals (Sweden)

    Bai Shiye

    2016-05-01

    Full Text Available An objective function defined by minimum compliance of topology optimization for 3D continuum structure was established to search optimal material distribution constrained by the predetermined volume restriction. Based on the improved SIMP (solid isotropic microstructures with penalization model and the new sensitivity filtering technique, basic iteration equations of 3D finite element analysis were deduced and solved by optimization criterion method. All the above procedures were written in MATLAB programming language, and the topology optimization design examples of 3D continuum structure with reserved hole were examined repeatedly by observing various indexes, including compliance, maximum displacement, and density index. The influence of mesh, penalty factors, and filter radius on the topology results was analyzed. Computational results showed that the finer or coarser the mesh number was, the larger the compliance, maximum displacement, and density index would be. When the filtering radius was larger than 1.0, the topology shape no longer appeared as a chessboard problem, thus suggesting that the presented sensitivity filtering method was valid. The penalty factor should be an integer because iteration steps increased greatly when it is a noninteger. The above modified variable density method could provide technical routes for topology optimization design of more complex 3D continuum structures in the future.

  17. Analysis of Human Activities in Nature Reserves Based on Nighttime Light Remote Sensing and Microblogging Data - by the Case of National Nature Reserves in Jiangxi Province

    Science.gov (United States)

    Shi, F.; Li, X.; Xu, H.

    2017-09-01

    The study used the mainstream social media in china - Sina microblogging data combined with nighttime light remote sensing and various geographical data to reveal the pattern of human activities and light pollution of the Jiangxi Provincial National Nature Reserves. Firstly, we performed statistical analysis based on both functional areas and km-grid from the perspective of space and time, and selected the key areas for in-depth study. Secondly, the relationship between microblogging data and nighttime light remote sensing, population, GDP, road coverage, road distance and road type in nature reserves was analyzed by Spearman correlation coefficient method, so the distribution pattern and influencing factors of the microblogging data were explored. Thirdly, a region where the luminance value was greater than 0.2 was defined as a light region. We evaluated the management status by analyzing the distribution of microblogging data in both light area and non-light area. Final results showed that in all nature reserves, the top three were the Lushan Nature Reserve, the Jinggangshan Nature Reserve, the Taohongling National Nature Reserve of Sikas both on the total number and density of microblogging ; microblogging had a significant correlation with nighttime light remote sensing , the GDP, population, road and other factors; the distribution of microblogging near roads in protected area followed power laws; luminous radiance of Lushan Nature Reserve was the highest, with 43 percent of region was light at night; analysis combining nighttime light remote sensing with microblogging data reflected the status of management of nature reserves.

  18. Power-Capacity and Ramp-Capability Reserves for Wind Integration in Power-Based UC

    NARCIS (Netherlands)

    Morales Espana, G.; Baldick, Ross; García-González, Javier; Ramos, Andres

    2015-01-01

    This paper proposes a power-based network-constrained unit commitment (UC) model as an alternative to the traditional deterministic UCs to deal with wind generation uncertainty. The formulation draws a clear distinction between power-capacity and ramp-capability reserves to deal with wind production

  19. Simultaneously Optimizing Storage Location Assignment at Forward Area and Reserve Area - a Decomposition Based Heuristic

    DEFF Research Database (Denmark)

    Bloch, Søren; Christiansen, Christian Holk

    versa. This, however, is often neglected in the existing literature. We solve the TSLAP simultaneously for the reserve area and the forward area. Based on randomly generated test instances we show that the solutions of TSLAP compare favorably to solutions found by other algorithms proposed...

  20. Providing Climate Policy Makers With a Strong Scientific Base (Invited)

    Science.gov (United States)

    Struzik, E.

    2009-12-01

    Scientists can and should inform public policy decisions in the Arctic. But the pace of climate change in the polar world has been occurring far more quickly than most scientists have been able to predict. This creates problems for decision-makers who recognize that difficult management decisions have to be made in matters pertaining to wildlife management, cultural integrity and economic development. With sea ice melting, glaciers receding, permafrost thawing, forest fires intensifying, and disease and invasive species rapidly moving north, the challenge for scientists to provide climate policy makers with a strong scientific base has been daunting. Clashing as this data sometimes does with the “traditional knowledge” of indigenous peoples in the north, it can also become very political. As a result the need to effectively communicate complex data is more imperative now than ever before. Here, the author describes how the work of scientists can often be misinterpreted or exploited in ways that were not intended. Examples include the inappropriate use of scientific data in decision-making on polar bears, caribou and other wildlife populations; the use of scientific data to debunk the fact that greenhouse gases are driving climate change, and the use of scientific data to position one scientist against another when there is no inherent conflict. This work will highlight the need for climate policy makers to increase support for scientists working in the Arctic, as well as illustrate why it is important to find new and more effective ways of communicating scientific data. Strategies that might be considered by granting agencies, scientists and climate policy decision-makers will also be discussed.

  1. Ensuring the Reliable Operation of the Power Grid: State-Based and Distributed Approaches to Scheduling Energy and Contingency Reserves

    Science.gov (United States)

    Prada, Jose Fernando

    Keeping a contingency reserve in power systems is necessary to preserve the security of real-time operations. This work studies two different approaches to the optimal allocation of energy and reserves in the day-ahead generation scheduling process. Part I presents a stochastic security-constrained unit commitment model to co-optimize energy and the locational reserves required to respond to a set of uncertain generation contingencies, using a novel state-based formulation. The model is applied in an offer-based electricity market to allocate contingency reserves throughout the power grid, in order to comply with the N-1 security criterion under transmission congestion. The objective is to minimize expected dispatch and reserve costs, together with post contingency corrective redispatch costs, modeling the probability of generation failure and associated post contingency states. The characteristics of the scheduling problem are exploited to formulate a computationally efficient method, consistent with established operational practices. We simulated the distribution of locational contingency reserves on the IEEE RTS96 system and compared the results with the conventional deterministic method. We found that assigning locational spinning reserves can guarantee an N-1 secure dispatch accounting for transmission congestion at a reasonable extra cost. The simulations also showed little value of allocating downward reserves but sizable operating savings from co-optimizing locational nonspinning reserves. Overall, the results indicate the computational tractability of the proposed method. Part II presents a distributed generation scheduling model to optimally allocate energy and spinning reserves among competing generators in a day-ahead market. The model is based on the coordination between individual generators and a market entity. The proposed method uses forecasting, augmented pricing and locational signals to induce efficient commitment of generators based on firm

  2. Self-Selected and Maximal Walking Speeds Provide Greater Insight Into Fall Status Than Walking Speed Reserve Among Community-Dwelling Older Adults.

    Science.gov (United States)

    Middleton, Addie; Fulk, George D; Herter, Troy M; Beets, Michael W; Donley, Jonathan; Fritz, Stacy L

    2016-07-01

    To determine the degree to which self-selected walking speed (SSWS), maximal walking speed (MWS), and walking speed reserve (WSR) are associated with fall status among community-dwelling older adults. WS and 1-year falls history data were collected on 217 community-dwelling older adults (median age = 82, range 65-93 years) at a local outpatient PT clinic and local retirement communities and senior centers. WSR was calculated as a difference (WSRdiff = MWS - SSWS) and ratio (WSRratio = MWS/SSWS). SSWS (P fall status. The cutpoints identified were 0.76 m/s for SSWS (65.4% sensitivity, 70.9% specificity), 1.13 m/s for MWS (76.6% sensitivity, 60.0% specificity), and 0.24 m/s for WSRdiff (56.1% sensitivity, 70.9% specificity). SSWS and MWS better discriminated between fallers and non-fallers (SSWS: AUC = 0.69, MWS: AUC = 0.71) than WSRdiff (AUC = 0.64). SSWS and MWS seem to be equally informative measures for assessing fall status in community-dwelling older adults. Older adults with SSWSs less than 0.76 m/s and those with MWSs less than 1.13 m/s may benefit from further fall risk assessment. Combining SSWS and MWS to calculate an individual's WSR does not provide additional insight into fall status in this population. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES:: Upon completion of this article, the reader should be able to: (1) Describe the different methods for calculating walking speed reserve and discuss the potential of the metric as an outcome measure; (2) Explain the degree to which self-selected walking speed, maximal walking speed, and walking speed reserve are associated with fall status among community-dwelling older adults; and (3) Discuss potential limitations to using walking speed reserve to identify fall status in populations without mobility restrictions. Advanced : The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to

  3. A Novel Trust Service Provider for Internet Based Commerce Applications.

    Science.gov (United States)

    Siyal, M. Y.; Barkat, B.

    2002-01-01

    Presents a framework for enhancing trust in Internet commerce. Shows how trust can be provided through a network of Trust Service Providers (TSp). Identifies a set of services that should be offered by a TSp. Presents a distributed object-oriented implementation of trust services using CORBA, JAVA and XML. (Author/AEF)

  4. A Network Flow-based Analysis of Cognitive Reserve in Normal Ageing and Alzheimer's Disease.

    Science.gov (United States)

    Wook Yoo, Sang; Han, Cheol E; Shin, Joseph S; Won Seo, Sang; Na, Duk L; Kaiser, Marcus; Jeong, Yong; Seong, Joon-Kyung

    2015-05-20

    Cognitive reserve is the ability to sustain cognitive function even with a certain amount of brain damages. Here we investigate the neural compensation mechanism of cognitive reserve from the perspective of structural brain connectivity. Our goal was to show that normal people with high education levels (i.e., cognitive reserve) maintain abundant pathways connecting any two brain regions, providing better compensation or resilience after brain damage. Accordingly, patients with high education levels show more deterioration in structural brain connectivity than those with low education levels before symptoms of Alzheimer's disease (AD) become apparent. To test this hypothesis, we use network flow measuring the number of alternative paths between two brain regions in the brain network. The experimental results show that for normal aging, education strengthens network reliability, as measured through flow values, in a subnetwork centered at the supramarginal gyrus. For AD, a subnetwork centered at the left middle frontal gyrus shows a negative correlation between flow and education, which implies more collapse in structural brain connectivity for highly educated patients. We conclude that cognitive reserve may come from the ability of network reorganization to secure the information flow within the brain network, therefore making it more resistant to disease progress.

  5. Calculation of benefit reserves based on true m-thly benefit premiums

    Science.gov (United States)

    Riaman; Susanti, Dwi; Supriatna, Agus; Nurani Ruchjana, Budi

    2017-10-01

    Life insurance is a form of insurance that provides risk mitigation in life or death of a human. One of its advantages is measured life insurance. Insurance companies ought to give a sum of money as reserves to the customers. The benefit reserves are an alternative calculation which involves net and cost premiums. An insured may pay a series of benefit premiums to an insurer equivalent, at the date of policy issue, to the sum of to be paid on the death of the insured, or on survival of the insured to the maturity date. A balancing item is required and this item is a liability for one of the parties and the other is an asset. The balancing item, in loan, is the outstanding principle, an asset for the lender and the liability for the borrower. In this paper we examined the benefit reserves formulas corresponding to the formulas for true m-thly benefit premiums by the prospective method. This method specifies that, the reserves at the end of the first year are zero. Several principles can be used for the determined of benefit premiums, an equivalence relation is established in our discussion.

  6. UK provides "step increase" in funding for its science base

    CERN Multimedia

    1998-01-01

    The British government has come good on pre-election promises when this week, it agreed to inject an extra 700 million into the country's science base over the next three years. This extra funding is boosted by a further 400 million pounds from the Welcome Trust over the same period (1 page).

  7. Community-based Forest Resources Management in Nigeria: Case study of Ngel Nyaki Forest Reserve, Mambilla Plateau, Taraba State, Nigeria

    Directory of Open Access Journals (Sweden)

    T.I. Borokini

    2012-05-01

    Full Text Available In Nigeria, human communities are found within or beside forest ecosystems, depending onthese ecosystems for survival. Their forest exploitation is considered a threat to conservation efforts,leading to constant conflicts between Government, law enforcement agencies and the communities. Thebest solution is a win-win system of participatory community-based forest resources management, inwhich the communities are regarded as stakeholders rather than as threats. This paper explains theadoption of this approach in Ngel Nyaki Forest Reserve, Mambilla Plateau, where the communities weretrained in establishment and management of forest plantations with readily available market for theirtimber; employment for some of the community youths as well as community development projects.This paper calls for the adoption of this system in other protected areas in Nigeria, while theGovernment should provide basic amenities for the communities as alternatives to those forest products.Keywords: Community-based forest management, Ngel Nyaki Forest Reserve, Protected areas, Nigeria.

  8. Agent-Based Modelling and Simulation to Assess the Impact of Parking Reservation System

    Directory of Open Access Journals (Sweden)

    Xun-You Ni

    2017-01-01

    Full Text Available With the increasing popularity of smart phones, Parking Reservation System (PRS becomes practical to reduce the travel time in cruising for vacant spaces. The aim of this study is to assess the impact of PRS explicitly. This paper was started with analyzing the processes of cruising for vacant spaces and making parking reservation decisions. The vehicles were divided into two categories: the intelligent vehicles and the regular ones. Only the intelligent vehicles have the ability to make a parking reservation beforehand, while the regular ones have to cruise for vacant spaces. All involved components were treated as different agents, including vehicles, parking lots, network, and management center. Based on this, agent-based simulation was introduced to evaluate the performances of the scenarios with different penetration rates. The simulation results indicate the average travel time increases with the improvement of the penetration rates for the regular vehicles. The assessment method presented in this study would assist in promoting the performances of PRS in urban areas.

  9. Fast Virtual Fractional Flow Reserve Based Upon Steady-State Computational Fluid Dynamics Analysis

    Directory of Open Access Journals (Sweden)

    Paul D. Morris, PhD

    2017-08-01

    Full Text Available Fractional flow reserve (FFR-guided percutaneous intervention is superior to standard assessment but remains underused. The authors have developed a novel “pseudotransient” analysis protocol for computing virtual fractional flow reserve (vFFR based upon angiographic images and steady-state computational fluid dynamics. This protocol generates vFFR results in 189 s (cf >24 h for transient analysis using a desktop PC, with <1% error relative to that of full-transient computational fluid dynamics analysis. Sensitivity analysis demonstrated that physiological lesion significance was influenced less by coronary or lesion anatomy (33% and more by microvascular physiology (59%. If coronary microvascular resistance can be estimated, vFFR can be accurately computed in less time than it takes to make invasive measurements.

  10. Providing a Science Base for the Evaluation of Tobacco Products.

    Science.gov (United States)

    Berman, Micah L; Connolly, Greg; Cummings, K Michael; Djordjevic, Mirjana V; Hatsukami, Dorothy K; Henningfield, Jack E; Myers, Matthew; O'Connor, Richard J; Parascandola, Mark; Rees, Vaughan; Rice, Jerry M; Shields, Peter G

    2015-04-01

    Evidence-based tobacco regulation requires a comprehensive scientific framework to guide the evaluation of new tobacco products and health-related claims made by product manufacturers. The Tobacco Product Assessment Consortium (TobPRAC) employed an iterative process involving consortia investigators, consultants, a workshop of independent scientists and public health experts, and written reviews in order to develop a conceptual framework for evaluating tobacco products. The consortium developed a four-phased framework for the scientific evaluation of tobacco products. The four phases addressed by the framework are: (1) pre-market evaluation, (2) pre-claims evaluation, (3) post-market activities, and (4) monitoring and re-evaluation. For each phase, the framework proposes the use of validated testing procedures that will evaluate potential harms at both the individual and population level. While the validation of methods for evaluating tobacco products is an ongoing and necessary process, the proposed framework need not wait for fully validated methods to be used in guiding tobacco product regulation today.

  11. A Poiseuille-based coronary angiographic index for prediction of fractional flow reserve.

    Science.gov (United States)

    Jaffe, Ronen; Halon, David A; Roguin, Ariel; Rubinshtein, Ronen; Lewis, Basil S

    2013-08-10

    Coronary revascularization is commonly based on the angiographic finding of percent diameter stenosis (%DS) >50 while lesion length (LL), which contributes to flow-limitation according to Poiseuille's equation, is disregarded. Fractional flow reserve (FFR) is superior to assessment of %DS for identifying flow-limiting lesions, but the technology is invasive and relatively expensive. We developed a Poiseuille-based angiographic index, incorporating both minimal lumen diameter (MLD) and LL, for improved assessment of the hemodynamic significance of intermediate coronary lesions. The present study was designed to test the hypothesis that the Poiseuille-based angiographic index correlated better with FFR measurements than angiographic assessment of %DS. We performed quantitative coronary angiography (QCA) and FFR measurements in 46 intermediate coronary lesions in 41 symptomatic patients referred for diagnostic coronary angiography. From QCA we determined LL, MLD and %DS and calculated an angiographic index, the LL/MLD(4) ratio. Mean LL was 14.2 ± 7.8 (range: 4.3-38.8) mm, MLD 1.4 ± 0.4 (range: 0.6-2.3) mm, %DS 46 ± 12 (range: 25-74) and FFR 0.85 ± 0.09 (range: 0.55-1.00). Fractional flow reserve correlated inversely with %DS (R=-0.39, p=0.008) and with the LL/MLD(4) ratio (R=-0.66, pvalue of 0.80 corresponded with a LL/MLD(4) ratio of 12 (p=0.003) but not with a %DS of 50 (p=NS). A LL/MLD(4) ratio ≤ 12 had a specificity of 94% and negative predictive value of 82% for excluding hemodynamically significant lesions with FFR (≥ 0.80). The LL/MLD(4) ratio was superior to standard angiographic measurement of %DS for exclusion of hemodynamically significant coronary lesions. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  12. Providing Pediatric Palliative Care Education Using Problem-Based Learning.

    Science.gov (United States)

    Moody, Karen; McHugh, Marlene; Baker, Rebecca; Cohen, Hillel; Pinto, Priya; Deutsch, Stephanie; Santizo, Ruth O; Schechter, Miriam; Fausto, James; Joo, Pablo

    2018-01-01

    The Institute of Medicine and the American Academy of Pediatrics has called for improvement in education and training of pediatricians in pediatric palliative care (PPC). Given the shortage of PPC physicians and the immediate need for PPC medical education, this study reports the outcomes of a problem-based learning (PBL) module facilitated by academic general and subspecialty pediatric faculty (non-PPC specialists) to third year medical students. Objectives/Setting: To test the effectiveness of a PPC-PBL module on third year medical students' and pediatric faculty's declarative knowledge, attitudes toward, perceived exposure, and self-assessed competency in PPC objectives. A PBL module was developed using three PPC learning objectives as a framework: define core concepts in palliative care; list the components of a total pain assessment; and describe key principles in establishing therapeutic relationships with patients. A PPC physician and nurse practitioner guided pediatric faculty on facilitating the PPC-PBL. In Part 1, students identified domains of palliative care for a child with refractory leukemia and self-assigned questions to research and present at the follow-up session. In Part 2, students were expected to develop a care plan demonstrating the three PPC objectives. Measures included a knowledge exam and a survey instrument to assess secondary outcomes. Students' declarative knowledge, perceived exposure, and self-assessed competency in all three PPC learning objectives improved significantly after the PPC-PBL, p = 0.002, p 80%). Students and faculty rated palliative care education as "important or very important" at baseline and follow-up. This study suggests that key concepts in PPC can be taught to medical students utilizing a PBL format and pediatric faculty resulting in improved knowledge and self-assessed competency in PPC.

  13. CBM Resources/reserves classification and evaluation based on PRMS rules

    Science.gov (United States)

    Fa, Guifang; Yuan, Ruie; Wang, Zuoqian; Lan, Jun; Zhao, Jian; Xia, Mingjun; Cai, Dechao; Yi, Yanjing

    2018-02-01

    This paper introduces a set of definitions and classification requirements for coalbed methane (CBM) resources/reserves, based on Petroleum Resources Management System (PRMS). The basic CBM classification criterions of 1P, 2P, 3P and contingent resources are put forward from the following aspects: ownership, project maturity, drilling requirements, testing requirements, economic requirements, infrastructure and market, timing of production and development, and so on. The volumetric method is used to evaluate the OGIP, with focuses on analyses of key parameters and principles of the parameter selection, such as net thickness, ash and water content, coal rank and composition, coal density, cleat volume and saturation and absorbed gas content etc. A dynamic method is used to assess the reserves and recovery efficiency. Since the differences in rock and fluid properties, displacement mechanism, completion and operating practices and wellbore type resulted in different production curve characteristics, the factors affecting production behavior, the dewatering period, pressure build-up and interference effects were analyzed. The conclusion and results that the paper achieved can be used as important references for reasonable assessment of CBM resources/reserves.

  14. The Assessment of Liver Reserve Function by Spectrophotometry based on Determination of Phenacetin and Paracetamol.

    Science.gov (United States)

    Ren, Rui; Ma, Yongmei; Ma, Wanshan; Lu, Sumei

    2015-01-01

    To establish a technical system for assessing liver reserve function based on spectrophotometry by detection of phenacetin and paracetamol in blood samples. Taking detected contents of phenacetin and paracetamol by high performance liquid chromatography (HPLC) as standard, which was proved to be able to detect drug concentrations with high resolution and accuracy, we established a technical system based on the spectrophotometric technique to assay phenacetin and paracetamol, including the color system, the maximum absorption wavelength, the influence factors of color system, and the optimal conditions for hydrolysis. Then we verified our established system compared with that under HPLC by recovery test. This study established a technical system to detect phenacetin and paracetamol in blood samples using spectrophotometry. Mainly, 3 mol/L hydrochloric acid (HCl) was added to samples for hydrolysis for 30 minutes, then, adding 0.02% 1,2-naphthoquinone-4-sulfonate (NQS), 1% cetyltrimethyl ammonium bromide (CTA) and 2% sodium hydroxide (or 3% sodium carbonate) (ratio of 1:6:1:2 or 3), and the absorbance was measured at 500 nm and 570 nm to calculate their concentrations. Using an established spectrophotometric system to detect phenacetin and paracetamol in blood samples could assess liver reserve function, which was proved comparable with HPLC in resolution and repeatability.

  15. PAPR reduction based on tone reservation scheme for DCO-OFDM indoor visible light communications.

    Science.gov (United States)

    Bai, Jurong; Li, Yong; Yi, Yang; Cheng, Wei; Du, Huimin

    2017-10-02

    High peak-to-average power ratio (PAPR) leads to out-of-band power and in-band distortion in the direct current-biased optical orthogonal frequency division multiplexing (DCO-OFDM) systems. In order to effectively reduce the PAPR with faster convergence and lower complexity, this paper proposes a tone reservation based scheme, which is the combination of the signal-to-clipping noise ratio (SCR) procedure and the least squares approximation (LSA) procedure. In the proposed scheme, the transmitter of the DCO-OFDM indoor visible light communication (VLC) system is designed to transform the PAPR reduced signal into real-valued positive OFDM signal without doubling the transmission bandwidth. Moreover, the communication distance and the light emitting diode (LED) irradiance angle are taking into consideration in the evaluation of the system bit error rate (BER). The PAPR reduction efficiency of the proposed scheme is remarkable for DCO-OFDM indoor VLC systems.

  16. Environmental Assessment for Type III Fuel Hydrant System at Grissom Air Reserve Base

    Science.gov (United States)

    2011-10-01

    emissions from  architectural  coatings and asphalt paving operations. Emissions of all criteria pollutants    Grissom Air Reserve Base  3‐7  October 2011...3.4 CULTURAL RESOURCES 3.4.1 EVALUATION CRITERIA Cultural resources include archaeological resources, historic  architectural  or engineering...potable water distribution  system (GARB 2007).    Drinking water is sampled periodically by  bioenvironmental  engineering personnel at various locations

  17. Learning-Based Precool Algorithms for Exploiting Foodstuff as Thermal Energy Reserve

    DEFF Research Database (Denmark)

    Vinther, Kasper; Rasmussen, Henrik; Izadi-Zamanabadi, Roozbeh

    2015-01-01

    . However, the refrigeration system might not be dimensioned to cope with hot summer days or performance degradation over time. Two learning-based algorithms are therefore proposed for thermostatically controlled loads, which precools the foodstuff in display cases in an anticipatory manner based on how...... saturated the system has been in recent days. A simulation model of a supermarket refrigeration system is provided and evaluation of the precool strategies shows that negative thermal energy can be stored in foodstuff to cope with saturation. A system model or additional hardware is not required, which...

  18. Is There an Optimal Strategic Oil Reserve for Each Country? A Study Based on the Game Theory

    DEFF Research Database (Denmark)

    Yang, Junan; Cong, Ronggang

    2014-01-01

    -cooperative game theory. It also analyzes the establishment of strategic oil reserve among different countries based on the coalition game theory and presents the core solution for it. The results show that based on a certain constraint mechanism, it is feasible for different countries to establish their own...... suitable strategic oil reserves in theory and practice....

  19. Resource on-demand reservation based on time-window in optical grid network

    Science.gov (United States)

    Wu, Runze; Ji, Yuefeng

    2007-11-01

    On-demand reservation strategy is proposed for optical network resource scheduling. The proposed approach introduces time window reservation on grid integrated with wavelength-routed optical network, according to the application request with anticipant time range and rate. The time window deploys variable size, when time-window is not suitable for current application requirement, the resource scheduler can negotiate the next time window allocation with the switch. Time-window resource reservation approach loans dividing time multiplexing mechanism. Considering with multiple parallel lightpaths' monopolization, the proposed reservation approach improves network resource request service rate and makes the application having the QoS-aware ability.

  20. Three dimensional quantitative coronary angiography can detect reliably ischemic coronary lesions based on fractional flow reserve.

    Science.gov (United States)

    Chung, Woo-Young; Choi, Byoung-Joo; Lim, Seong-Hoon; Matsuo, Yoshiki; Lennon, Ryan J; Gulati, Rajiv; Sandhu, Gurpreet S; Holmes, David R; Rihal, Charanjit S; Lerman, Amir

    2015-06-01

    Conventional coronary angiography (CAG) has limitations in evaluating lesions producing ischemia. Three dimensional quantitative coronary angiography (3D-QCA) shows reconstructed images of CAG using computer based algorithm, the Cardio-op B system (Paieon Medical, Rosh Ha'ayin, Israel). The aim of this study was to evaluate whether 3D-QCA can reliably predict ischemia assessed by myocardial fractional flow reserve (FFR) < 0.80. 3D-QCA images were reconstructed from CAG which also were evaluated with FFR to assess ischemia. Minimal luminal diameter (MLD), percent diameter stenosis (%DS), minimal luminal area (MLA), and percent area stenosis (%AS) were obtained. The results of 3D-QCA and FFR were compared. A total of 266 patients was enrolled for the present study. FFR for all lesions ranged from 0.57 to 1.00 (0.85 ± 0.09). Measurement of MLD, %DS, MLA, and %AS all were significantly correlated with FFR (r = 0.569, 0609, 0.569, 0.670, respectively, all P < 0.001). In lesions with MLA < 4.0 mm(2), %AS of more than 65.5% had a 80% sensitivity and a 83% specificity to predict FFR < 0.80 (area under curve, AUC was 0.878). 3D-QCA can reliably predict coronary lesions producing ischemia and may be used to guide therapeutic approach for coronary artery disease.

  1. Costs of Providing Infusion Therapy for Rheumatoid Arthritis in a Hospital-based Infusion Center Setting.

    Science.gov (United States)

    Schmier, Jordana; Ogden, Kristine; Nickman, Nancy; Halpern, Michael T; Cifaldi, Mary; Ganguli, Arijit; Bao, Yanjun; Garg, Vishvas

    2017-08-01

    Many hospital-based infusion centers treat patients with rheumatoid arthritis (RA) with intravenous biologic agents, yet may have a limited understanding of the overall costs of infusion in this setting. The purposes of this study were to conduct a microcosting analysis from a hospital perspective and to develop a model using an activity-based costing approach for estimating costs associated with the provision of hospital-based infusion services (preparation, administration, and follow-up) in the United States for maintenance treatment of moderate to severe RA. A spreadsheet-based model was developed. Inputs included hourly wages, time spent providing care, supply/overhead costs, laboratory testing, infusion center size, and practice pattern information. Base-case values were derived from data from surveys, published studies, standard cost sources, and expert opinion. Costs are presented in year-2017 US dollars. The base case modeled a hospital infusion center serving patients with RA treated with abatacept, tocilizumab, infliximab, or rituximab. Estimated overall costs of infusions per patient per year were $36,663 (rituximab), $36,821 (tocilizumab), $44,973 (infliximab), and $46,532 (abatacept). Of all therapies, the biologic agents represented the greatest share of overall costs, ranging from 87% to $91% of overall costs per year. Excluding infusion drug costs, labor accounted for 53% to 57% of infusion costs. Biologic agents represented the highest single cost associated with RA infusion care; however, personnel, supplies, and overhead costs also contributed substantially to overall costs (8%-16%). This model may provide a helpful and adaptable framework for use by hospitals in informing decision making about services offered and their associated financial implications. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  2. Updating ARI Educational Benefits Usage Data Bases for Army Regular, Reserve, and Guard: 2005 - 2006

    National Research Council Canada - National Science Library

    Young, Winnie

    2007-01-01

    This report describes the updating of ARI's educational benefits usage database with Montgomery GI Bill and Army College Fund data for Army Regular, Reserve, and Guard components over the 2005 and 2006 period...

  3. Cost of providing injectable contraceptives through a community-based social marketing program in Tigray, Ethiopia.

    Science.gov (United States)

    Prata, Ndola; Downing, Janelle; Bell, Suzanne; Weidert, Karen; Godefay, Hagos; Gessessew, Amanuel

    2016-06-01

    To provide a cost analysis of an injectable contraceptive program combining community-based distribution and social marketing in Tigray, Ethiopia. We conducted a cost analysis, modeling the costs and programmatic outcomes of the program's initial implementation in 3 districts of Tigray, Ethiopia. Costs were estimated from a review of program expense records, invoices, and interviews with health workers. Programmatic outcomes include number of injections and couple-year of protection (CYP) provided. We performed a sensitivity analysis on the average number of injections provided per month by community health workers (CHWs), the cost of the commodity, and the number of CHWs trained. The average programmatic CYP was US $17.91 for all districts with a substantial range from US $15.48-38.09 per CYP across districts. Direct service cost was estimated at US $2.96 per CYP. The cost per CYP was slightly sensitive to the commodity cost of the injectable contraceptives and the number of CHWs. The capacity of each CHW, measured by the number of injections sold, was a key input that drove the cost per CYP of this model. With a direct service cost of US $2.96 per CYP, this study demonstrates the potential cost of community-based social marketing programs of injectable contraceptives. The findings suggest that the cost of social marketing of contraceptives in rural communities is comparable to other delivery mechanisms with regards to CYP, but further research is needed to determine the full impact and cost-effectiveness for women and communities beyond what is measured in CYP. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Attitudes of heart failure patients and health care providers towards mobile phone-based remote monitoring.

    Science.gov (United States)

    Seto, Emily; Leonard, Kevin J; Masino, Caterina; Cafazzo, Joseph A; Barnsley, Jan; Ross, Heather J

    2010-11-29

    Mobile phone-based remote patient monitoring systems have been proposed for heart failure management because they are relatively inexpensive and enable patients to be monitored anywhere. However, little is known about whether patients and their health care providers are willing and able to use this technology. The objective of our study was to assess the attitudes of heart failure patients and their health care providers from a heart function clinic in a large urban teaching hospital toward the use of mobile phone-based remote monitoring. A questionnaire regarding attitudes toward home monitoring and technology was administered to 100 heart failure patients (94/100 returned a completed questionnaire). Semi-structured interviews were also conducted with 20 heart failure patients and 16 clinicians to determine the perceived benefits and barriers to using mobile phone-based remote monitoring, as well as their willingness and ability to use the technology. The survey results indicated that the patients were very comfortable using mobile phones (mean rating 4.5, SD 0.6, on a five-point Likert scale), even more so than with using computers (mean 4.1, SD 1.1). The difference in comfort level between mobile phones and computers was statistically significant (Pmobile phones to view health information (mean 4.4, SD 0.9). Patients and clinicians were willing to use the system as long as several conditions were met, including providing a system that was easy to use with clear tangible benefits, maintaining good patient-provider communication, and not increasing clinical workload. Clinicians cited several barriers to implementation of such a system, including lack of remuneration for telephone interactions with patients and medicolegal implications. Patients and clinicians want to use mobile phone-based remote monitoring and believe that they would be able to use the technology. However, they have several reservations, such as potential increased clinical workload, medicolegal

  5. Power generation scheduling. A free market based procedure with reserve constraints included

    International Nuclear Information System (INIS)

    Huse, Einar Staale

    1998-01-01

    This thesis deals with the short-term scheduling of electric power generation in a competitive market. This involves determination of start-ups and shut-downs, and production levels of all units in all hours of the optimization period, considering unit characteristics and system restrictions. The unit characteristics and restrictions handled are minimum and maximum production levels, fuel cost function, start-up costs, minimum up time and minimum down time. The system restrictions handled are power balance (supply equals demand in all hours) and spinning reserve requirement. The thesis has two main contributions: (1) A new organization of an hourly electric power market that simultaneously sets the price of both energy and reserve power is proposed. A power exchange is used as a trading place for electricity. Its responsibility is to balance supply and demand bids and to secure enough spinning reserve. Routines for bidding and market clearing are developed. (2) A computer programme that simulates the proposed electricity market has been implemented. The program can also be used as a new method for solving the single owner generation scheduling problem. Simulations show that the performance of the program is excellent. Simulations also show that it is possible to obtain efficient schedules through the proposed electricity market. 37 refs., 20 figs., 15 tabs

  6. Power generation scheduling. A free market based procedure with reserve constraints included

    Energy Technology Data Exchange (ETDEWEB)

    Huse, Einar Staale

    1998-12-31

    This thesis deals with the short-term scheduling of electric power generation in a competitive market. This involves determination of start-ups and shut-downs, and production levels of all units in all hours of the optimization period, considering unit characteristics and system restrictions. The unit characteristics and restrictions handled are minimum and maximum production levels, fuel cost function, start-up costs, minimum up time and minimum down time. The system restrictions handled are power balance (supply equals demand in all hours) and spinning reserve requirement. The thesis has two main contributions: (1) A new organization of an hourly electric power market that simultaneously sets the price of both energy and reserve power is proposed. A power exchange is used as a trading place for electricity. Its responsibility is to balance supply and demand bids and to secure enough spinning reserve. Routines for bidding and market clearing are developed. (2) A computer programme that simulates the proposed electricity market has been implemented. The program can also be used as a new method for solving the single owner generation scheduling problem. Simulations show that the performance of the program is excellent. Simulations also show that it is possible to obtain efficient schedules through the proposed electricity market. 37 refs., 20 figs., 15 tabs.

  7. Contextual Computing: A Bluetooth based approach for tracking healthcare providers in the emergency room.

    Science.gov (United States)

    Frisby, Joshua; Smith, Vernon; Traub, Stephen; Patel, Vimla L

    2017-01-01

    Hospital Emergency Departments (EDs) frequently experience crowding. One of the factors that contributes to this crowding is the "door to doctor time", which is the time from a patient's registration to when the patient is first seen by a physician. This is also one of the Meaningful Use (MU) performance measures that emergency departments report to the Center for Medicare and Medicaid Services (CMS). Current documentation methods for this measure are inaccurate due to the imprecision in manual data collection. We describe a method for automatically (in real time) and more accurately documenting the door to physician time. Using sensor-based technology, the distance between the physician and the computer is calculated by using the single board computers installed in patient rooms that log each time a Bluetooth signal is seen from a device that the physicians carry. This distance is compared automatically with the accepted room radius to determine if the physicians are present in the room at the time logged to provide greater precision. The logged times, accurate to the second, were compared with physicians' handwritten times, showing automatic recordings to be more precise. This real time automatic method will free the physician from extra cognitive load of manually recording data. This method for evaluation of performance is generic and can be used in any other setting outside the ED, and for purposes other than measuring physician time. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Provider Perspectives on School-Based Mental Health for Urban Minority Youth: Access and Services

    Science.gov (United States)

    Gamble, Brandon E.; Lambros, Katina M.

    2014-01-01

    This article provides results from a qualitative study on the efforts of school-based mental health providers (SBMHPs) who serve students in urban, suburban, and ethnically diverse settings to help families access quality mental health services. School-based mental health plays a key role in the provision of direct and indirect intervention…

  9. Installation Restoration Program Records Search for Twin Cities Air Force Reserve Base, Minnesota.

    Science.gov (United States)

    1983-03-01

    Sandstone, white, mediu poorly sorted and silty.!0-80+ Galesville Sandstone Sandstone, yellow to whi grained, poorly cemented Eau Claire Sandstone 0-150...Quality Data All potable water for Twin Cities AFRB is obtained from the City of Minneapolis. The potable water is supplied to the base by one 12-inch main...34 Exploration drilling, testing, and design of well fields for potable water supply with an installed capacity of over 65 mgd. " Determination of

  10. VOLTTRON-Based System for Providing Ancillary Services with Residential Building Loads

    Energy Technology Data Exchange (ETDEWEB)

    Jin, Xin

    2016-07-01

    Ancillary services entail controlled modulation of building equipment to maintain a stable balance of generation and load in the power system. Ancillary services include frequency regulation and contingency reserves, whose acting time ranges from several seconds to several minutes. Many pilot studies have been implemented to use industrial loads to provide ancillary services, and some have explored services from commercial building loads or electric vehicle charging loads. Residential loads, such as space conditioning and water heating, represent a largely untapped resource for providing ancillary services. The residential building sector accounts for a significant fraction of the total electricity use in the United States. Many loads in residential buildings are flexible and could potentially be curtailed or shifted at the request of the grid. However, there are many barriers that prevent residential loads being widely used for ancillary services. One of the major technical barriers is the lack of communication capabilities between end-use devices and the grid. End-use devices need to be able to receive the automatic generation control (AGC) signal from the grid operator and supply certain types of telemetry to verify response. With the advance of consumer electronics, communication-enabled, or 'connected,' residential equipment has emerged to overcome the communication barrier. However, these end-use devices have introduced a new interoperability challenge due to the existence of numerous standards and communication protocols among different end devices. In this paper, we present a VOLTTRON-based system that overcomes these technical challenges and provides ancillary services with residential loads. VOLTTRON is an open-source control and sensing platform for building energy management, facilitating interoperability solutions for end devices. We have developed drivers to communicate and control different types of end devices through standard-based

  11. What's in a Name? Health Care Providers' Perceptions of Pediatric Pain Patients Based on Diagnostic Labels.

    Science.gov (United States)

    Betsch, Taylor A; Gorodzinsky, Ayala Y; Finley, G A; Sangster, Michael; Chorney, Jill

    2017-08-01

    Diagnostic labels can help patients better understand their symptoms and can influence providers' treatment planning and patient interactions. Recurrent pain is common in childhood; however, there are various diagnostic labels used. The objective of this study was to evaluate the influence of diagnostic labels on pediatric health care providers' perceptions of pediatric chronic pain patients. Using an online survey, providers were randomly assigned to 1 of 2 vignette conditions (differing only in diagnostic label provided) and completed questionnaires about their perceptions of the vignette patient. Responses from 58 participants were analyzed. The 2 groups, based on diagnostic conditions used (fibromyalgia and chronic widespread pain) did not differ significantly on general demographics and health care providers' perceptions of the patient. Perceived origin of the pain influenced providers' perceptions; pain of a perceived medical origin was negatively correlated with stigmatization and positively correlated with sympathy. Perceived psychological origin was positively correlated with stigmatization and providers' age. Health care providers' perceptions of children's pain are more likely influenced by the presumed etiology rather than the diagnostic label used. Pain believed to be more medically based was associated with more positive reactions from providers (ie, less stigmatization). Older providers in particular perceived the patient more negatively if they believe the pain to be psychologically based. The findings of this pediatric study replicated findings from adult literature on chronic pain, suggesting that children and adults are subject to negative perceptions from health care providers when the providers believe the pain to be psychological in origin.

  12. Postpartum Depression Prevention for Reservation-Based American Indians: Results from a Pilot Randomized Controlled Trial.

    Science.gov (United States)

    Ginsburg, Golda S; Barlow, Allison; Goklish, Novalene; Hastings, Ranelda; Baker, Elena Varipatis; Mullany, Britta; Tein, Jenn-Yun; Walkup, John

    2012-06-01

    BACKGROUND: Postpartum depression is a devastating condition that affects a significant number of women and their offspring. Few preventive interventions have targeted high risk youth, such as American Indians (AIs). OBJECTIVE: To evaluate the feasibility of a depression prevention program for AI adolescents and young adults. METHODS: Expectant AI women (mean age = 18.15; N = 47) were randomized (1:1) to either the Living in Harmony program (LIH, an 8 lesson cognitive-behaviorally based program) or an Educational-Support program (ES, an 8 lesson education program). Both interventions were delivered by AI paraprofessionals. Adolescents were evaluated during their pregnancy at baseline, at post-intervention, and at 4, 12, and 24 weeks postpartum. The primary outcome measure was the Center for Epidemiological Studies-Depression scale (CES-D). Additional measures of depression included the onset of major depressive disorder (MDD; assessed via computerized diagnostic interview) and the Edinburgh Postpartum Depression Scale (EPDS). Secondary outcomes included changes in mothers' global functioning and social support. RESULTS: At all post intervention assessments, mothers in both groups showed similar reductions in depressive symptoms and similar rates of MDD (0 and 6% in LIH and ES respectively). Both groups of participants also showed similar improvements in global functioning. No changes in either group were found on the measure of social support. CONCLUSIONS: Findings suggest that both paraprofessional-delivered interventions may reduce symptoms of depression among AIs. Replication with a larger sample, a usual care control condition, blinded evaluators, and a longer follow-up is needed.

  13. Support Vector Machine Based Monitoring of Cardio-Cerebrovascular Reserve during Simulated Hemorrhage

    Directory of Open Access Journals (Sweden)

    Björn J. P. van der Ster

    2018-01-01

    derived pulse height. The highest combination for class 2 was found for the model with the volumetric features (0.72 and 0.91.Conclusion: The most sensitive models for the detection of advanced CBV reduction comprised data that describe features from volumetric parameters and from cerebral blood flow velocity hemodynamics. In a validated model of hemorrhage in humans these parameters provide the best indication of the progression of central hypovolemia.

  14. Support Vector Machine Based Monitoring of Cardio-Cerebrovascular Reserve during Simulated Hemorrhage.

    Science.gov (United States)

    van der Ster, Björn J P; Bennis, Frank C; Delhaas, Tammo; Westerhof, Berend E; Stok, Wim J; van Lieshout, Johannes J

    2017-01-01

    pulse height. The highest combination for class 2 was found for the model with the volumetric features (0.72 and 0.91). Conclusion: The most sensitive models for the detection of advanced CBV reduction comprised data that describe features from volumetric parameters and from cerebral blood flow velocity hemodynamics. In a validated model of hemorrhage in humans these parameters provide the best indication of the progression of central hypovolemia.

  15. Population-Based Provider Engagement in Delivery of Evidence-Based Parenting Interventions: Challenges and Solutions

    Science.gov (United States)

    Shapiro, Cheri J.; Prinz, Ronald J.; Sanders, Matthew R.

    2010-01-01

    Population-wide interventions do not often address parenting, and relatively little is known about large scale dissemination of evidence-based parenting interventions. Most parenting interventions are not designed to reach the majority of parents in a geographic area or to influence prevalence rates for a problem, nor do they take full advantage…

  16. State Variability in Supply of Office-based Primary Care Providers: United States, 2012

    Science.gov (United States)

    ... Order from the National Technical Information Service NCHS State Variability in Supply of Office-based Primary Care Providers: United States, 2012 Recommend on Facebook Tweet Share Compartir NCHS ...

  17. Distribution-Based Supply System: Will It Provide More Effective Support to the Warfighter?

    National Research Council Canada - National Science Library

    Wade, Steven

    1999-01-01

    ... Vision 2010's focused logistics. The primary research question answered is: Will a distribution-based supply system provide more effective supply support to the warfighter in a major theater of war scenario...

  18. Providing Evidence-Based, Intelligent Support for Flood Resilient Planning and Policy: The PEARL Knowledge Base

    Directory of Open Access Journals (Sweden)

    George Karavokiros

    2016-09-01

    Full Text Available While flood risk is evolving as one of the most imminent natural hazards and the shift from a reactive decision environment to a proactive one sets the basis of the latest thinking in flood management, the need to equip decision makers with necessary tools to think about and intelligently select options and strategies for flood management is becoming ever more pressing. Within this context, the Preparing for Extreme and Rare Events in Coastal Regions (PEARL intelligent knowledge-base (PEARL KB of resilience strategies is presented here as an environment that allows end-users to navigate from their observed problem to a selection of possible options and interventions worth considering within an intuitive visual web interface assisting advanced interactivity. Incorporation of real case studies within the PEARL KB enables the extraction of (evidence-based lessons from all over the word, while the KB’s collection of methods and tools directly supports the optimal selection of suitable interventions. The Knowledge-Base also gives access to the PEARL KB Flood Resilience Index (FRI tool, which is an online tool for resilience assessment at a city level available to authorities and citizens. We argue that the PEARL KB equips authorities with tangible and operational tools that can improve strategic and operational flood risk management by assessing and eventually increasing resilience, while building towards the strengthening of risk governance. The online tools that the PEARL KB gives access to were demonstrated and tested in the city of Rethymno, Greece.

  19. 75 FR 21297 - Submission for OMB Review; Comment Request Web Based Training for Pain Management Providers

    Science.gov (United States)

    2010-04-23

    ... Based Training for Pain Management Providers, via the Web site PainAndAddictionTreatment.com , to... addiction co-occurring in the provider's patients. In order to evaluate the effectives of the program... technological collection techniques or other forms of information technology. Direct Comments to OMB: Written...

  20. 75 FR 19978 - Proposed Collection; Comment Request; Web Based Training for Pain Management Providers

    Science.gov (United States)

    2010-04-16

    ... Based Training for Pain Management Providers, via the Web site PainAndAddictionTreatment.com , to... addiction co-occurring in the provider's patients. In order to evaluate the effectives of the program... technological collection techniques or other forms of information technology. Direct Comments to OMB: Written...

  1. 75 FR 6208 - Proposed Collection; Comment Request; Web Based Training for Pain Management Providers

    Science.gov (United States)

    2010-02-08

    ... effectiveness of the Web Based Training for Pain Management Providers, via the Web site PainAndAddiction... their ability to treat pain and addiction co-occurring in the provider's patients. In order to evaluate..., mechanical, or other technological collection techniques or other forms of information technology. FOR...

  2. Providers' Perceptions of and Receptivity toward Evidence-Based HIV Prevention Interventions

    Science.gov (United States)

    Owczarzak, Jill; Dickson-Gomez, Julia

    2011-01-01

    Since 1999, the Centers for Disease Control and Prevention have trained over 10,000 service providers from more than 5,000 agencies to implement evidence-based HIV prevention interventions through its Diffusion of Effective Behavioral Interventions DEBI) program. Based on in-depth, semistructured interviews with a convenience sample of 22 HIV…

  3. [Suitability of spatial pattern of camping sites in Langxiang Natural Reserve, Northeast Chi- na, based on GIS technology].

    Science.gov (United States)

    Yuan, Wei; Zhang, Jie; Tan Ji-qiang; Zhou, Bo; Kang, Rui-cun; Wang, Ai-hong; Liu, Wei; Zhang, Lu

    2015-09-01

    It is an effective way for natural reserves to enhance self-supportive ability and realize sustainable development by developing ecotourism. Taking the experimental zone of Langxiang Natural Reserve in Heilongjiang Province as research object, the forest sub-compartment as research unit, and spatial pattern of environmental suitability of camping sites as research content, an evaluation index system taking natural environment, geographical security, infrastructure and traffic as project levels was built. Delphi and AHP methods were used to determine index weights. A spatial distribution map of camping environmental suitability in Langxiang Natural Reserve was drawn using the GIS spatial information processing technology based on "3S" measurement and the survey data. The results showed that the highest score for quantification of environmental suitability was 90, while the lowest score was 78, and the average value was 83.66 in the 1067 forest sub-compartments for test. The area of forest sub-compartments which were suitable for camping was 1094.44 hm2, being 12.2% of the experimental zone. The forest sub-compartments which had high environmental suitability in the research area were distributed uniformly and centralized with low degree of fragmentation. It was suggested that the contiguous forest sub-compartments with high scores of environmental suitability could be integrated for camping tourism. Due to the high level of environmental suitability for camping, the experimental zone of Langxiang Natural Reserve is suitable for developing camping tourism. Based on "3S" technology, the land use conditions of ecotourism environment of a natural reserve could be evaluated quickly and quantitatively by mathematical model.

  4. A Network Flow-based Analysis of Cognitive Reserve in Normal Ageing and Alzheimer’s Disease

    Science.gov (United States)

    Wook Yoo, Sang; Han, Cheol E.; Shin, Joseph S.; Won Seo, Sang; Na, Duk L.; Kaiser, Marcus; Jeong, Yong; Seong, Joon-Kyung

    2015-01-01

    Cognitive reserve is the ability to sustain cognitive function even with a certain amount of brain damages. Here we investigate the neural compensation mechanism of cognitive reserve from the perspective of structural brain connectivity. Our goal was to show that normal people with high education levels (i.e., cognitive reserve) maintain abundant pathways connecting any two brain regions, providing better compensation or resilience after brain damage. Accordingly, patients with high education levels show more deterioration in structural brain connectivity than those with low education levels before symptoms of Alzheimer’s disease (AD) become apparent. To test this hypothesis, we use network flow measuring the number of alternative paths between two brain regions in the brain network. The experimental results show that for normal aging, education strengthens network reliability, as measured through flow values, in a subnetwork centered at the supramarginal gyrus. For AD, a subnetwork centered at the left middle frontal gyrus shows a negative correlation between flow and education, which implies more collapse in structural brain connectivity for highly educated patients. We conclude that cognitive reserve may come from the ability of network reorganization to secure the information flow within the brain network, therefore making it more resistant to disease progress. PMID:25992968

  5. Patient and provider attitudes to emergency department-based HIV counselling and testing in South Africa.

    Science.gov (United States)

    Hansoti, Bhakti; Hill, Sarah E; Whalen, Madeleine; Stead, David; Parrish, Andy; Rothman, Richard; Hsieh, Yu-Hsiang; Quinn, Thomas C

    2017-01-01

    The national South African HIV Counselling and Testing (HCT) guidelines mandate that voluntary counselling and testing (VCT) should be offered in all healthcare facilities. Emergency departments (EDs) are at the forefront of many healthcare facilities, yet VCT is not routinely implemented in this setting. We conducted a cross-sectional study that surveyed patients and healthcare providers at a tertiary care ED in the spring and summer of 2016 to ascertain their attitudes to VCT in the ED. We also used two previously validated survey instruments to gather data on patients' HIV knowledge and providers' stigma against patients living with HIV, as we anticipated that these may have an impact on providers' and patients' attitudes to the provision of HIV testing within the ED, and may offer insights for future intervention development. A total of 104 patients and 26 providers were enrolled in the study. Overall, patients responded more favourably to ED-based HIV testing (92.3%) compared to providers (only 40% responded favourably). When asked about potential barriers to receiving or providing HIV testing, 16.4% of patients and 24% of providers felt that the subject of HIV was too sensitive and 58.7% of patients and 80% of providers indicated that privacy and confidentiality issues would pose major barriers to implementing ED-based HIV testing. This study shows that while ED-based HIV testing is overall highly acceptable to patients, providers seem less willing to provide this service. The survey data also suggest that future development of ED-based testing strategies should take into consideration privacy and confidentiality concerns that may arise within a busy emergency care setting. Furthermore, every effort should be made to tackle HIV stigma among providers to improve overall attitudes towards HIV-positive individuals that present for care in the ED.

  6. Gaussian Pulse-Based Two-Threshold Parallel Scaling Tone Reservation for PAPR Reduction of OFDM Signals

    Directory of Open Access Journals (Sweden)

    Lei Guan

    2011-01-01

    Full Text Available Tone Reservation (TR is a technique proposed to combat the high Peak-to-Average Power Ratio (PAPR problem of Orthogonal Frequency Division Multiplexing (OFDM signals. However conventional TR suffers from high computational cost due to the difficulties in finding an effective cancellation signal in the time domain by using only a few tones in the frequency domain. It also suffers from a high cost of hardware implementation and long handling time delay issues due to the need to conduct multiple iterations to cancel multiple high signal peaks. In this paper, we propose an efficient approach, called two-threshold parallel scaling, for implementing a previously proposed Gaussian pulse-based Tone Reservation algorithm. Compared to conventional approaches, this technique significantly reduces the hardware implementation complexity and cost, while also reducing signal processing time delay by using just two iterations. Experimental results show that the proposed technique can effectively reduce the PAPR of OFDM signals with only a very small number of reserved tones and with limited usage of hardware resources. This technique is suitable for any OFDM-based communication systems, especially for Digital Video Broadcasting (DVB systems employing large IFFT/FFT transforms.

  7. Patient and provider attitudes to emergency department-based HIV counselling and testing in South Africa

    Directory of Open Access Journals (Sweden)

    Bhakti Hansoti

    2017-05-01

    Full Text Available Background: The national South African HIV Counselling and Testing (HCT guidelines mandate that voluntary counselling and testing (VCT should be offered in all healthcare facilities. Emergency departments (EDs are at the forefront of many healthcare facilities, yet VCT is not routinely implemented in this setting. Methods: We conducted a cross-sectional study that surveyed patients and healthcare providers at a tertiary care ED in the spring and summer of 2016 to ascertain their attitudes to VCT in the ED. We also used two previously validated survey instruments to gather data on patients’ HIV knowledge and providers’ stigma against patients living with HIV, as we anticipated that these may have an impact on providers’ and patients’ attitudes to the provision of HIV testing within the ED, and may offer insights for future intervention development. Results: A total of 104 patients and 26 providers were enrolled in the study. Overall, patients responded more favourably to ED-based HIV testing (92.3% compared to providers (only 40% responded favourably. When asked about potential barriers to receiving or providing HIV testing, 16.4% of patients and 24% of providers felt that the subject of HIV was too sensitive and 58.7% of patients and 80% of providers indicated that privacy and confidentiality issues would pose major barriers to implementing ED-based HIV testing. Conclusion: This study shows that while ED-based HIV testing is overall highly acceptable to patients, providers seem less willing to provide this service. The survey data also suggest that future development of ED-based testing strategies should take into consideration privacy and confidentiality concerns that may arise within a busy emergency care setting. Furthermore, every effort should be made to tackle HIV stigma among providers to improve overall attitudes towards HIV-positive individuals that present for care in the ED.

  8. Evidence-based medicine: medical librarians providing evidence at the point of care.

    Science.gov (United States)

    Yaeger, Lauren H; Kelly, Betsy

    2014-01-01

    Evidence-based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. .. by best available external clinical evidence we mean clinically relevant research.' Health care reform authorized by the Affordable Care Act is based on the belief that evidence-based practice (EBP) generates cost savings due to the delivery of more effective care.2 Medical librarians, skilled in identifying appropriate resources and working with multiple complex interfaces, can support clinicians' efforts to practice evidence based medicine by providing time and expertise in articulating the clinical question and identifying the best evidence.

  9. Basic nursing care: the most provided, the least evidence based. A discussion paper.

    Science.gov (United States)

    Zwakhalen, S M G; Hamers, J P H; Metzelthin, S F; Ettema, R; Heinen, M; De Man-Van Ginkel, J M; Huisman-De Waal, G; Vermeulen, H; Schuurmans, M J

    2018-02-04

    The aim of this paper is to describe and discuss the 'Basic Care Revisited' (BCR) research programme, a collaborative initiative that contributes to evidence-based basic nursing care and raises awareness about the importance of basic nursing care activities. While basic nursing care serves nearly all people at some point in their lifetime, it is poorly informed by evidence. There is a need to prioritize and evaluate basic nursing care activities to improve patient outcomes and improve the quality of care. Discussion paper. The discussion presented in this paper is based on nursing literature and theory and supported by the authors' clinical and research experiences. We present the developmental process and content of a research programme called 'Basic Care Revisited' (BCR) as a solution to move forward and improve basic nursing care. To prioritise basic nursing care, we propose a research programme entitled 'Basic Care Revisited' that aims to create awareness and expand knowledge on evidence-based basic nursing care by addressing four basic nursing care themes (bathing and dressing, communication, mobility, and nutrition) in different settings. The paper discusses a pathway to create a sustainable and productive research collaborative on basic nursing care and addresses issues to build research capacity. Revaluation of these important nursing activities will not only positively influence patient outcomes, but also have an impact on staff outcomes and organisational outcomes. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  10. Providing written information increases patient satisfaction: a web-based questionnaire survey of Japanese cancer survivors.

    Science.gov (United States)

    Sakai, Hitomi; Katsumata, Noriyuki; Takahashi, Miyako

    2017-07-01

    The Institute of Medicine (IOM) of the United States recommends that all cancer survivors be provided with a survivorship care plan (SCP), which includes a patient treatment summary and a follow-up care plan. However, SCPs have not been widely adopted in Japan. To provide basic data necessary for implementing SCPs in Japan, we aimed to investigate the forms of clinical and survivorship-related information that Japanese cancer survivors receive from their healthcare providers, and to examine whether written information increases their satisfaction. We performed a cross-sectional online survey of cancer survivors who underwent acute cancer treatment and had at least one follow-up with a physician in the past year. Cancer survivors provided the elements and forms (verbally and/or written) of information they received, as well as the degree of satisfaction with the information provided. Responses were obtained from 545 cancer survivors. Information elements such as surgical procedure (98.3%), surgical outcome (98.1%), and names of administered chemotherapy agents (97.8%) were commonly provided, whereas mental care resources and providers (29.7%), effects on marital relationship and sexual health (35.7%), and effects on fertility (43.4%) were less common. A large proportion of cancer survivors received verbal information only. For 18 of 20 elements, except for effects on fertility and duration of hormonal therapy, satisfaction was significantly higher when both forms of information were provided (P information can better meet the needs of Japanese cancer survivors. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  11. Decoding incident-to and provider-based billing: ensuring payment and avoiding liability.

    Science.gov (United States)

    Hofstra, Patricia S; Hart, Elinor L

    2012-01-01

    In this increasingly complex world of Medicare reimbursement, physicians must constantly review their billing practices to ensure compliance with all Medicare requirements. "Incident-to" billing and provider-based billing are two areas that present unique challenges for providers, especially those practicing in hospital-owned practices such as hospital outpatient departments. Both incident-to and provider-based billing limit providers' abilities to bill for and receive reimbursement in those practice settings. The Office of Inspector General's 2012 Work Plan Report identified both incident-to billing and place-of-service errors as two of the many areas for investigation and compliance efforts in 2012. This article focuses on identifying the unique point-of-service challenges presented by physicians practicing in hospital outpatient departments or hospital-owned clinics.

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

    Science.gov (United States)

    Lehtinen, Antti; Viiri, Jouni

    2017-04-01

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

  13. ANALYSIS OF HUMAN ACTIVITIES IN NATURE RESERVES BASED ON NIGHTTIME LIGHT REMOTE SENSING AND MICROBLOGGING DATA –ILLUSTRATED BY THE CASE OF NATIONAL NATURE RESERVES IN JIANGXI PROVINCE

    Directory of Open Access Journals (Sweden)

    F. Shi

    2017-09-01

    Full Text Available The study used the mainstream social media in china - Sina microblogging data combined with nighttime light remote sensing and various geographical data to reveal the pattern of human activities and light pollution of the Jiangxi Provincial National Nature Reserves. Firstly, we performed statistical analysis based on both functional areas and km-grid from the perspective of space and time, and selected the key areas for in-depth study. Secondly, the relationship between microblogging data and nighttime light remote sensing, population, GDP, road coverage, road distance and road type in nature reserves was analyzed by Spearman correlation coefficient method, so the distribution pattern and influencing factors of the microblogging data were explored. Thirdly, a region where the luminance value was greater than 0.2 was defined as a light region. We evaluated the management status by analyzing the distribution of microblogging data in both light area and non-light area. Final results showed that in all nature reserves, the top three were the Lushan Nature Reserve, the Jinggangshan Nature Reserve, the Taohongling National Nature Reserve of Sikas both on the total number and density of microblogging ; microblogging had a significant correlation with nighttime light remote sensing , the GDP, population, road and other factors; the distribution of microblogging near roads in protected area followed power laws; luminous radiance of Lushan Nature Reserve was the highest, with 43 percent of region was light at night; analysis combining nighttime light remote sensing with microblogging data reflected the status of management of nature reserves.

  14. Association of lifelong exposure to cognitive reserve-enhancing factors with dementia risk: A community-based cohort study.

    Science.gov (United States)

    Wang, Hui-Xin; MacDonald, Stuart W S; Dekhtyar, Serhiy; Fratiglioni, Laura

    2017-03-01

    Variation in the clinical manifestation of dementia has been associated with differences in cognitive reserve, although less is known about the cumulative effects of exposure to cognitive reserve factors over the life course. We examined the association of cognitive reserve-related factors over the lifespan with the risk of dementia in a community-based cohort of older adults. Information on early-life education, socioeconomic status, work complexity at age 20, midlife occupation attainment, and late-life leisure activities was collected in a cohort of dementia-free community dwellers aged 75+ y residing in the Kungsholmen district of Stockholm, Sweden, in 1987-1989. The cohort was followed up to 9 y (until 1996) to detect incident dementia cases. To exclude preclinical phases of disease, participants who developed dementia at the first follow-up examination 3 y after the baseline were excluded (n = 602 after exclusions). Structural equation modelling was used to generate latent factors of cognitive reserve from three periods over the life course: early (before 20 y), adulthood (around 30-55 y), and late life (75 y and older). The correlation between early- and adult-life latent factors was strong (γ = 0.9), whereas early-late (γ = 0.27) and adult-late (γ = 0.16) latent factor correlations were weak. One hundred forty-eight participants developed dementia during follow-up, and 454 remained dementia-free. The relative risk (RR) of dementia was estimated using Cox models with life-course cognitive reserve-enhancing factors modelled separately and simultaneously to assess direct and indirect effects. The analysis was repeated among carriers and noncarriers of the apolipoprotein E (APOE) ε4 allele. A reduced risk of dementia was associated with early- (RR 0.57; 95% CI 0.36-0.90), adult- (RR 0.60; 95% CI 0.42-0.87), and late-life (RR 0.52; 95% CI 0.37-0.73) reserve-enhancing latent factors in separate multivariable Cox models. In a mutually adjusted model, which may

  15. 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.

  16. 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.

  17. Criteria for the evaluation of a cloud-based hospital information system outsourcing provider.

    Science.gov (United States)

    Low, Chinyao; Hsueh Chen, Ya

    2012-12-01

    As cloud computing technology has proliferated rapidly worldwide, there has been a trend toward adopting cloud-based hospital information systems (CHISs). This study examines the critical criteria for selecting the CHISs outsourcing provider. The fuzzy Delphi method (FDM) is used to evaluate the primary indicator collected from 188 useable responses at a working hospital in Taiwan. Moreover, the fuzzy analytic hierarchy process (FAHP) is employed to calculate the weights of these criteria and establish a fuzzy multi-criteria model of CHISs outsourcing provider selection from 42 experts. The results indicate that the five most critical criteria related to CHISs outsourcing provider selection are (1) system function, (2) service quality, (3) integration, (4) professionalism, and (5) economics. This study may contribute to understanding how cloud-based hospital systems can reinforce content design and offer a way to compete in the field by developing more appropriate systems.

  18. Approaches based on behavioral economics could help nudge patients and providers toward lower health spending growth.

    Science.gov (United States)

    King, Dominic; Greaves, Felix; Vlaev, Ivo; Darzi, Ara

    2013-04-01

    Policies that change the environment or context in which decisions are made and "nudge" people toward particular choices have been relatively ignored in health care. This article examines the role that approaches based on behavioral economics could play in "nudging" providers and patients in ways that could slow health care spending growth. The basic insight of behavioral economics is that behavior is guided by the very fallible human brain and greatly influenced by the environment or context in which choices are made. In policy arenas such as pensions and personal savings, approaches based on behavioral economics have provided notable results. In health care, such approaches have been used successfully but in limited ways, as in the use of surgical checklists that have increased patient safety and reduced costs. With health care spending climbing at unsustainable rates, we review the role that approaches based on behavioral economics could play in offering policy makers a potential set of new tools to slow spending growth.

  19. Stereotactic body radiation therapy in hepatocellular carcinoma: Optimal treatment strategies based on liver segmentation and functional hepatic reserve.

    Science.gov (United States)

    Wang, Po-Ming; Chung, Na-Na; Hsu, Wei-Chung; Chang, Feng-Ling; Jang, Chin-Jyh; Scorsetti, Marta

    2015-01-01

    To discuss current dosage for stereotactic body radiation therapy (SBRT) in hepatocellular carcinoma (HCC) patients and suggest alternative treatment strategies according to liver segmentation as defined by the Couinaud classification. SBRT is a safe and effective alternative treatment for HCC patients who are unable to undergo liver ablation/resection. However, the SBRT fractionation schemes and treatment planning strategies are not well established. In this article, the latest developments and key findings from research studies exploring the efficacy of SBRT fractionation schemes for treatment of HCC are reviewed. Patients' characteristics, fractionation schemes, treatment outcomes and toxicities were compiled. Special attention was focused on SBRT fractionation approaches that take into consideration liver segmentation according to the Couinaud classification and functional hepatic reserve based on Child-Pugh (CP) liver cirrhosis classification. The most common SBRT fractionation schemes for HCC were 3 × 10-20 Gy, 4-6 × 8-10 Gy, and 10 × 5-5.5 Gy. Based on previous SBRT studies, and in consideration of tumor size and CP classification, we proposed 3 × 15-25 Gy for patients with tumor size 5 cm or CP-B score. Treatment schemes in SBRT for HCC vary according to liver segmentation and functional hepatic reserve. Further prospective studies may be necessary to identify the optimal dose of SBRT for HCC.

  20. Effective porosity and density of carbonate rocks (Maynardville Limestone and Copper Ridge Dolomite) within Bear Creek Valley on the Oak Ridge Reservation based on modern petrophysical techniques

    International Nuclear Information System (INIS)

    Dorsch, J.

    1997-02-01

    The purpose of this study is to provide quantitative data on effective porosity of carbonate rock from the Maynardville Limestone and Copper Ridge Dolomite within Bear Creek Valley based on modern petrophysical techniques. The data will be useful for groundwater-flow and contaminant-flow modeling in the vicinity of the Y-12 Plant on the Oak Ridge Reservation (ORR). Furthermore, the data provides needed information on the amount of interconnected pore space potentially available for operation of matrix diffusion as a transport process within the fractured carbonate rock. A second aspect of this study is to compare effective porosity data based on modern petrophysical techniques to effective porosity data determined earlier by Goldstrand et al. (1995) with a different technique. An added bonus of the study is quantitative data on the bulk density and grain density of dolostone and limestone of the Maynardville Limestone and Copper Ridge Dolomite which might find use for geophysical modeling on the ORR

  1. Conducting Meta-Analyses Based on p Values: Reservations and Recommendations for Applying p-Uniform and p-Curve

    NARCIS (Netherlands)

    van Aert, Robbie C M; Wicherts, Jelte M.; van Assen, Marcel A L M

    2016-01-01

    Because of overwhelming evidence of publication bias in psychology, techniques to correct meta-analytic estimates for such bias are greatly needed. The methodology on which the p-uniform and p-curve methods are based has great promise for providing accurate meta-analytic estimates in the presence of

  2. [Effects of "menstrual cycle-based acupuncture therapy" on IVF-ET in patients with decline in ovarian reserve].

    Science.gov (United States)

    Zhou, Li; Xia, Youbing; Ma, Xiang; Tang, Limei; Lu, Jing; Tang, Qingqing; Wang, Yinping

    2016-01-01

    To observe the effects of "menstrual cycle-based acupuncture therapy" on ovarian function and pregnancy results of in vitro fertilization-embryo transfer (IVF-ET) in patients with decline in ovarian reserve (DOR). A total of 63 patients of DOR who received treatment of IVF/intracytoplasmic sperm injection (ICSI) were randomly divided into an observation group (30 cases) and a control group (33 cases). The patients in the observation group were treated with "menstrual cycle-based acupuncture therapy". The syndrome differentiation and treatment were given based on different phases of menstruation. Shiqizhui (EX-B 8) and Mingmen (GV 4) were selected during menstrual phase, Shenshu (BL 23), Geshu (BL 17), Sanyinjiao (SP 6) and Taixi (KI 3) were selected after menstruation, Qihai (CV 6), Guanyuan (CV 4), Zigong (EX-CA 1), Zusanli (ST 36) were selected during ovulatory period, Qihai (CV 6), Guanyuan (CV 4), Yanglingquan (GB 34), Taichong (LR 3) were selected before menstruation. The acupuncture was given twice a week until second menstrual cycle of oocyte retrieval. The total times of acupuncture was (15 ± 2). After acupuncture, patients were treated with IVF-ET. The patients in the control group were treated with IVF-ET but no acupuncture. The indices of ovarian reserve function, including basic follicle-stimulating hormone (FSH), estradiol (E2), antral follicle count (AFC), number of retrieved oocytes, number of fertilization and number of high quality embryo, were compared and analyzed before and after acupuncture in the observation group. The differences of outcomes of IVF-ET, including the cycle cancellation rate, implantation rate, the clinical pregnancy rate, were compared between the two groups. Compared before acupuncture, the E2, AFC, number of retrieved oocytes, number of high quality embrgo and number of fertilization were all increased after acupuncture in the observation group (all Pcycle cancellation rate was reduced (Pmenstrual cycle-based acupuncture

  3. Providing web-based mental health services to at-risk women

    Directory of Open Access Journals (Sweden)

    Kenny Meghan

    2011-08-01

    Full Text Available Abstract Background We examined the feasibility of providing web-based mental health services, including synchronous internet video conferencing of an evidence-based support/education group, to at-risk women, specifically poor lone mothers. The objectives of this study were to: (i adapt a face-to-face support/education group intervention to a web-based format for lone mothers, and (ii evaluate lone mothers' response to web-based services, including an online video conferencing group intervention program. Methods Participating mothers were recruited through advertisements. To adapt the face-to-face intervention to a web-based format, we evaluated participant motivation through focus group/key informant interviews (n = 7, adapted the intervention training manual for a web-based environment and provided a computer training manual. To evaluate response to web-based services, we provided the intervention to two groups of lone mothers (n = 15. Pre-post quantitative evaluation of mood, self-esteem, social support and parenting was done. Post intervention follow up interviews explored responses to the group and to using technology to access a health service. Participants received $20 per occasion of data collection. Interviews were taped, transcribed and content analysis was used to code and interpret the data. Adherence to the intervention protocol was evaluated. Results Mothers participating in this project experienced multiple difficulties, including financial and mood problems. We adapted the intervention training manual for use in a web-based group environment and ensured adherence to the intervention protocol based on viewing videoconferencing group sessions and discussion with the leaders. Participant responses to the group intervention included decreased isolation, and increased knowledge and confidence in themselves and their parenting; the responses closely matched those of mothers who obtained same service in face-to-face groups. Pre-and post

  4. ORGANIZING OF MANAGERIAL ACCOUNTING IN THE FORMING OF INFORMATION BASE OF BUILDING ENTERPRISES PROVIDING DEVELOPMENT

    Directory of Open Access Journals (Sweden)

    Nadiia Pylypiv

    2017-03-01

    Full Text Available This article explores the impact of organization of managerial accounting on formation of informational base on the local (level of the individual enterprise, regional, disciplinary and national levels in the context of providing stable economic development for building enterprises. Based on our findings, we built a cognitive map of such an influence, which shows itself through different spheres, such as: economic, ecological and social, and will enjoy informational requests of management for improving of effectiveness of management system of such kind of  enterprises. Keywords: managerial accounting, organization, provision, stable economic development, building enterprises

  5. Barriers to providing school-based health care: international case comparisons.

    Science.gov (United States)

    Seigart, Denise; Dietsch, Elaine; Parent, Michèle

    2013-01-01

    This article reports on an international collaborative study which compared school-based health care in the United States of America, Canada and Australia. Tri-nation school-based health care was compared and contrasted through the utilisation of a series of interpretive case studies. Grounded theory approaches informed the data analysis and reporting processes. Unlike the US, Canadian and Australian school students rarely have access to school-based health care on site. All three nations face structural, cultural and societal barriers, often related to limited resources which limit the effectiveness of school-based health care. The benefits of school-based health care and providing comprehensive services through schools can include healthier children, better learning, healthier parents, and healthier communities. Unfortunately, based on our research, comprehensive school health services have not been adequately implemented in the US, Canada or Australia. Given the findings of this study, increased comprehensive school-based health services are urgently needed in the US, Canada and Australia.

  6. On providing the fault-tolerant operation of information systems based on open content management systems

    Science.gov (United States)

    Kratov, Sergey

    2018-01-01

    Modern information systems designed to service a wide range of users, regardless of their subject area, are increasingly based on Web technologies and are available to users via Internet. The article discusses the issues of providing the fault-tolerant operation of such information systems, based on free and open source content management systems. The toolkit available to administrators of similar systems is shown; the scenarios for using these tools are described. Options for organizing backups and restoring the operability of systems after failures are suggested. Application of the proposed methods and approaches allows providing continuous monitoring of the state of systems, timely response to the emergence of possible problems and their prompt solution.

  7. Surmounting difficulties to provide home based neonatal care - reflections of community health workers.

    Science.gov (United States)

    Prabhughate, Abhijit Shrinivas; Tiwari, Pearl; Sohoni, Shubhangi; Morgaonkar, Vallaree Anant; Phatak, Ajay Gajanan; Nimbalkar, Somashekhar Marutirao; Mahajani, Anagha Anand

    2018-01-15

    In India, community health workers' (CHW) effectiveness in providing home-based neonatal care (HBNC) has been well documented. The nature of challenges faced and strategies adopted while providing HBNC services need to be studied in-depth. A qualitative study to understand the challenges faced and strategies used by Sakhis (women CHW) while providing services as part of a HBNC program implemented by a non-profit organization. Data consisted of 20 in-depth interviews and three focus group discussions (FGD) with Sakhis. Sakhis negotiated with the community to start working as a CHW. They faced challenges while changing behaviors at individual level and also while bringing about a change in harmful normative practices that increased chances of maternal and neonatal mortality. Managing crises at the time of deliveries and facilitating a safe delivery was the most critical challenge faced by many Sakhis. The key strategies used by Sakhis included: proactively and persistently providing services even when they faced resistance from the woman or her family; evolving contextually suitable counseling techniques and tactics to bring about behavioral change; balancing compliance to traditional practices and promoting HBNC; defying traditional practices and assisting the woman in times of an emergency to save lives. Having on-call support from supervisors and cultivating a good working relationship with health providers facilitated effective service provision by Sakhis. CHWs having a strong sense of commitment can develop strategies to address challenges and provide HBNC services effectively if they also have strong supervisory support.

  8. iTRAQ-based comparative proteomic analysis provides insights into somatic embryogenesis in Gossypium hirsutum L.

    OpenAIRE

    Zhu, Hua-Guo; Cheng, Wen-Han; Tian, Wen-Gang; Li, Yang-Jun; Liu, Feng; Xue, Fei; Zhu, Qian-Hao; Sun, Yu-Qiang; Sun, Jie

    2017-01-01

    Key message iTRAQ based proteomic identified key proteins and provided new insights into the molecular mechanisms underlying somatic embryogenesis in cotton. Abstract Somatic embryogenesis, which involves cell dedifferentiation and redifferentiation, has been used as a model system for understanding molecular events of plant embryo development in vitro. In this study, we performed comparative proteomics analysis using samples of non-embryogenic callus (NEC), embryogenic callus (EC) and somati...

  9. Prevalence of Dementia and Cognitive Complaints in the Context of High Cognitive Reserve: A Population-Based Study.

    Directory of Open Access Journals (Sweden)

    Magali Perquin

    Full Text Available This study aimed to assess the prevalence of dementia and cognitive complaints in a cross-sectional sample of Luxembourg seniors, and to discuss the results in the societal context of high cognitive reserve resulting from multilingualism.A population sample of 1,377 people representative of Luxembourg residents aged over 64 years was initially identified via the national social insurance register. There were three different levels of contribution: full participation in the study, partial participation, and non-participation. We examined the profiles of these three different samples so that we could infer the prevalence estimates in the Luxembourgish senior population as a whole using the prevalence estimates obtained in this study.After careful attention to the potential bias and of the possibility of underestimation, we considered the obtained prevalence estimates of 3.8% for dementia (with corresponding 95% confidence limits (CL of 2.8% and 4.8% and 26.1% for cognitive complaints (CL = [17.8-34.3] as trustworthy.Based on these findings, we postulate that high cognitive reserve may result in surprisingly low prevalence estimates of cognitive complaints and dementia in adults over the age of 64 years, which thereby corroborates the longer disability-free life expectancy observed in the Luxembourg population. To the best of our knowledge, this study is the first to report such Luxembourgish public health data.

  10. Prevalence of Dementia and Cognitive Complaints in the Context of High Cognitive Reserve: A Population-Based Study

    Science.gov (United States)

    Perquin, Magali; Diederich, Nico; Pastore, Jessica; Lair, Marie-Lise; Stranges, Saverio; Vaillant, Michel

    2015-01-01

    Objectives This study aimed to assess the prevalence of dementia and cognitive complaints in a cross-sectional sample of Luxembourg seniors, and to discuss the results in the societal context of high cognitive reserve resulting from multilingualism. Methods A population sample of 1,377 people representative of Luxembourg residents aged over 64 years was initially identified via the national social insurance register. There were three different levels of contribution: full participation in the study, partial participation, and non-participation. We examined the profiles of these three different samples so that we could infer the prevalence estimates in the Luxembourgish senior population as a whole using the prevalence estimates obtained in this study. Results After careful attention to the potential bias and of the possibility of underestimation, we considered the obtained prevalence estimates of 3.8% for dementia (with corresponding 95% confidence limits (CL) of 2.8% and 4.8%) and 26.1% for cognitive complaints (CL = [17.8–34.3]) as trustworthy. Conclusion Based on these findings, we postulate that high cognitive reserve may result in surprisingly low prevalence estimates of cognitive complaints and dementia in adults over the age of 64 years, which thereby corroborates the longer disability-free life expectancy observed in the Luxembourg population. To the best of our knowledge, this study is the first to report such Luxembourgish public health data. PMID:26390288

  11. Training medical providers in evidence-based approaches to suicide prevention.

    Science.gov (United States)

    DeHay, Tamara; Ross, Sarah; McFaul, Mimi

    2015-01-01

    Suicide is a significant issue in the United States and worldwide, and its prevention is a public health imperative. Primary care practices are an important setting for suicide prevention, as primary care providers have more frequent contact with patients at risk for suicide than any other type of health-care provider. The Western Interstate Commission for Higher Education, in partnership with the Suicide Prevention Resource Center, has developed a Suicide Prevention Toolkit and an associated training curriculum. These resources support the education of primary care providers in evidence-based strategies for identifying and treating patients at risk for suicide. The application of this curriculum to post-graduate medical training is presented here. © The Author(s) 2015.

  12. Funnel plots for comparing provider performance based on patient-reported outcome measures.

    Science.gov (United States)

    Neuburger, Jenny; Cromwell, David A; Hutchings, Andrew; Black, Nick; van der Meulen, Jan H

    2011-12-01

    Patient-reported outcome measures (PROMs) often produce skewed distributions of individual scores after a healthcare intervention. For health performance indicators derived from skewed distributions, funnel plots designed with symmetric control limits may increase the risk of false alarms about poor performance. To investigate the accuracy of funnel plots with symmetric control limits when comparing provider performance based on PROMs. The authors used a database containing condition-specific PROMs for 17,453 hip replacements and 7656 varicose vein procedures performed by providers in the English NHS. The mean postoperative PROM score, adjusted for patient characteristics, was used as the measure of performance. To compare performance, symmetric 99.8% control limits were calculated on funnel plots, 3 SDs away from the overall mean on either side. These were compared to control limits derived directly from percentiles of simulated (bootstrap) distributions of mean scores. The simulated control limits on funnel plots for both procedures were asymmetric. The empirical probability of falling outside the symmetric 99.8% 'poor performance' control limit was inflated from the stipulated rate of 0.1% to 0.2-0.3% for provider sample sizes of up to 150 procedures. The authors observed that, out of 237 providers of hip replacement, eight had adjusted mean scores that exceeded the symmetric 'poor performance' limit compared with only five that exceeded the corresponding simulated limit. In other words, three (1.3%) were differently classified. For varicose vein surgery, five out of 160 providers exceeded the symmetric limit and four exceeded the simulated limit, that is, 1 (0.6%) was differently classified. When designing funnel plots for comparisons of provider performance based on highly skewed data, the use of simulated control limits should be considered.

  13. Cognitive Behavioral Intervention for Trauma in Schools (CBITS): school-based treatment on a rural American Indian reservation.

    Science.gov (United States)

    Morsette, Aaron; Swaney, Gyda; Stolle, Darrell; Schuldberg, David; van den Pol, Richard; Young, Melissa

    2009-03-01

    This study examines a pilot school-based treatment program for American Indian adolescents residing on a reservation who presented with symptoms of Posttraumatic Stress Disorder (PTSD) and symptoms of depression. This is the first study directed at treating American Indian children with trauma; seven case studies demonstrate our findings that a manualized cognitive behavior therapy intervention delivered in group format for 10 weeks has potential for helping some children who experience PTSD symptoms and depression. The findings generally replicate previous research conducted with groups of non-Indian adolescents in urban settings. PTSD and depressive symptoms decreased for three of the four students who completed treatment. Directions for future research include the need to understand and control attrition and to address cultural influences, including making adaptations in the cognitive behavioral formulations and techniques regarding feelings as operant behaviors. Results contribute to knowledge of feasibility and acceptability of cultural adaptations of CBT for trauma in an under-served population.

  14. [Development of Internet-based system to collect and provide drug information for patients/consumers].

    Science.gov (United States)

    Kurimoto, Fuki; Hori, Satoko; Satoh, Hiroki; Miki, Akiko; Sawada, Yasufumi

    2013-01-01

    For drug fostering and evolution, it is important to collect information directly from patients on the efficacy and safety of drugs as well as patient needs. At present, however, information gathered by healthcare professionals, pharmaceutical companies, or governments is not sufficient. There is concern that patients may fail to recognize the importance of providing information voluntarily. The present study was conducted to provide drug information to patients/consumers, to enlighten them on the importance of providing drug information by themselves, and to develop an Internet website, called "Minkusu," for collecting drug information from patients. This website is based on a registration system (free of charge). It is designed to provide information on proper drug use, and to collect opinions about drugs. As of May 31, 2012, a total of 1149 people had been registered. The male/female ratio of registered members was approximately 1:1, and patients/consumers accounted for 23%. According to the results of a questionnaire survey, several patient/consumer members appreciated the usefulness of the information service, and they took an opportunity to know of the concepts of drug development and evolution (Ikuyaku, in Japanese) through the information services provided by this site. In conclusion, the developed information system would contribute to the proper use of drugs by patients/consumers and to the promotion of drug development and evolution.

  15. [Barriers to the normalization of telemedicine in a healthcare system model based on purchasing of healthcare services using providers' contracts].

    Science.gov (United States)

    Roig, Francesc; Saigí, Francesc

    2011-01-01

    Despite the clear political will to promote telemedicine and the large number of initiatives, the incorporation of this modality in clinical practice remains limited. The objective of this study was to identify the barriers perceived by key professionals who actively participate in the design and implementation of telemedicine in a healthcare system model based on purchasing of healthcare services using providers' contracts. We performed a qualitative study based on data from semi-structured interviews with 17 key informants belonging to distinct Catalan health organizations. The barriers identified were grouped in four areas: technological, organizational, human and economic. The main barriers identified were changes in the healthcare model caused by telemedicine, problems with strategic alignment, resistance to change in the (re)definition of roles, responsibilities and new skills, and lack of a business model that incorporates telemedicine in the services portfolio to ensure its sustainability. In addition to suitable management of change and of the necessary strategic alignment, the definitive normalization of telemedicine in a mixed healthcare model based on purchasing of healthcare services using providers' contracts requires a clear and stable business model that incorporates this modality in the services portfolio and allows healthcare organizations to obtain reimbursement from the payer. 2010 SESPAS. Published by Elsevier Espana. All rights reserved.

  16. Protein structure prediction provides comparable performance to crystallographic structures in docking-based virtual screening.

    Science.gov (United States)

    Du, Hongying; Brender, Jeffrey R; Zhang, Jian; Zhang, Yang

    2015-01-01

    Structure based virtual screening has largely been limited to protein targets for which either an experimental structure is available or a strongly homologous template exists so that a high-resolution model can be constructed. The performance of state of the art protein structure predictions in virtual screening in systems where only weakly homologous templates are available is largely untested. Using the challenging DUD database of structural decoys, we show here that even using templates with only weak sequence homology (identity) structural models can be constructed by I-TASSER which achieve comparable enrichment rates to using the experimental bound crystal structure in the majority of the cases studied. For 65% of the targets, the I-TASSER models, which are constructed essentially in the apo conformations, reached 70% of the virtual screening performance of using the holo-crystal structures. A correlation was observed between the success of I-TASSER in modeling the global fold and local structures in the binding pockets of the proteins versus the relative success in virtual screening. The virtual screening performance can be further improved by the recognition of chemical features of the ligand compounds. These results suggest that the combination of structure-based docking and advanced protein structure modeling methods should be a valuable approach to the large-scale drug screening and discovery studies, especially for the proteins lacking crystallographic structures. Copyright © 2014 Elsevier Ltd. All rights reserved.

  17. A review of online evidence-based practice point-of-care information summary providers.

    Science.gov (United States)

    Banzi, Rita; Liberati, Alessandro; Moschetti, Ivan; Tagliabue, Ludovica; Moja, Lorenzo

    2010-07-07

    Busy clinicians need easy access to evidence-based information to inform their clinical practice. Publishers and organizations have designed specific tools to meet doctors' needs at the point of care. The aim of this study was to describe online point-of-care summaries and evaluate their breadth, content development, and editorial policy against their claims of being "evidence-based." We searched Medline, Google, librarian association websites, and information conference proceedings from January to December 2008. We included English Web-based point-of-care summaries designed to deliver predigested, rapidly accessible, comprehensive, periodically updated, evidence-based information to clinicians. Two investigators independently extracted data on the general characteristics and content presentation of summaries. We assessed and ranked point-of-care products according to: (1) coverage (volume) of medical conditions, (2) editorial quality, and (3) evidence-based methodology. We explored how these factors were associated. We retrieved 30 eligible summaries. Of these products, 18 met our inclusion criteria and were qualitatively described, and 16 provided sufficient data for quantitative evaluation. The median volume of medical conditions covered was 80.6% (interquartile range, 68.9%-84.2%) and varied for the different products. Similarly, differences emerged for editorial policy (median 8.0, interquartile range 5.8-10.3) and evidence-based methodology scores (median 10.0, interquartile range 1.0-12.8) on a 15-point scale. None of these dimensions turned out to be significantly associated with the other dimensions (editorial quality and volume, Spearman rank correlation r = -0.001, P = .99; evidence-based methodology and volume, r = -0.19, P = .48; editorial and evidence-based methodology, r = 0.43, P =.09). Publishers are moving to develop point-of-care summary products. Some of these have better profiles than others, and there is room for improved reporting of the

  18. The feasibility of providing community pharmacy-based services for alcohol misuse: a literature review.

    Science.gov (United States)

    Watson, Margaret C; Blenkinsopp, Alison

    2009-08-01

    Excessive consumption of alcohol is a major public health concern. The use of community pharmacies and pharmacists as sources of public health information and services is gaining greater recognition. The objective of this review was to provide an overview of the evidence on the feasibility, effectiveness and acceptability of providing community pharmacy-based services to address the excessive consumption of alcohol. Electronic databases were searched for the period 1996-2007 to identify relevant evidence. Searches were also conducted of relevant pharmacy and addiction journals. Information was sought from key contacts in pharmacy and alcohol research. Studies were included if they were conducted in a community pharmacy setting. The review comprised three feasibility studies which included 14 pharmacies and 500 customers. Non-significant reductions in alcohol consumption were reported with two studies following brief interventions by pharmacists. Between 30% and 53% of pharmacy customers were identified as having hazardous or harmful drinking behaviour. Customer opinion of the pharmacy-based alcohol services was not reported. There has been little empirical evaluation of the effectiveness of community pharmacy-based services for alcohol misuse. The evidence presented in this review suggests that community pharmacy-based screening is feasible. Organisations and individuals involved with tackling excessive alcohol consumption should consider the inclusion of community pharmacies and pharmacists as part of their strategies to address this problem. Large-scale studies are needed to evaluate the short- and long-term effects and cost-effectiveness of community pharmacy-based interventions to reduce excessive alcohol consumption, as well as to explore the acceptability of the service to

  19. Web-Based Self-Service Systems for Managed IT Support: Service Provider Perspectives of Stakeholder-Based Issues

    Science.gov (United States)

    Cooper, Vanessa A.; Lichtenstein, Sharman; Smith, Ross

    This chapter explores the provision of after-sales information technology (IT) support services using Web-based self-service systems (WSSs) in a business-to-business (B2B) context. A recent study conducted at six large multi-national IT support organisations revealed a number of critical success factors (CSFs) and stakeholder-based issues. To better identify and understand these important enablers and barriers, we explain how WSSs should be considered within a complex network of service providers, business partners and customer firms. The CSFs and stakeholder-based issues are discussed. The chapter highlights that for more successful service provision using WSSs, IT service providers should collaborate more effectively with enterprise customers and business partners and should better integrate their WSSs.

  20. Agent-based organizational modelling for analysis of safety culture at an air navigation service provider

    International Nuclear Information System (INIS)

    Stroeve, Sybert H.; Sharpanskykh, Alexei; Kirwan, Barry

    2011-01-01

    Assessment of safety culture is done predominantly by questionnaire-based studies, which tend to reveal attitudes on immaterial characteristics (values, beliefs, norms). There is a need for a better understanding of the implications of the material aspects of an organization (structures, processes, etc.) for safety culture and their interactions with the immaterial characteristics. This paper presents a new agent-based organizational modelling approach for integrated and systematic evaluation of material and immaterial characteristics of socio-technical organizations in safety culture analysis. It uniquely considers both the formal organization and the value- and belief-driven behaviour of individuals in the organization. Results are presented of a model for safety occurrence reporting at an air navigation service provider. Model predictions consistent with questionnaire-based results are achieved. A sensitivity analysis provides insight in organizational factors that strongly influence safety culture indicators. The modelling approach can be used in combination with attitude-focused safety culture research, towards an integrated evaluation of material and immaterial characteristics of socio-technical organizations. By using this approach an organization is able to gain a deeper understanding of causes of diverse problems and inefficiencies both in the formal organization and in the behaviour of organizational agents, and to systematically identify and evaluate improvement options.

  1. Cognitive reserve in aging.

    Science.gov (United States)

    Tucker, A M; Stern, Y

    2011-06-01

    Cognitive reserve explains why those with higher IQ, education, occupational attainment, or participation in leisure activities evidence less severe clinical or cognitive changes in the presence of age-related or Alzheimer's disease pathology. Specifically, the cognitive reserve hypothesis is that individual differences in how tasks are processed provide reserve against brain pathology. Cognitive reserve may allow for more flexible strategy usage, an ability thought to be captured by executive functions tasks. Additionally, cognitive reserve allows individuals greater neural efficiency, greater neural capacity, and the ability for compensation via the recruitment of additional brain regions. Taking cognitive reserve into account may allow for earlier detection and better characterization of age-related cognitive changes and Alzheimer's disease. Importantly, cognitive reserve is not fixed but continues to evolve across the lifespan. Thus, even late-stage interventions hold promise to boost cognitive reserve and thus reduce the prevalence of Alzheimer's disease and other age-related problems.

  2. Estimating the development assistance for health provided to faith-based organizations, 1990-2013.

    Directory of Open Access Journals (Sweden)

    Annie Haakenstad

    Full Text Available Faith-based organizations (FBOs have been active in the health sector for decades. Recently, the role of FBOs in global health has been of increased interest. However, little is known about the magnitude and trends in development assistance for health (DAH channeled through these organizations.Data were collected from the 21 most recent editions of the Report of Voluntary Agencies. These reports provide information on the revenue and expenditure of organizations. Project-level data were also collected and reviewed from the Bill & Melinda Gates Foundation and the Global Fund to Fight AIDS, Tuberculosis and Malaria. More than 1,900 non-governmental organizations received funds from at least one of these three organizations. Background information on these organizations was examined by two independent reviewers to identify the amount of funding channeled through FBOs.In 2013, total spending by the FBOs identified in the VolAg amounted to US$1.53 billion. In 1990, FB0s spent 34.1% of total DAH provided by private voluntary organizations reported in the VolAg. In 2013, FBOs expended 31.0%. Funds provided by the Global Fund to FBOs have grown since 2002, amounting to $80.9 million in 2011, or 16.7% of the Global Fund's contributions to NGOs. In 2011, the Gates Foundation's contributions to FBOs amounted to $7.1 million, or 1.1% of the total provided to NGOs.Development assistance partners exhibit a range of preferences with respect to the amount of funds provided to FBOs. Overall, estimates show that FBOS have maintained a substantial and consistent share over time, in line with overall spending in global health on NGOs. These estimates provide the foundation for further research on the spending trends and effectiveness of FBOs in global health.

  3. Estimating the Development Assistance for Health Provided to Faith-Based Organizations, 1990–2013

    Science.gov (United States)

    Haakenstad, Annie; Johnson, Elizabeth; Graves, Casey; Olivier, Jill; Duff, Jean; Dieleman, Joseph L.

    2015-01-01

    Background Faith-based organizations (FBOs) have been active in the health sector for decades. Recently, the role of FBOs in global health has been of increased interest. However, little is known about the magnitude and trends in development assistance for health (DAH) channeled through these organizations. Material and Methods Data were collected from the 21 most recent editions of the Report of Voluntary Agencies. These reports provide information on the revenue and expenditure of organizations. Project-level data were also collected and reviewed from the Bill & Melinda Gates Foundation and the Global Fund to Fight AIDS, Tuberculosis and Malaria. More than 1,900 non-governmental organizations received funds from at least one of these three organizations. Background information on these organizations was examined by two independent reviewers to identify the amount of funding channeled through FBOs. Results In 2013, total spending by the FBOs identified in the VolAg amounted to US$1.53 billion. In 1990, FB0s spent 34.1% of total DAH provided by private voluntary organizations reported in the VolAg. In 2013, FBOs expended 31.0%. Funds provided by the Global Fund to FBOs have grown since 2002, amounting to $80.9 million in 2011, or 16.7% of the Global Fund’s contributions to NGOs. In 2011, the Gates Foundation’s contributions to FBOs amounted to $7.1 million, or 1.1% of the total provided to NGOs. Conclusion Development assistance partners exhibit a range of preferences with respect to the amount of funds provided to FBOs. Overall, estimates show that FBOS have maintained a substantial and consistent share over time, in line with overall spending in global health on NGOs. These estimates provide the foundation for further research on the spending trends and effectiveness of FBOs in global health. PMID:26042731

  4. Estimating the development assistance for health provided to faith-based organizations, 1990-2013.

    Science.gov (United States)

    Haakenstad, Annie; Johnson, Elizabeth; Graves, Casey; Olivier, Jill; Duff, Jean; Dieleman, Joseph L

    2015-01-01

    Faith-based organizations (FBOs) have been active in the health sector for decades. Recently, the role of FBOs in global health has been of increased interest. However, little is known about the magnitude and trends in development assistance for health (DAH) channeled through these organizations. Data were collected from the 21 most recent editions of the Report of Voluntary Agencies. These reports provide information on the revenue and expenditure of organizations. Project-level data were also collected and reviewed from the Bill & Melinda Gates Foundation and the Global Fund to Fight AIDS, Tuberculosis and Malaria. More than 1,900 non-governmental organizations received funds from at least one of these three organizations. Background information on these organizations was examined by two independent reviewers to identify the amount of funding channeled through FBOs. In 2013, total spending by the FBOs identified in the VolAg amounted to US$1.53 billion. In 1990, FB0s spent 34.1% of total DAH provided by private voluntary organizations reported in the VolAg. In 2013, FBOs expended 31.0%. Funds provided by the Global Fund to FBOs have grown since 2002, amounting to $80.9 million in 2011, or 16.7% of the Global Fund's contributions to NGOs. In 2011, the Gates Foundation's contributions to FBOs amounted to $7.1 million, or 1.1% of the total provided to NGOs. Development assistance partners exhibit a range of preferences with respect to the amount of funds provided to FBOs. Overall, estimates show that FBOS have maintained a substantial and consistent share over time, in line with overall spending in global health on NGOs. These estimates provide the foundation for further research on the spending trends and effectiveness of FBOs in global health.

  5. Comparison of different discriminant functions for mangrove species analysis in Matang Mangrove Forest Reserve (MMFR), Perak based on statistical approach

    Science.gov (United States)

    Beh, Boon Chun; Tan, Kok Chooi; Mat Jafri, Mohd. Zubir; Lim, Hwee San

    2017-10-01

    Mangroves are known as salt-tolerant evergreen forests, whereas its create land-ocean interface ecosystems. Besides, mangroves bring direct and indirect benefits to human activities and play a major role as significant habitat for sustaining biodiversity. However, mangrove ecosystem study based on the mangrove species are very crucial to get a better understanding of their characteristics and ways to separate among them. In this paper, discriminant functions obtained using statistical approach were used to generate the score range for six mangrove species (Rhizophora apiculata, Acrostichum aurem, Acrostichum speciosum, Acanthus ilicifolius, Ceriops tagal and Sonneratia ovata) in Matang Mangrove Forest Reserve (MMFR), Perak. With the computation of score range for each species, the fraction of the species can be determined using the proposed algorithm. The results indicate that by using 11 discriminant functions out of 16 are more effective to separate the mangrove species as the higher accuracy was obtained. Overall, the determination of leaf sample's species is chosen base on the highest fraction measured among the six mangrove species. The obtained accuracy for mangrove species using statistical approach is low since it is impossible to successfully separate all the mangrove species in leaf level using their inherent reflectance properties. However, the obtained accuracy results are satisfactory and able to discriminate the examined mangrove species at species scale.

  6. Landscapes‘ Capacities to Provide Ecosystem Services – a Concept for Land-Cover Based Assessments

    Directory of Open Access Journals (Sweden)

    Benjamin Burkhard

    2009-12-01

    Full Text Available Landscapes differ in their capacities to provide ecosystem goods and services, which are the benefits humans obtain from nature. Structures and functions of ecosystems needed to sustain the provision of ecosystem services are altered by various human activities. In this paper, a concept for the assessment of multiple ecosystem services is proposed as a basis for discussion and further development of a respective evaluation instrument. Using quantitative and qualitative assessment data in combination with land cover and land use information originated from remote sensing and GIS, impacts of human activities can be evaluated. The results reveal typical patterns of different ecosystems‘ capacities to provide ecosystem services. The proposed approach thus delivers useful integrative information for environmental management and landscape planning, aiming at a sustainable use of services provided by nature. The research concept and methodological framework presented here for discussion have initially been applied in different case studies and shall be developed further to provide a useful tool for the quantification and spatial modelling of multiple ecosystem services in different landscapes. An exemplary application of the approach dealing with food provision in the Halle-Leipzig region in Germany is presented. It shows typical patterns of ecosystem service distribution around urban areas. As the approach is new and still rather general, there is great potential for improvement, especially with regard to a data-based quantification of the numerous hypotheses, which were formulated as base for the assessment. Moreover, the integration of more detailed landscape information on different scales will be needed in future in order to take the heterogeneous distribution of landscape properties and values into account. Therefore, the purpose of this paper is to foster critical discussions on the methodological development presented here.

  7. BeetleBase in 2010: revisions to provide comprehensive genomic information for Tribolium castaneum.

    Science.gov (United States)

    Kim, Hee Shin; Murphy, Terence; Xia, Jing; Caragea, Doina; Park, Yoonseong; Beeman, Richard W; Lorenzen, Marcé D; Butcher, Stephen; Manak, J Robert; Brown, Susan J

    2010-01-01

    BeetleBase (http://www.beetlebase.org) has been updated to provide more comprehensive genomic information for the red flour beetle Tribolium castaneum. The database contains genomic sequence scaffolds mapped to 10 linkage groups (genome assembly release Tcas_3.0), genetic linkage maps, the official gene set, Reference Sequences from NCBI (RefSeq), predicted gene models, ESTs and whole-genome tiling array data representing several developmental stages. The database was reconstructed using the upgraded Generic Model Organism Database (GMOD) modules. The genomic data is stored in a PostgreSQL relatational database using the Chado schema and visualized as tracks in GBrowse. The updated genetic map is visualized using the comparative genetic map viewer CMAP. To enhance the database search capabilities, the BLAST and BLAT search tools have been integrated with the GMOD tools. BeetleBase serves as a long-term repository for Tribolium genomic data, and is compatible with other model organism databases.

  8. Psychotherapies provided for eating disorders by community clinicians: infrequent use of evidence-based treatment.

    Science.gov (United States)

    von Ranson, Kristin M; Wallace, Laurel M; Stevenson, Andrea

    2013-01-01

    This study describes the psychological interventions used for eating disorders (EDs) by community practitioners. Of 573 clinicians we screened across Alberta, 130 (22.7%) had treated EDs; 118 (90.8%) were interviewed. Clinicians reported varied reasons for psychotherapy choice and diverse training experiences; the primary approaches used varied by education and field. The most common primary approach was eclectic (43.2%), followed by cognitive-behavior therapy (CBT; 22.9%). However, self-reported CBT clinicians used specific CBT techniques infrequently. Half of clinicians incorporated addictions-based techniques. These results indicate that ED treatment provided by community clinicians is varied and generally does not align with evidence-based practice guidelines.

  9. A method for analyzing the business case for provider participation in the National Cancer Institute's Community Clinical Oncology Program and similar federally funded, provider-based research networks.

    Science.gov (United States)

    Reiter, Kristin L; Song, Paula H; Minasian, Lori; Good, Marjorie; Weiner, Bryan J; McAlearney, Ann Scheck

    2012-09-01

    The Community Clinical Oncology Program (CCOP) plays an essential role in the efforts of the National Cancer Institute (NCI) to increase enrollment in clinical trials. Currently, there is little practical guidance in the literature to assist provider organizations in analyzing the return on investment (ROI), or business case, for establishing and operating a provider-based research network (PBRN) such as the CCOP. In this article, the authors present a conceptual model of the business case for PBRN participation, a spreadsheet-based tool and advice for evaluating the business case for provider participation in a CCOP organization. A comparative, case-study approach was used to identify key components of the business case for hospitals attempting to support a CCOP research infrastructure. Semistructured interviews were conducted with providers and administrators. Key themes were identified and used to develop the financial analysis tool. Key components of the business case included CCOP start-up costs, direct revenue from the NCI CCOP grant, direct expenses required to maintain the CCOP research infrastructure, and incidental benefits, most notably downstream revenues from CCOP patients. The authors recognized the value of incidental benefits as an important contributor to the business case for CCOP participation; however, currently, this component is not calculated. The current results indicated that providing a method for documenting the business case for CCOP or other PBRN involvement will contribute to the long-term sustainability and expansion of these programs by improving providers' understanding of the financial implications of participation. Copyright © 2011 American Cancer Society.

  10. Juicebox.js Provides a Cloud-Based Visualization System for Hi-C Data.

    Science.gov (United States)

    Robinson, James T; Turner, Douglass; Durand, Neva C; Thorvaldsdóttir, Helga; Mesirov, Jill P; Aiden, Erez Lieberman

    2018-02-28

    Contact mapping experiments such as Hi-C explore how genomes fold in 3D. Here, we introduce Juicebox.js, a cloud-based web application for exploring the resulting datasets. Like the original Juicebox application, Juicebox.js allows users to zoom in and out of such datasets using an interface similar to Google Earth. Juicebox.js also has many features designed to facilitate data reproducibility and sharing. Furthermore, Juicebox.js encodes the exact state of the browser in a shareable URL. Creating a public browser for a new Hi-C dataset does not require coding and can be accomplished in under a minute. The web app also makes it possible to create interactive figures online that can complement or replace ordinary journal figures. When combined with Juicer, this makes the entire process of data analysis transparent, insofar as every step from raw reads to published figure is publicly available as open source code. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

  11. Mobile-based blended learning for capacity building of health providers in rural Afghanistan.

    Science.gov (United States)

    Tirmizi, Syeda Nateela; Khoja, Shariq; Patten, Scott; Yousafzai, Abdul Wahab; Scott, Richard E; Durrani, Hammad; Khoja, Wafa; Husyin, Nida

    2017-01-01

    Mobile-based blended learning initiative was launched in November 2014 in Badakshan province of Afghanistan by Tech4Life Enterprises, Aga Khan Health Service, Afghanistan (AKHS, A), and the University of Calgary, Canada. The goal of this initiative was to improve knowledge of health providers related to four major mental health problems, namely depression, psychosis, post-traumatic stress disorder (PTSD) and drug abuse. This paper presents the results of quasi-experimental study conducted in 4 intervention districts in Badakshan for improvement in the knowledge among health providers about depression. The results were compared with three control districts for the change in knowledge scores. Sixty-two health providers completed pre and post module questionnaires from case district, while 31 health providers did so from the control sites. Significant change was noticed in the case districts, where overall knowledge scores changed from 45% in pre-intervention test to 63% in post-intervention test. Overall background knowledge of pre to post module test scores changed from 30% to 40%, knowledge of symptoms showed correct responses raised from 25% to 44%, knowledge related to causes of depression from overall districts showed change from 22% to 51%, and treatment knowledge of depression improved from 29% to 35%. Average gain in scores among cases was 16.06, compared to 6.8 in controls. The study confirms that a blended Learning approach with multiple learning techniques for health providers in Badakshan, Afghanistan, enhanced their knowledge and offers an effective solution to overcome challenges in continuing education. Further research is needed to confirm that the gains in knowledge reported here translate into better practice and improved mental health.

  12. Providing Consumers with Web-Based Information on the Environmental Effects of Automobiles

    Energy Technology Data Exchange (ETDEWEB)

    Saulsbury, J.W.

    2003-08-25

    The Department of Energy (DOE) and the Environmental Protection Agency (EPA) provide consumers with web-based information on the environmental effects of automobiles so that individuals can make informed choices about the vehicles they use or may purchase. DOE and EPA maintain a web site (www.fueleconomy.gov) that provides users with information about fuel economy [as well as greenhouse gas (GHG) emissions and air pollution emissions] for the cars and trucks they use or may consider purchasing. EPA also maintains a separate web site (www.epa.gov/greenvehicles) that offers similar information, with the focus on air pollution emissions rather than fuel economy. The American Council for an Energy-Efficient Economy (ACEEE) (www.greenercars.com) and the California Air Resources Board (CARB) (www.arb.ca.gov/msprog/ccbg/ccbg.htm) also maintain web sites that provide consumers with information on the environmental effects of automobiles. Through the National Transportation Research Center (NTRC) at Oak Ridge National Laboratory, DOE has supported some initial qualitative research with people who are interested in purchasing a new or used vehicle and whose actions identify them as at least somewhat concerned about the environment. The purpose of this research was to explore and understand how these people respond to the different ratings and measurements of environmental effects provided by the four web sites. The goal of the research is to optimize the communication of information provided on the DOE/EPA web site (www.fueleconomy.gov). Working with a private marketing research firm (The Looking Glass Group of Knoxville, Tennessee), NTRC staff initiated this research by meeting with two focus groups in Knoxville on February 27, 2001. To obtain information for comparison, staff from the NTRC and the Looking Glass Group also met with two focus groups in Los Angeles, California, on August 13, 2001.

  13. [Does WIKIPEDIA provide evidence-based health care information? A content analysis].

    Science.gov (United States)

    Mühlhauser, Ingrid; Oser, Friederike

    2008-01-01

    Patients and consumers are increasingly searching the Internet for medical and healthcare information. Using the criteria of evidence-based medicine the present study analyses the websites of Wikipedia and two major German statutory health insurances for content and presentation of patient information. 22 senior students of health sciences and education evaluated one topic each. In a first step, they identified the evidence for their specific question. Afterwards they used their results as reference for the evaluation of the three websites. Using a check list each student and a second researcher independently rated content and presentation of the information offered. All these websites failed to meet relevant criteria, and key information such as the presentation of probabilities of success on patient-relevant outcomes, probabilities of unwanted effects, and unbiased risk communication was missing. On average items related to the objectives of interventions, the natural course of disease and treatment options were only rated as "partially fulfilled". Overall, there were only minor differences between the three providers, except for items related to the specific nature of the websites such as disclosure of authorship, conflict of interest and support offers. In addition, the Wikipedia information tended to achieve lower comprehensibility. In conclusion, the quality of the healthcare information provided by Wikipedia and two major German statutory health insurances is comparable. They do not meet important criteria of evidence-based patient and consumer information though.

  14. Mapping allied health evidence-based practice: providing a basis for organisational realignment.

    Science.gov (United States)

    Ziviani, Jenny; Wilkinson, Shelley A; Hinchliffe, Fiona; Feeney, Rachel

    2015-06-01

    Ahead of the convergence of two major paediatric services, we examined evidence-based practice (EBP) self-efficacy, outcome expectance, knowledge and use among allied health (AH) staff in two major Queensland (Qld) paediatric services. This was to determine whether any differences existed based on organisational affiliation, profession and any previous training to inform a strategy to enhance AH EBP within the new organisational setting. All AH staff from the two Brisbane (Qld) tertiary paedritic hospitals were invited to participate in the survey. Using a cross-sectional design EBP self-efficacy, outcome expectancy, knowledge and use, as well as previous EBP training, were assessed with an online survey. Background demographic information obtained included professional discipline and hospital. One hundreD and thirty-eight health practitioners completed the survey (37% respone rate). Most practioners had accessed EBP training. Mean scores for EBP attitudes (self-efficacy and outcome expectancy) and knowledge were higher than for EBP use scores. Greater variation was observed across professional disciplines than organisations. Training impacted positively on EBP measures but explained a small proportion of total variance in regression models. The results underscore the need to provide organisational supports to AH staff ro EBP implementation. Strategies other than training are requred to maximally enhance EBP attitudes. The new organisational structure provides an oppotunity for this cultural shift to occur.

  15. Brain reserve capacity in frontotemporal dementia: a voxel-based {sup 18}F-FDG PET study

    Energy Technology Data Exchange (ETDEWEB)

    Perneczky, Robert; Diehl-Schmid, Janine; Kurz, Alexander [Technische Universitaet Muenchen, Klinik und Poliklinik fuer Psychiatrie und Psychotherapie, Muenchen (Germany); Drzezga, Alexander [Technische Universitaet Muenchen, Nuklearmedizinische Klinik, Muenchen (Germany)

    2007-07-15

    The association of the regional cerebral metabolic rate of glucose utilisation (rCMRglc) and years of schooling has been extensively studied in Alzheimer's disease (AD). The results suggest that brain reserve capacity (BRC) allows patients with more years of schooling to cope better with AD pathology. The objective of this study was to provide initial evidence for BRC in frontotemporal dementia (FTD). Twenty-nine patients with FTD and 16 healthy age- and education-matched controls underwent PET imaging of the brain with {sup 18}F-fluoro-2-deoxy-glucose. A group comparison of rCMRglc was conducted between patients and controls and the output was saved as region of interest (ROI). A linear regression analysis with education as the independent and rCMRglc as the dependent variable, adjusted for age, gender and total score on the CERAD neuropsychological battery, was conducted in SPM2 over the pre-assigned ROI. Patients showed a reduced rCMRglc in almost the entire prefrontal cortex and the anterior cingulate cortex as compared with controls (p < 0.05 corrected for multiple comparisons). The regression analysis revealed a significant negative association between years of schooling and rCMRglc in the bilateral inferior frontal cortex (p < 0.001, uncorrected for multiple comparisons), which was independent of demographic variables and cognitive performance level. There was a strong negative correlation of rCMRglc and education (r = -0.45). The study provides initial evidence for BRC in FTD. The findings suggest that interindividual differences in educational level affect BRC by partially mediating the relationship between neurodegeneration and the clinical manifestation of FTD. (orig.)

  16. A Web Page That Provides Map-Based Interfaces for VRML/X3D Contents

    Science.gov (United States)

    Miyake, Yoshihiro; Suzaki, Kenichi; Araya, Shinji

    The electronic map is very useful for navigation in the VRML/X3D virtual environments. So far various map-based interfaces have been developed. But they are lacking for generality because they have been separately developed for individual VRML/X3D contents, and users must use different interfaces for different contents. Therefore we have developed a web page that provides a common map-based interface for VRML/X3D contents on the web. Users access VRML/X3D contents via the web page. The web page automatically generates a simplified map by analyzing the scene graph of downloaded contents, and embeds the mechanism to link the virtual world and the map. An avatar is automatically created and added to the map, and both a user and its avatar are bi-directionally linked together. In the simplified map, obstructive objects are removed and the other objects are replaced by base boxes. This paper proposes the architecture of the web page and the method to generate simplified maps. Finally, experimental system is developed in order to show the improvement of flame rates by simplifying the map.

  17. Ways of providing the patient with a prognosis: a terminology of employed strategies based on qualitative data.

    Science.gov (United States)

    Graugaard, Peter Kjær; Rogg, Lotte; Eide, Hilde; Uhlig, Till; Loge, Jon Håvard

    2011-04-01

    To identify, denote, and structure strategies applied by physicians and patients when communicating information about prognosis. A descriptive qualitative study based on audiotaped physician-patient encounters between 23 haematologists and rheumatologists, and 89 patients in Oslo. Classification of identified prognostic sequences was based on consensus. Physicians seldom initiated communication with patients explicitly to find out their overall preferences for prognostic information (metacommunication). Instead, they used sounding and implicit strategies such as invitations, implicatures, and non-specific information that might result in further disclosure of information if requested by the patients. In order to balance the obligation to promote hope and provide (true) information, they used strategies such as bad news/good news spirals, authentications, safeguardings, and softenings. Identified strategies applied by the patients to adjust the physician-initiated prognostic information to their needs were requests for specification, requests for optimism, and emotional warnings. The study presents an empirically derived terminology so that clinicians and educators involved in medical communication can increase their awareness of prognostic communication. Based on qualitative data obtained from communication excerpts, we suggest that individual clinicians and researchers evaluate the possible benefits of more frequent use of metacommunication and explicit prognostic information. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  18. Assessment of current and proposed nature reserves of Mexico based on their capacity to protect geophysical features and biodiversity

    Science.gov (United States)

    Cantu, C.; Wright, R.G.; Scott, J.M.; Strand, Espen

    2004-01-01

    Mexico currently has 144 nature reserves covering approximately 9.1% of its land area. These reserves were established for a variety of reasons - often unrelated to the protection of biodiversity. In 2000 in response to a growing concern about the lack of organized conservation reserve planning to protect the important threatened biological and physical features of Mexico, the Mexican Commission for Knowledge and Use of Biodiversity (CONABIO) proposed the establishment of 151 new reserves for Mexico covering 51,429,500 ha. We compiled a GIS analysis using digital thematic maps of physical and biological features to examine how the existing and proposed reserves serve to protect the biodiversity and physical features of the country. Using a conservation target of placing a minimum of 12% of the land area of each important biophysical feature in nature reserves, we found that the 144 existing nature reserves covering 18 million ha (9% of the country) only meet that target for elevation ranges >3000 m and areas with poor soils. These mountainous areas represent less than 1% of the country. The gaps in the existing nature reserves network occur mainly at lower and intermediate elevations (<3000 m) areas with xeric, tropical, and temperate ecosystems, and high productivity soils. The areas proposed by CONABIO increase the proportion of protected lands in the country to over 27% and most of the conservation targets for geophysical features, and land cover, categories are met. Whether this area would be sufficient to maintain viable populations and ecological integrity of species and ecosystems is unknown. Even with the new reserves, low elevation coastal lands would be below the conservation target in the nature reserves. To include a representative sample of these lands would be difficult as these are the same areas where the majority of people live. ?? 2003 Elsevier Ltd. All rights reserved.

  19. Characterization of reaction conditions providing rapid and specific cysteine alkylation for peptide-based mass spectrometry.

    Science.gov (United States)

    Paulech, Jana; Solis, Nestor; Cordwell, Stuart J

    2013-01-01

    Alkylation converts Cys thiols to thioethers and prevents unwanted side reactions, thus facilitating mass spectrometric identification of Cys-containing peptides. Alkylation occurs preferentially at Cys due to its high nucleophilicity, however reactions at other such sites are possible. N-ethylmaleimide (NEM) shows rapid reaction kinetics with Cys and careful definition of reaction conditions results in little reactivity at other sites. Analysis of a protein standard alkylated under differing reaction conditions (pH, NEM concentrations and reaction times) was performed using liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) and selected reaction monitoring (SRM) of NEM-modified and unmodified peptide pairs. Mis-alkylation sites at primary and secondary amines were identified and limited to one equivalent of NEM. No evidence for hydroxyl or thioether alkylation was observed. Improved specificity was achieved by restricting the pH below neutral, NEM concentration below 10mM and/or reaction time to below 5min. Maximal removal of Cys activity was observed in tissue homogenates at 40mM NEM within 1min, dependent upon efficient protein denaturation. SRM assays identified peptide-specific levels of mis-alkylation, indicating that NEM-modified to unmodified ratios did not exceed 10%, with the exception of Cys alkylation that proceeded to 100%, and some Lys residues that resulted in tryptic missed cleavages. High reactivity was observed for His residues considering their relatively low abundance. These data indicate that rapid and specific Cys alkylation is possible with NEM under relatively mild conditions, with more abrasive conditions leading to increased non-specific alkylation without appreciable benefit for MS-based proteomics. Copyright © 2012 Elsevier B.V. All rights reserved.

  20. Carbon based secondary compounds do not provide protection against heavy metal road pollutants in epiphytic macrolichens.

    Science.gov (United States)

    Gauslaa, Yngvar; Yemets, Olena A; Asplund, Johan; Solhaug, Knut Asbjørn

    2016-01-15

    Lichens are useful monitoring organisms for heavy metal pollution. They are high in carbon based secondary compounds (CBSCs) among which some may chelate heavy metals and thus increase metal accumulation. This study quantifies CBSCs in four epiphytic lichens transplanted for 6months on stands along transects from a highway in southern Norway to search for relationships between concentrations of heavy metals and CBSCs along a gradient in heavy metal pollutants. Viability parameters and concentrations of 21 elements including nutrients and heavy metals in these lichen samples were reported in a separate paper. Medullary CBSCs in fruticose lichens (Ramalina farinacea, Usnea dasypoga) were reduced in the most polluted sites, but not in foliose ones (Parmelia sulcata, Lobaria pulmonaria), whereas cortical CBSC did not change with distance from the road in any species. Strong positive correlations only occurred between the major medullary compound stictic acid present in L. pulmonaria and most heavy metals, consistent with a chelating role of stictic acid, but not of other studied CBSCs or in other species. However, heavy metal chelating did not protect L. pulmonaria against damage because this species experienced the strongest reduction in viability in the polluted sites. CBSCs with an accumulation potential for heavy metals should be quantified in lichen biomonitoring studies of heavy metals because they, like stictic acid, could overshadow pollutant inputs in some species rendering biomonitoring data less useful. In the two fruticose lichen species, CBSCs decreased with increasing heavy metal concentration, probably because heavy metal exposure impaired secondary metabolism. Thus, we found no support for a heavy metal protection role of any CBSCs in studied epiphytic lichens. No intraspecific relationships occurred between CBSCs versus N or C/N-ratio. Interspecifically, medullary CBSCs decreased and cortical CBSCs increased with increasing C/N-ratio. Copyright © 2015

  1. Web-Based Tools for Text-Based Patient-Provider Communication in Chronic Conditions: Scoping Review.

    Science.gov (United States)

    Voruganti, Teja; Grunfeld, Eva; Makuwaza, Tutsirai; Bender, Jacqueline L

    2017-10-27

    Patients with chronic conditions require ongoing care which not only necessitates support from health care providers outside appointments but also self-management. Web-based tools for text-based patient-provider communication, such as secure messaging, allow for sharing of contextual information and personal narrative in a simple accessible medium, empowering patients and enabling their providers to address emerging care needs. The objectives of this study were to (1) conduct a systematic search of the published literature and the Internet for Web-based tools for text-based communication between patients and providers; (2) map tool characteristics, their intended use, contexts in which they were used, and by whom; (3) describe the nature of their evaluation; and (4) understand the terminology used to describe the tools. We conducted a scoping review using the MEDLINE (Medical Literature Analysis and Retrieval System Online) and EMBASE (Excerpta Medica Database) databases. We summarized information on the characteristics of the tools (structure, functions, and communication paradigm), intended use, context and users, evaluation (study design and outcomes), and terminology. We performed a parallel search of the Internet to compare with tools identified in the published literature. We identified 54 papers describing 47 unique tools from 13 countries studied in the context of 68 chronic health conditions. The majority of tools (77%, 36/47) had functions in addition to communication (eg, viewable care plan, symptom diary, or tracker). Eight tools (17%, 8/47) were described as allowing patients to communicate with the team or multiple health care providers. Most of the tools were intended to support communication regarding symptom reporting (49%, 23/47), and lifestyle or behavior modification (36%, 17/47). The type of health care providers who used tools to communicate with patients were predominantly allied health professionals of various disciplines (30%, 14

  2. Challenges and Strategies in Providing Home Based Primary Care for Refugees in the US.

    Science.gov (United States)

    Febles, C; Nies, M A; Fanning, K; Tavernier, S S

    2017-12-01

    The recent crisis in the Middle East has prompted the exodus of millions of refugees from the region who are at present seeking shelter across Europe and in the United States. Among the most immediate needs of refugees upon arrival in a host country is health care, and it is one of the most sustained interactions they experience. Home visits are a common form of primary care for refugees. The authors review the literature to identify themes related to challenges and strategies for providing home based primary care to refugees. The literature review was performed by searching cross-disciplinary databases utilizing Onesearch, but focusing primarily on results produced through CINAHL, EBSCOHOST, and Pub Med databases. To maximize the number of studies included, there was no time frame placed upon publication dates of articles within the search. A total of 55 articles were included in this paper.

  3. Providing choices for a marginalized community. A community-based project with Malaysian aborigines.

    Science.gov (United States)

    Kaur, P

    1994-01-01

    In 1991, the Family Planning Association (FPA) of the Malaysian state of Perak initiated a community-based development project in the remote Aborigine village of Kampung Tisong. The community consists of approximately 34 households who survive on an average income of about US $37. Malnutrition is pervasive, even minor ailments cause death, more serious afflictions are prevalent, and the closest government clinic is 20 kilometers away and seldom used by the Aborigines. 70% of the children have access to education, but parental illiteracy is a serious educational obstacle. The goals of the FPA program are to 1) promote maternal and child health and responsible parenthood, 2) provide health education, 3) encourage women to seek self-determination, and 4) encourage the development of self-reliance in the community as a whole. The first step was to survey the community's culture, beliefs, and health status with the help of the Aborigines Department and the village headman. After a series of preliminary meetings with other agencies, the FPA began to provide activities including health talks, health courses and demonstrations, medical examinations and check-ups, and first aid training. Environmental protection and sanitation measures were included in the educational activities, and following the traditional "mutual aid system," a small plot of land was cleared for vegetable production. Vegetable gardens and needlecraft will become income-producing activities for the women. Attempts to motivate the women to use family planning have been hindered by the fact that the health of 2 women deteriorated after they began using oral contraceptives. Positive changes are occurring slowly and steadily, however, and the FPA has been instrumental in having the settlement included in a program for the hardcore poor which will provide new housing and farming projects.

  4. [Practical chemistry education provided by team-based learning (TBL) and peer evaluation].

    Science.gov (United States)

    Yasuhara, Tomohisa; Konishi, Motomi; Nishida, Takahiro; Kushihata, Taro; Sone, Tomomichi; Kurio, Wasako; Yamamoto, Yumi; Nishikawa, Tomoe; Yanada, Kazuo; Nakamura, Mitsutaka

    2014-01-01

    Learning chemistry is cumulative: basic knowledge and chemical calculation skills are required to gain understanding of higher content. However, we often suffer from students' lack of learning skills to acquire these concepts. One of the reasons is the lack of adequate training in the knowledge and skills of chemistry, and one of the reasons for this lack is the lack of adequate evaluation of training procedures and content. Team-based learning (TBL) is a strong method for providing training in the knowledge and skills of chemistry and reaffirms the knowledge and skills of students of various levels. In our faculty, TBL exercises are provided for first-year students concurrently with lectures in physical chemistry and analytical chemistry. In this study, we researched the adoption of a peer evaluation process for this participatory learning model. Questionnaires taken after TBL exercises in the previous year showed a positive response to TBL. Further, a questionnaire taken after TBL exercises in the spring semester of the current year also yielded a positive response not only to TBL but also to peer evaluation. In addition, a significant correlation was observed between the improvement of students' grades in chemistry classes and the feeling the percentage (20%) of peer evaluation in overall evaluation low (logistic regression analysis, p=0.022). On the basis of the findings, we argue that TBL provides a generic, practical learning environment including an effective focus on learning strategy and evaluation of knowledge, skills, and attitudes, and studies on the educational effects of TBL and peer evaluation.

  5. Single-filament kinetic studies provide novel insights into regulation of actin-based motility.

    Science.gov (United States)

    Shekhar, Shashank; Carlier, Marie-France

    2016-01-01

    Polarized assembly of actin filaments forms the basis of actin-based motility and is regulated both spatially and temporally. Cells use a variety of mechanisms by which intrinsically slower processes are accelerated, and faster ones decelerated, to match rates observed in vivo. Here we discuss how kinetic studies of individual reactions and cycles that drive actin remodeling have provided a mechanistic and quantitative understanding of such processes. We specifically consider key barbed-end regulators such as capping protein and formins as illustrative examples. We compare and contrast different kinetic approaches, such as the traditional pyrene-polymerization bulk assays, as well as more recently developed single-filament and single-molecule imaging approaches. Recent development of novel biophysical methods for sensing and applying forces will in future allow us to address the very important relationship between mechanical stimulus and kinetics of actin-based motility. © 2016 Shekhar and Carlier. This article is distributed by The American Society for Cell Biology under license from the author(s). Two months after publication it is available to the public under an Attribution–Noncommercial–Share Alike 3.0 Unported Creative Commons License (http://creativecommons.org/licenses/by-nc-sa/3.0).

  6. Wind farms providing secondary frequency regulation: Evaluating the performance of model-based receding horizon control

    International Nuclear Information System (INIS)

    Shapiro, Carl R.; Meneveau, Charles; Gayme, Dennice F.; Meyers, Johan

    2016-01-01

    We investigate the use of wind farms to provide secondary frequency regulation for a power grid. Our approach uses model-based receding horizon control of a wind farm that is tested using a large eddy simulation (LES) framework. In order to enable real-time implementation, the control actions are computed based on a time-varying one-dimensional wake model. This model describes wake advection and interactions, both of which play an important role in wind farm power production. This controller is implemented in an LES model of an 84-turbine wind farm represented by actuator disk turbine models. Differences between the velocities at each turbine predicted by the wake model and measured in LES are used for closed-loop feedback. The controller is tested on two types of regulation signals, “RegA” and “RegD”, obtained from PJM, an independent system operator in the eastern United States. Composite performance scores, which are used by PJM to qualify plants for regulation, are used to evaluate the performance of the controlled wind farm. Our results demonstrate that the controlled wind farm consistently performs well, passing the qualification threshold for all fastacting RegD signals. For the RegA signal, which changes over slower time scales, the controlled wind farm's average performance surpasses the threshold, but further work is needed to enable the controlled system to achieve qualifying performance all of the time. (paper)

  7. Providing Access to Census-based Interaction Data in the UK: That's WICID!

    Directory of Open Access Journals (Sweden)

    John Stillwell

    2006-08-01

    Full Text Available The Census Interaction Data Service (CIDS is funded by the Economic and Social Research Council in the UK to provide access for social science researchers and students to the detailed migration and journey-to-work statistics that are collected by the national statistical agencies. These interaction data sets are known collectively as the Special Migration Statistics (SMS and the Special Workplace Statistics (SWS. This paper outlines how problems of user access to these data have been tackled through the development of a web-based system known as WICID (Web-based Interface to Census Interaction Data. The paper illustrates various interface features including some of the query building facilities that enable users to extract counts of flows of particular groups of individuals between selected origin and destination areas. New tools are outlined for assisting area selection using digital maps of census geographies, for planning output and for adding value to the data through analysis. Mapping of flows of migrants between London boroughs and the rest of the UK demonstrates the value of the data. The paper begins with a summary of the data sets that are contained within the system and an outline of the system architecture.

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

    Directory of Open Access Journals (Sweden)

    Teal Randall

    2012-05-01

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

  9. A novel Internet-based blended learning programme providing core competency in clinical research.

    Science.gov (United States)

    Tsugihashi, Yukio; Kakudate, Naoki; Yokoyama, Yoko; Yamamoto, Yosuke; Mishina, Hiroki; Fukumori, Norio; Nakamura, Fumiaki; Takegami, Misa; Ohno, Shinya; Wakita, Takafumi; Watanabe, Kazuhiro; Yamaguchi, Takuhiro; Fukuhara, Shunichi

    2013-04-01

    We developed a novel Internet-based blended learning programme that allows busy health care professionals to attain core competency in clinical research. This study details the educational strategies and learning outcomes of the programme. This study was conducted at Kyoto University and seven satellite campuses from September 2009 to March 2010. A total of 176 health care professionals who had never attempted to attain core competency in clinical research were enrolled. The participants were supplied with a novel programme comprising the following four strategies: online live lectures at seven satellite campuses, short examinations after each lecture, an Internet-based feedback system and an end-of-course examination. We assessed the proportion of attendance at the lectures as the main outcome. In addition, we evaluated interaction via the feedback system and scores for end-of-course examination. Of the 176 participants, 134 (76%) reported working more than 40 hours per week. The mean proportion of attendance over all 23 lectures was 82%. A total of 156 (89%) participants attended more than 60% of all lectures and were eligible for the end-of-course examination. A total of the participants accessed the feedback system 3564 times and asked 284 questions. No statistically significant differences were noted in the end-of-course scores among medical doctors, pharmacists, registered nurses and other occupations. We developed an Internet-based blended learning programme providing core competency in clinical research. Most busy health care professionals completed the programme successfully. In addition, the participants could attain the core competency effectively, regardless of their occupation. © 2011 Blackwell Publishing Ltd.

  10. Omp16-based vaccine encapsulated by alginate-chitosan microspheres provides significant protection against Haemophilus parasuis in mice.

    Science.gov (United States)

    Zheng, Xintian; Yang, Xiaoyan; Li, Xiaohua; Qiu, Guo-Hua; Dai, Ailing; Huang, Qichun; Huang, Cuiqin; Guo, Xiaofeng

    2017-03-07

    Haemophilus parasuis (H. parasuis) is the etiological agent of swine Glässer's disease, which leads to significant economic loss in swine industry over the world. Subunit vaccine based on outer membrane protein is one of the promising choices to protect pigs against H. parasuis infection despite low immunity efficiency. In this paper, outer membrane protein 16 (Omp16) of H. parasuis encapsulated by alginate-chitosan microspheres as antigen carriers was explored for the first time in a mouse model. Our results showed that the microspheres with Omp16 induced significant higher H. parasuis-specific antibodies, and higher titers of IL-2, IL-4, and IFN-γ than those by Omp16-FIA in treated mice (pmice immunized with microspheres containing Omp16 was significantly decreased (pmice treated with Omp16 and 70% mice with Omp16-FIA were survived after challenged with H. parasuis virulent strain LY02 (serovar 5). Therefore, Omp16-based microsphere vaccine induces both humoral and cellular immune responses and provides promising protection against H. parasuis infection in mice. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. Understanding the roles of faith-based health-care providers in Africa: review of the evidence with a focus on magnitude, reach, cost, and satisfaction.

    Science.gov (United States)

    Olivier, Jill; Tsimpo, Clarence; Gemignani, Regina; Shojo, Mari; Coulombe, Harold; Dimmock, Frank; Nguyen, Minh Cong; Hines, Harrison; Mills, Edward J; Dieleman, Joseph L; Haakenstad, Annie; Wodon, Quentin

    2015-10-31

    At a time when many countries might not achieve the health targets of the Millennium Development Goals and the post-2015 agenda for sustainable development is being negotiated, the contribution of faith-based health-care providers is potentially crucial. For better partnership to be achieved and for health systems to be strengthened by the alignment of faith-based health-providers with national systems and priorities, improved information is needed at all levels. Comparisons of basic factors (such as magnitude, reach to poor people, cost to patients, modes of financing, and satisfaction of patients with the services received) within faith-based health-providers and national systems show some differences. As the first report in the Series on faith-based health care, we review a broad body of published work and introduce some empirical evidence on the role of faith-based health-care providers, with a focus on Christian faith-based health providers in sub-Saharan Africa (on which the most detailed documentation has been gathered). The restricted and diverse evidence reported supports the idea that faith-based health providers continue to play a part in health provision, especially in fragile health systems, and the subsequent reports in this Series review controversies in faith-based health care and recommendations for how public and faith sectors might collaborate more effectively. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Perceived quality of care for common childhood illnesses: facility versus community based providers in Uganda.

    Directory of Open Access Journals (Sweden)

    Agnes Nanyonjo

    Full Text Available OBJECTIVE: To compare caretakers' perceived quality of care (PQC for under-fives treated for malaria, pneumonia and diarrhoea by community health workers (CHWs and primary health facility workers (PHFWs. METHODS: Caretaker rated PQC for children aged (2-59 months treated by either CHWs or PHFWs for a bought of malaria, pneumonia or diarrhoea was cross-sectionally compared in quality domains of accessibility, continuity, comprehensiveness, integration, clinical interaction, interpersonal treatment and trust. Child samples were randomly drawn from CHW (419 and clinic (399 records from eight Midwestern Uganda districts. An overall PQC score was predicted through factor analysis. PQC scores were compared for CHWs and PHFWs using Wilcoxon rank-sum test. Multinomial logistic regression models were used to specify the association between categorized PQC and service providers for each quality domain. Finally, overall PQC was dichotomized into "high" and "low" based on median score and relative risks (RR for PQC-service provider association were modeled in a "modified" Poisson regression model. RESULTS: Mean (SD overall PQC was significantly higher for CHWs 0.58 (0 .66 compared to PHFWs -0.58 (0.94, p<0.0001. In "modified" Poisson regression, the proportion of caretakers reporting high PQC was higher for CHWS compared to PHFWs, RR=3.1, 95%CI(2.5-3.8. In multinomial models PQC was significantly higher for CHWs compared to PHFWs in all domains except for continuity. CONCLUSION: PQC was significantly higher for CHWs compared to PHFWs in this resource constrained setting. CHWs should be tapped human resources for universal health coverage while scaling up basic child intervention as PQC might improve intervention utilization.

  13. Providing lipid-based nutrient supplements does not affect developmental milestones among Malawian children.

    Science.gov (United States)

    Mangani, Charles; Cheung, Yin Bun; Maleta, Kenneth; Phuka, John; Thakwalakwa, Chrissie; Dewey, Kathryn; Manary, Mark; Puumalainen, Taneli; Ashorn, Per

    2014-01-01

    To assess whether using lipid-based nutrient supplements (LNS) to complement the diets of infants and young children affected when they achieved selected developmental milestones. In rural Malawi, 840 6-month-old healthy infants were enrolled to a randomised trial. Control participants received no supplements, others were provided with milk-containing LNS, soy-containing LNS or corn-soy blend (CSB) for 12 months. Outcomes were the age at which they achieved key milestone: motor (walking with assistance, standing and walking alone, running), social (drinking from a cup and eating by themselves) and language (saying single comprehensible words and waving goodbye). The mean age at which the subjects walked with assistance was 42.5, 42.3, 42.7 and 43.2 weeks in the control, milk-LNS, soy-LNS and CSB groups, respectively (p = 0.748). There were also no significant differences in the mean age at standing alone (45.0, 44.9, 45.1 and 46.3 weeks), walking alone (54.6, 55.1, 55.3, 56.5 weeks), running (64.6, 63.7, 64.8, 65.9 weeks) or any other social or language milestones (each p > 0.10). The findings do not support a hypothesis that providing tested formulations and doses of micronutrient-fortified LNS or CSB would have an impact on when young children in rural Malawi achieved selected developmental milestones. ©2013 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  14. Online advertising and marketing claims by providers of proton beam therapy: are they guideline-based?

    Science.gov (United States)

    Corkum, Mark T; Liu, Wei; Palma, David A; Bauman, Glenn S; Dinniwell, Robert E; Warner, Andrew; Mishra, Mark V; Louie, Alexander V

    2018-03-15

    Cancer patients frequently search the Internet for treatment options, and hospital websites are seen as reliable sources of knowledge. Guidelines support the use of proton radiotherapy in specific disease sites or on clinical trials. This study aims to evaluate direct-to-consumer advertising content and claims made by proton therapy centre (PTC) websites worldwide. Operational PTC websites in English were identified through the Particle Therapy Co-Operative Group website. Data abstraction of website content was performed independently by two investigators. Eight international guidelines were consulted to determine guideline-based indications for proton radiotherapy. Univariate and multivariate logistic regression models were used to determine the characteristics of PTC websites that indicated proton radiotherapy offered greater disease control or cure rates. Forty-eight PTCs with 46 English websites were identified. 60·9% of PTC websites claimed proton therapy provided improved disease control or cure. U.S. websites listed more indications than international websites (15·5 ± 5·4 vs. 10·4 ± 5·8, p = 0·004). The most common disease sites advertised were prostate (87·0%), head and neck (87·0%) and pediatrics (82·6%), all of which were indicated in least one international guideline. Several disease sites advertised were not present in any consensus guidelines, including pancreatobiliary (52·2%), breast (50·0%), and esophageal (43·5%) cancers. Multivariate analysis found increasing number of disease sites and claiming their centre was a local or regional leader in proton radiotherapy was associated with indicating proton radiotherapy offers greater disease control or cure. Information from PTC websites often differs from recommendations found in international consensus guidelines. As online marketing information may have significant influence on patient decision-making, alignment of such information with accepted guidelines and consensus

  15. Comparison of provider and plan-based targeting strategies for disease management.

    Science.gov (United States)

    Annis, Ann M; Holtrop, Jodi Summers; Tao, Min; Chang, Hsiu-Ching; Luo, Zhehui

    2015-05-01

    We aimed to describe and contrast the targeting methods and engagement outcomes for health plan-delivered disease management with those of a provider-delivered care management program. Health plan epidemiologists partnered with university health services researchers to conduct a quasi-experimental, mixed-methods study of a 2-year pilot. We used semi-structured interviews to assess the characteristics of program-targeting strategies, and calculated target and engagement rates from clinical encounter data. Five physician organizations (POs) with 51 participating practices implemented care management. Health plan member lists were sent monthly to the practices to accept patients, and then the practices sent back data reports regarding targeting and engagement in care management. Among patients accepted by the POs, we compared those who were targeted and engaged by POs with those who met health plan targeting criteria. The health plan's targeting process combined claims algorithms and employer group preferences to identify candidates for disease management; on the other hand, several different factors influenced PO practices' targeting approaches, including clinical and personal knowledge of the patients, health assessment information, and availability of disease-relevant programs. Practices targeted a higher percentage of patients for care management than the health plan (38% vs 16%), where only 7% of these patients met the targeting criteria of both. Practices engaged a higher percentage of their targeted patients than the health plan (50% vs 13%). The health plan's claims-driven targeting approach and the clinically based strategies of practices both provide advantages; an optimal model may be to combine the strengths of each approach to maximize benefits in care management.

  16. Primary Care Providers' experiences with Pharmaceutical Care-based Medication Therapy Management Services

    Directory of Open Access Journals (Sweden)

    Heather L. Maracle

    2012-01-01

    Full Text Available This study explored primary care providers' (PCPs experiences with the practice of pharmaceutical care-based medication therapy management (MTM. Qualitative, semi-structured interviews were conducted with six PCPs who have experiences working with MTM pharmacists for at least three years. The first author conducted the interviews that were audio-taped, transcribed, and coded independently. The codes were then harmonized via discussion and consensus with the other authors. Data were analyzed for themes using the hermeneutic-phenomenological method as proposed by Max van Manen. Three men and three women were interviewed. On average, the interviewees have worked with MTM pharmacists for seven years. The six (6 themes uncovered from the interviews included: (1 "MTM is just part of our team approach to the practice of medicine": MTM as an integral part of PCPs' practices; (2 "Frankly it's education for the patient but it's also education for me": MTM services as a source of education; (3 "It's not exactly just the pharmacist that passes out the medicines at the pharmacy": The MTM practitioner is different from the dispensing pharmacist; (4 "So, less reactive, cleaning up the mess, and more proactive and catching things before they become so involved": MTM services as preventative health care efforts; (5"I think that time is the big thing": MTM pharmacists spend more time with patients; (6 "There's an access piece, there's an availability piece, there's a finance piece": MTM services are underutilized at the clinics. In conclusion, PCPs value having MTM pharmacists as part of their team in ambulatory clinics. MTM pharmacists are considered an important source of education to patients as well as to providers as they are seen as having a unique body of knowledge äóñmedication expertise. All PCPs highly treasure the time and education provided by the MTM pharmacists, their ability to manage and adjust patients' medications, and their capability to

  17. Resource-level QoS metric for CPU-based guarantees in cloud providers

    OpenAIRE

    Goiri Presa, Íñigo; Julià Massó, Ferran; Fitó, Josep Oriol; Macías Lloret, Mario; Guitart Fernández, Jordi

    2010-01-01

    Success of Cloud computing requires that both customers and providers can be confident that signed Service Level Agreements (SLA) are supporting their respective business activities to their best extent. Currently used SLAs fail in providing such confidence, especially when providers outsource resources to other providers. These resource providers typically support very simple metrics, or metrics that hinder an efficient exploitation of their resources. In this paper, we propose a re...

  18. Health Promoting Schools Provide Community-Based Learning Opportunities Conducive to Careers in Rural Practice

    Directory of Open Access Journals (Sweden)

    Andrew Macnab

    2011-01-01

    Full Text Available The World Health Organization conceived “health-promoting schools” as a means of providing the information and support systems necessary for the worldwide changes in behavior that are needed to improve health globally and decrease health care costs. We developed and evaluated a model of progressively implementing health-promoting schools with support from university medical school trainees in Canada and Uganda. The model uses oral health as a medium for establishing rapport and success around a topic with little stigma. The evaluation involved questionnaires of the Canadian trainees about practice intentions before and after involvement in the health-promoting schools to determine whether community-based learning in health-promoting schools resulted in more trainees planning to work in rural areas or underserved countries. We found that Canadian medical trainees cited their personal involvement and perceived ability to effect significant and identifiable positive change in both the school children and the community as reasons why they were more willing to practice in rural or under-served areas.

  19. Simulation of the spatial stresses due to territorial land development on Yellow River Delta Nature Reserve using a GIS-based assessment model.

    Science.gov (United States)

    Zhang, Baolei; Zhang, Qiaoyun; Feng, Qingyu; Cui, Bohao; Zhang, Shumin

    2017-07-01

    This study aimed at assessing the stresses from land development in or around Yellow River Delta Nature Reserve (YRDNR) and identifying the impacted areas. Major land development types (reservoirs, pond, aquafarm, salt pan, road, residential land, industry land, farming land, and fishing land) in or around the YRDNR from 1995 to 2014 were identified using spatial data sets derived from remote sensing imageries. The spatial stresses were simulated by considering disturbance due to land development activities and accessibility of disturbance using a geographic information system based model. The stresses were then used to identify the impacted area by land development (IALD). The results indicated that main increasing land development types in the study area from 1995 to 2014 were salt pan and construction land. The 98.2% of expanded land development area and 93.7% of increased pump number showed a good control of reserve function zone on land development spread. The spatial stress values and percentages of IALD increased from 1995 to 2014, and IALD percentage exceeded 50% for both parts of YRDNR in 2014. The results of this study also provided the information that detailed planning of the YRDNR (2014-2020) could decrease the spatial stress and IALD percentage of the whole YRDNR on the condition that the area of land development activities increased by 24.4 km 2 from 2014 to 2020. Effective measures should be taken to protect such areas from being further disturbed in order to achieve the goal of a more effective conservation of the YRDNR, and attention should be paid to the disordered land development activities in or around the natural reserves.

  20. Poverty and corruption compromise tropical forest reserves.

    Science.gov (United States)

    Wright, S Joseph; Sanchez-Azofeifa, G Arturo; Portillo-Quintero, Carlos; Davies, Diane

    2007-07-01

    We used the global fire detection record provided by the satellite-based Moderate Resolution Imaging Spectroradiometer (MODIS) to determine the number of fires detected inside 823 tropical and subtropical moist forest reserves and for contiguous buffer areas 5, 10, and 15 km wide. The ratio of fire detection densities (detections per square kilometer) inside reserves to their contiguous buffer areas provided an index of reserve effectiveness. Fire detection density was significantly lower inside reserves than in paired, contiguous buffer areas but varied by five orders of magnitude among reserves. The buffer: reserve detection ratio varied by up to four orders of magnitude among reserves within a single country, and median values varied by three orders of magnitude among countries. Reserves tended to be least effective at reducing fire frequency in many poorer countries and in countries beset by corruption. Countries with the most successful reserves include Costa Rica, Jamaica, Malaysia, and Taiwan and the Indonesian island of Java. Countries with the most problematic reserves include Cambodia, Guatemala, Paraguay, and Sierra Leone and the Indonesian portion of Borneo. We provide fire detection density for 3964 tropical and subtropical reserves and their buffer areas in the hope that these data will expedite further analyses that might lead to improved management of tropical reserves.

  1. [Gender based violence: knowledge and attitudes of health care providers in Nicaragua].

    Science.gov (United States)

    Rodríguez-Bolaños, Rosibel de los Angeles; Márquez-Serrano, Margarita; Kageyama-Escobar, María de la Luz

    2005-01-01

    To assess the knowledge and attitudes of health care personnel towards the identification and referral of gender-based violence victims (GBV). Also, to identify barriers to identification and referral of GBV, and to assess the levels of knowledge about Norms and Procedures for Intra-Family Violence Care by the health care personnel of the Nicaraguan's Minister of Health (MINSA, for its initials in Spanish). A cross-sectional study was conducted among healthcare professionals, including physicians, nurses and nursing technical aides (n=213), in 5 of the 17 Local Systems of Integral Attention (SILAIS) from the Integral Program of Attention for Women, Children and Adolescence (AIMNA) in the primary level of attention in MINSA, from April to June 2003. Attitude was measured with a Likert scale and an awareness index was created for intra-family violence care guidelines. The information was obtained using a self-administered instrument, based on the questionnaire of the study made among the personnel of the Mexican Institute for Social Security (IMSS, for its initials in Spanish), Morelos, Mexico. A logistic regression model was used to evaluate the association between attitude and several factors, as well as with the knowledge of care guidelines. In our population, 76.06% showed an attitude opposing GBV. In the multivariate analysis, the factors associated with opposition to GBV were: medical profession (OR 6.5, 95%CI 2.70-15.82), having a middle (OR 4.3, 95%CI 1.87-10.26) or high level (OR 3.3, 95%CI 1.03-10.75) of knowledge about intra-family violence guidelines and the closeness to relatives or friends who were victims of gender violence (OR 3.2, 95%CI 1.56-6.80). The lack of training on the subject (59.9%), fear of getting involved in legal issues (52.6%), and the concept that violence is a private affair and not a social one (50.7%), constituted the most important barriers to providing medical care. The health care personnel generally were observed to have high

  2. Systems and methods for providing power to a load based upon a control strategy

    Science.gov (United States)

    Perisic, Milun; Kajouke, Lateef A; Ransom, Ray M

    2013-12-24

    Systems and methods are provided for an electrical system. The electrical system includes a load, an interface configured to receive a voltage from a voltage source, and a controller configured to receive the voltage from the voltage source through the interface and to provide a voltage and current to the load. Wherein, when the controller is in a constant voltage mode, the controller provides a constant voltage to the load, when the controller is in a constant current mode, the controller provides a constant current to the load, and when the controller is in a constant power mode, the controller provides a constant power to the load.

  3. Access: A Directory of Contacts, Environmental Data Bases, and Scientific Infrastructure on 175 Biosphere Reserves in 32 Countries.

    Science.gov (United States)

    Department of State, Washington, DC. Bureau of Oceans and International Environmental and Scientific Affairs.

    Following the EuroMAB meeting in Strasbourg, France (September 1991) and on an initiative of the Man and the Biosphere National Committee of the United States, a decision was made to create a research network from information available in biosphere reserves in 30 European countries, Canada and the United States. This Directory of EuroMAB Biosphere…

  4. Opportunity-to-learn context-based tasks provided by mathematics textbooks

    NARCIS (Netherlands)

    Wijaya, Ariyadi; Van den Heuvel-Panhuizen, M.; Doorman, Michiel

    2015-01-01

    Based on the findings of an error analysis revealing that Indonesian ninth- and tenth-graders had difficulties in solving context-based tasks, we investigated the opportunity-to-learn offered by Indonesian textbooks for solving context-based mathematics tasks and the relation of this

  5. Opportunity-to-Learn Context-Based Tasks Provided by Mathematics Textbooks

    Science.gov (United States)

    Wijaya, Ariyadi; van den Heuvel-Panhuizen, Marja; Doorman, Michiel

    2015-01-01

    Based on the findings of an error analysis revealing that Indonesian ninth- and tenth-graders had difficulties in solving context-based tasks, we investigated the opportunity-to-learn offered by Indonesian textbooks for solving context-based mathematics tasks and the relation of this opportunity-to-learn to students' difficulties in solving these…

  6. Demand as frequency controlled reserve

    Energy Technology Data Exchange (ETDEWEB)

    Xu, Z.; Togeby, M.; OEstergaard, J.

    2008-09-15

    Using demand as frequency controlled reserve (DFR) is an emerging technology which allow demand to participate actively in maintaining the system operation without reducing the energy service delivered to the customer and without need of user interaction. The basic premise is that traditional frequency controlled reserves from power plants and interconnections with neighbouring systems can be costly, slow and not fulfil the need for future power grids with a high share of wind power and fewer central power plants, and an intention to perform flexible operation such as is landing. Electricity demands, on the other hand, have advantages as frequency reserve including fast activation speed, smooth linear activation, low expected costs, and well-dispersed in the distribution grid. The main challenge of DFR is new methods for monitoring the available capacity. This project has investigated the technology of using electricity demands for providing frequency reserve to power systems. Within the project the potential and economy of DFR compatible loads in Denmark has been investigated, control logic has been designed, power system impact has been investigated, potential business models has been evaluated and an implementation strategy has been suggested. The tasks and goals of the project have been successfully accomplished based on which the conclusion and future recommendation are made. This project has developed the DFR technology that enables electricity demands to autonomously disconnect or reconnect to the grid in response to system frequency variations. The developed DFR technology is proved to be a promising technology from several perspectives. Technically, using DFR is feasible to provide reserves and enhance power system frequency control, while fulfilling technical requirements such as linear activation (or reconnection) according to frequency (or time). Environmentally, the DFR technology is pollution free in contrast to traditional reserves from generation

  7. The GNSS-based component for the new Indonesian tsunami early warning centre provided by GITEWS

    Science.gov (United States)

    Falck, C.; Ramatschi, M.; Bartsch, M.; Merx, A.; Hoeberechts, J.; Rothacher, M.

    2009-04-01

    Introduction Nowadays GNSS technologies are used for a large variety of precise positioning applications. The accuracy can reach the mm level depending on the data analysis methods. GNSS technologies thus offer a high potential to support tsunami early warning systems, e.g., by detection of ground motions due to earthquakes and of tsunami waves on the ocean by GNSS instruments on a buoy. Although GNSS-based precise positioning is a standard method, it is not yet common to apply this technique under tight time constraints and, hence, in the absence of precise satellite orbits and clocks. The new developed GNSS-based component utilises on- and offshore measured GNSS data and is the first system of its kind that was integrated into an operational early warning system. (Indonesian Tsunami Early Warning Centre INATEWS, inaugurated at BMKG, Jakarta on November, 11th 2008) Motivation After the Tsunami event of 26th December 2004 the German government initiated the GITEWS project (German Indonesian Tsunami Early Warning System) to develop a tsunami early warning system for Indonesia. The GFZ Potsdam (German Research Centre for Geosciences) as the consortial leader of GITEWS also covers several work packages, most of them related to sensor systems. The geodetic branch (Department 1) of the GFZ was assigned to develop a GNSS-based component. Brief system description The system covers all aspects from sensor stations with new developed hard- and software designs, manufacturing and installation of stations, real-time data transfer issues, a new developed automatic near real-time data processing and a graphical user interface for early warning centre operators including training on the system. GNSS sensors are installed on buoys, at tide gauges and as real-time reference stations (RTR stations), either stand-alone or co-located with seismic sensors. The GNSS data are transmitted to the warning centre where they are processed in a near real-time data processing chain. For

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

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2013-06-01

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

  9. Improved Prevention Counseling by HIV Care Providers in a Multisite, Clinic-Based Intervention: Positive STEPs

    Science.gov (United States)

    Thrun, Mark; Cook, Paul F.; Bradley-Springer, Lucy A.; Gardner, Lytt; Marks, Gary; Wright, Julie; Wilson, Tracey E.; Quinlivan, E. Byrd; O'Daniels, Christine; Raffanti, Stephen; Thompson, Melanie; Golin, Carol

    2009-01-01

    The Centers for Disease Control and Prevention have recommended that HIV care clinics incorporate prevention into clinical practice. This report summarizes HIV care providers' attitudes and counseling practices before and after they received training to deliver a counseling intervention to patients. Providers at seven HIV clinics received training…

  10. Health organizations providing and seeking social support: a Twitter-based content analysis.

    Science.gov (United States)

    Rui, Jian Raymond; Chen, Yixin; Damiano, Amanda

    2013-09-01

    Providing and seeking social support are important aspects of social exchange. New communication technologies, especially social network sites (SNSs), facilitate the process of support exchange. An increasing number of health organizations are using SNSs. However, how they provide and seek social support via SNSs has yet to garner academic attention. This study examined the types of social support provided and sought by health organizations on Twitter. A content analysis was conducted on 1,500 tweets sent by a random sample of 58 health organizations within 2 months. Findings indicate that providing informational and emotional support, as well as seeking instrumental support, were the main types of social support exchanged by health organizations through Twitter. This study provides a typology for studying social support exchanges by health organizations, and recommends strategies for health organizations regarding the effective use of Twitter.

  11. COGNITIVE RESERVE IN AGING

    Science.gov (United States)

    Tucker, Adrienne M.; Stern, Yaakov

    2011-01-01

    Cognitive reserve explains why those with higher IQ, education, occupational attainment, or participation in leisure activities evidence less severe clinical or cognitive changes in the presence of age-related or Alzheimer’s disease pathology. Specifically, the cognitive reserve hypothesis is that individual differences in how tasks are processed provide reserve against brain pathology. Cognitive reserve may allow for more flexible strategy usage, an ability thought to be captured by executive functions tasks. Additionally, cognitive reserve allows individuals greater neural efficiency, greater neural capacity, and the ability for compensation via the recruitment of additional brain regions. Taking cognitive reserve into account may allow for earlier detection and better characterization of age-related cognitive changes and Alzheimer’s disease. Importantly, cognitive reserve is not fixed but continues to evolve across the lifespan. Thus, even late-stage interventions hold promise to boost cognitive reserve and thus reduce the prevalence of Alzheimer’s disease and other age-related problems. PMID:21222591

  12. Relationship of Evidence-Based Practice and Treatments: A Survey of Community Mental Health Providers

    Science.gov (United States)

    DiMeo, Michelle A.; Moore, G. Kurt; Lichtenstein, Carolyn

    2012-01-01

    Evidence-based treatments (EBTs) are "interventions" that have been proven effective through rigorous research methodologies. Evidence-based practice (EBP), however, refers to a "decision-making process" that integrates the best available research, clinician expertise, and client characteristics. This study examined community mental health service…

  13. Providing Feedback on Computer-Based Algebra Homework in Middle-School Classrooms

    Science.gov (United States)

    Fyfe, Emily R.

    2016-01-01

    Homework is transforming at a rapid rate with continuous advances in educational technology. Computer-based homework, in particular, is gaining popularity across a range of schools, with little empirical evidence on how to optimize student learning. The current aim was to test the effects of different types of feedback on computer-based homework.…

  14. Exploring mental health providers' interest in using web and mobile-based tools in their practices

    Directory of Open Access Journals (Sweden)

    Stephen M. Schueller

    2016-05-01

    Full Text Available A growing number of Internet sites and mobile applications are being developed intended for use in clinical practice. However, during the development process (e.g., creating features and determining use cases, the needs and interests of providers are often overlooked. We explored providers' interests using a mixed-methods approach incorporating both qualitative and quantitative research methods. A first study used an interview approach to identify the challenges providers faced, tools they used, and any use of computers and apps specifically. Fifteen providers from both the United States and Canada completed the interview and recordings were transcribed and analyzed using a constructivist grounded theory approach. Four primary themes were identified including challenges, potential tools, access and usability. A second study used a brief survey completed by 132 providers at a large healthcare system to explore current use of and potential interest in Internet and mobile technologies. Although many providers (80.9% reported recommending some form of technology to patients, these were mostly Internet websites that were predominantly informational/psychoeducational in nature. Overall, these studies combine to suggest a strong interest in websites and apps for use in clinical settings while highlighting potential areas (ease of use, patient security and privacy that should be considered in the design and deployment of these tools.

  15. Are Healthcare Providers Asking about Environmental Exposures? A Community-Based Mixed Methods Study

    Directory of Open Access Journals (Sweden)

    Kristina M. Zierold

    2015-01-01

    Full Text Available People living near environmental hazards may develop symptoms and health conditions that require specialized monitoring and treatment by healthcare providers. One emerging environmental hazard is coal ash. Coal ash is comprised of small particles containing heavy metals, polycyclic aromatic hydrocarbons, and radioactive elements. The overall purpose of this study was to explore whether healthcare providers ask patients if they live near an environmental hazard like coal ash storage sites and to assess what health conditions prompt a provider inquiry. Focus groups were conducted in 2012 and a cross-sectional survey was administered in 2013. Overall, 61% of survey respondents reported that their healthcare providers never asked if they lived near an environmental hazard. One focus group member stated “No, they don’t ask that. They just always blame stuff on you….” Respondents with asthma and other lung conditions were significantly more likely to be asked by a healthcare provider if they lived near an environmental hazard. Due to the unique exposures from environmental hazards and the low prevalence of patients being asked about environmental hazards, we recommend that healthcare providers take environmental health histories in order to understand patients’ exposures, to monitor symptoms of exposure, and to assist with education about reducing exposure.

  16. Reasons for computerised provider order entry (CPOE)-based inpatient medication ordering errors: an observational study of voided orders.

    Science.gov (United States)

    Abraham, Joanna; Kannampallil, Thomas G; Jarman, Alan; Sharma, Shivy; Rash, Christine; Schiff, Gordon; Galanter, William

    2017-07-11

    Medication voiding is a computerised provider order entry (CPOE)-based discontinuation mechanism that allows clinicians to identify erroneous medication orders. We investigated the accuracy of voiding as an indicator of clinician identification and interception of a medication ordering error, and investigated reasons and root contributors for medication ordering errors. Using voided orders identified with a void alert, we conducted interviews with ordering and voiding clinicians, followed by patient chart reviews. A structured coding framework was used to qualitatively analyse the reasons for medication ordering errors. We also compared clinician-CPOE-selected (at time of voiding), clinician-reported (interview) and chart review-based reasons for voiding. We conducted follow-up interviews on 101 voided orders. The positive predictive value (PPV) of voided orders that were medication ordering errors was 93.1% (95% CI 88.1% to 98.1%, n=94). Using chart review-based reasons as the gold standard, we found that clinician-CPOE-selected reasons were less reflective (PPV=70.2%, 95% CI 61.0% to 79.4%) than clinician-reported (interview) (PPV=86.1%, 95%CI 78.2% to 94.1%) reasons for medication ordering errors. Duplicate (n=44) and improperly composed (n=41) ordering errors were common, often caused by predefined order sets and data entry issues. A striking finding was the use of intentional violations as a mechanism to notify and seek ordering assistance from pharmacy service. Nearly half of the medication ordering errors were voided by pharmacists. We demonstrated that voided orders effectively captured medication ordering errors. The mismatch between clinician-CPOE-selected and the chart review-based reasons for error emphasises the need for developing standardised operational descriptions for medication ordering errors. Such standardisation can help in accurately identifying, tracking, managing and sharing erroneous orders and their root contributors between healthcare

  17. Provider and Patient Determinants of Generic Levothyroxine Prescribing: An Electronic Health Records-Based Study.

    Science.gov (United States)

    Romanelli, Robert J; Nimbal, Vani; Dutcher, Sarah K; Pu, Xia; Segal, Jodi B

    2017-08-01

    Despite the availability of generic levothyroxine products for more than a decade, uptake of these products is poor. We sought to evaluate determinants of generic prescribing of levothyroxine. In a cross-sectional analysis of electronic health records data between 2010 and 2013, we identified adult patients with a levothyroxine prescription from a primary-care physician (PCP) or endocrinologist. We used mixed-effect logistic regression models with random intercepts for prescribing provider to examine predictors of generic levothyroxine prescribing. Models include patient, prescription, and provider fixed-effect covariates. Odds ratios (ORs) and 95% CIs were generated. Between-provider random variation was quantified by the intraclass correlation coefficient (ICC). Study patients (n = 63 838) were clustered among 941 prescribing providers within 25 ambulatory care clinics. The overall prevalence of generic prescribing of levothyroxine was 73%. In the multivariable mixed-effect model, patients were significantly less likely to receive generic levothyroxine from an endocrinologist than a PCP (OR = 0.43; 95% CI = 0.33-0.55; P levothyroxine than men from endocrinologists (OR = 0.68; 95% CI = 0.59-0.78; P levothyroxine prescribing differed by PCPs and endocrinologists. Residual variation in generic prescribing, after accounting for measurable factors, indicates the need for provider interventions or patient education aimed at improving levothyroxine generic uptake.

  18. TIME-BASED COMPETITION IN THE SUPPLY-CHAIN: THE ROLE OF THE LOGISTICS SERVICE PROVIDERS

    Directory of Open Access Journals (Sweden)

    Judit OLÁH

    2018-05-01

    Full Text Available Among the service industries, the analysis logistics as an academic field which has a great influence on firms’ creation of value and competitiveness, and within this the analysis of firms providing logistics services (3PLP, has become more relevant than in previous years. Among the expectations of logistics service providers, and among the sources of competitive advantage, are timeliness and flexibility, which can only be handled and measured together, because of the integration of services. At the same time, when supply chains (not corporations compete with each other, we must create the opportunity to manage chains beyond company boundaries. Our aim is to investigate the time-related problems of supply chains (and sections and logistics service providers, and their consequences and solutions. We have found that the development of time factors which appear and can be measured in the realization of logistics services contributes to the competitiveness of a logistics service company. The performance provided by companies that are integrated into the supply chain’s member companies and operate as flexible logistics service providers can have a significant impact on the (full operation and efficiency of the supply chain.

  19. Team-based education in a palliative approach for rural nurses and unlicensed care providers.

    Science.gov (United States)

    Potter, Gail; Pesut, Barbara; Hooper, Brenda Pherne; Erbacker, Lynnelle

    2015-06-01

    This article describes the preparation and delivery of an educational intervention designed to improve rural nurses and unlicensed care providers' confidence in a palliative approach to care. A palliative approach takes the principles of supportive palliative care and adapts them for application earlier in nonspecialized palliative contexts for individuals living with life-limiting chronic illness. Curriculum in a palliative approach was constructed for nurses and unlicensed care providers (care aides and home health workers) and was delivered through a workshop and monthly follow-up sessions offered through distance technology. Participants valued the joint interactive education and came away with greater appreciation for one another's contributions to care. Insights were gained into common challenges when attempting to apply a palliative approach in rural areas. Important lessons were learned about educating nurses and unlicensed care providers together, about the use of technology for this group, and about teaching the concept of a palliative approach. Copyright 2015, SLACK Incorporated.

  20. Development of skills-based competencies for forensic nurse examiners providing elder abuse care

    Science.gov (United States)

    Du Mont, Janice; Kosa, Daisy; Macdonald, Sheila; Elliot, Shannon; Yaffe, Mark

    2016-01-01

    Objective As a critical step in advancing a comprehensive response to elder abuse built on existing forensic nursing-led hospital-based programmes, we developed a list of skills-based competencies for use in an Elder Abuse Nurse Examiner curriculum. Participants and setting Programme leaders of 30 hospital-based forensic nursing-led sexual assault and domestic violence treatment centres. Primary and secondary outcome measures 149 verbatim recommendations for components of an elder abuse response were identified from a systematic scoping review. In 2 online Delphi consensus survey rounds, these components of care were evaluated by an expert panel for their overall importance to the elder abuse intervention under development and for their appropriateness to the scope of practice of an elder abuse nurse examiner. The components retained after evaluation were translated into skills-based competencies using Bloom's Taxonomy of Learning and, using the Nominal Group Technique, were subsequently reviewed and revised by a subset of members of the expert panel in a consensus meeting. Results Of the 148 recommendations evaluated, 119 were rated as important and achieved consensus or high level of agreement. Of these, 101 were determined to be within the scope of practice of an Elder Abuse Nurse Examiner and were translated into skills-based competencies. Following review and revision by meeting experts, 47 final competencies were organised by content into 5 metacompetencies: documentation, legal and legislative issues; interview with older adult, caregiver and other relevant contacts; assessment; medical and forensic examination; and case summary, discharge plan and follow-up care. Conclusions We determined the skills-based competencies of importance to training forensic nurse examiners to respond to elder abuse in the context of a hospital-based intervention. These findings may have implications for violence and abuse treatment programmes with a forensic nursing component

  1. A Policy-based System for Handoffs between Intermediary Content Providers in the Wireless Internet

    NARCIS (Netherlands)

    Kamilova, M.; Hesselman, C.E.W.; Widya, I.A.; Huizer, E.

    We consider the distribution of real-time multimedia content (e.g., radio or TV broadcasts) through multiple aggregators. An aggregator is an intermediary content provider that operates a pool of proxy servers to aggregate content from sources and forward it to mobile hosts. Aggregators package

  2. Providing the full DDF link protection for bus-connected SIEPON based system architecture

    Science.gov (United States)

    Hwang, I.-Shyan; Pakpahan, Andrew Fernando; Liem, Andrew Tanny; Nikoukar, AliAkbar

    2016-09-01

    Currently a massive amount of traffic per second is delivered through EPON systems, one of the prominent access network technologies for delivering the next generation network. Therefore, it is vital to keep the EPON optical distribution network (ODN) working by providing the necessity protection mechanism in the deployed devices; otherwise, when failures occur it will cause a great loss for both network operators and business customers. In this paper, we propose a bus-connected architecture to protect and recover distribution drop fiber (DDF) link faults or transceiver failures at ONU(s) in SIEPON system. The proposed architecture provides a cost-effective architecture, which delivers the high fault-tolerance in handling multiple DDF faults, while also providing flexibility in choosing the backup ONU assignments. Simulation results show that the proposed architecture provides the reliability and maintains quality of service (QoS) performance in terms of mean packet delay, system throughput, packet loss and EF jitter when DDF link failures occur.

  3. Grandparents Providing Care to Grandchildren: A Population-Based Study of Continuity and Change

    Science.gov (United States)

    Luo, Ye; LaPierre, Tracey A.; Hughes, Mary Elizabeth; Waite, Linda J.

    2012-01-01

    This study examines transitions in grandchild care and the characteristics of grandparents making these transitions, using longitudinal data from a nationally representative sample of 13,626 grandparents in the 1998-2008 Health and Retirement Study. More than 60% of grandparents provided grandchild care over the 10-year period; more than 70% of…

  4. Make Time to Talk: Language Building Tips for Center-Based Child Care Providers

    Science.gov (United States)

    National Institute for Literacy, 2010

    2010-01-01

    Everyone knows that it's important to talk every day with each child, using the kind of talk that builds language and thinking skills. The phrase MAKE TIME TO TALK is to help child care providers remember things they can do when talking to children to help them learn new vocabulary and how to use language to express their ideas and needs, and that…

  5. Notices about method of appreciation of productivity of fungal fruit-bodies based on observations in Las Piwnicki Natyre Reserve

    Directory of Open Access Journals (Sweden)

    Irena Hołownia

    2014-11-01

    Full Text Available The productivity of fungal fruit-bodies (Agaricales and Gasteromycetes obtained on the basis of observations performed in 1972 on two 1 hectare areas of the reservation. On each of these areas 40 test plots 5 square meters each were marked (1 X 5 m. The productivity was 185 650 fruit-bodies/ha/year and had a biomass off 22.15 kg dry weight in the association Pino-Quercetum and 108 950/ha year with a biomass of equal to 7.5 kg dry weight in the association Tilio-Carpinetum typicum. The observations were performed twice a month from April till November, but the production in the montMs August-November was over 90°/0 of the total production in both associations.

  6. The Efficacy of an American Indian Culturally-Based Risk Prevention Program for Upper Elementary School Youth Residing on the Northern Plains Reservations.

    Science.gov (United States)

    Usera, John J

    2017-04-01

    Culturally-based risk behavior prevention programs for American Indian elementary school children are sparse. Thus a group of American Indian educators collaborated in the creation of a program that helps children make healthy decisions based on their cultural and traditional value system. In this paper the effectiveness of Lakota Circles of Hope (LCH), an elementary school culturally-based prevention program was studied and evaluated. Three cohorts of fourth and fifth graders participated in a mixed methods quasi-experimental evaluative research design that included focus groups and surveys prior to and following the intervention. Five research questions regarding the program's impact on students' self-esteem and self-efficacy, Lakota identity, communication, conflict resolution and risk behaviors were addressed in this study. Participants were compared to non-participants in three American Indian reservation school sites. Educators completed a survey to record their observations and feedback regarding the implementation of the program within their respective school sites. The study provides preliminary evidence that, when delivered with fidelity, LCH contributes to statistically significant changes in risk behaviors, Lakota identity, respect for others, and adult and parent communication. A two-way multivariate analysis of variance with post hoc analysis of data collected from the LCH participants (N = 1392) were used to substantiate a significant increase in respect for others and a decrease in risk behaviors which included alcohol, tobacco, and substance use at the 0.10 alpha level. Significant positive improvements in parent and adult communication and an increased Lakota identity at the 0.01 alpha level were obtained. There were no significant differences in self-esteem and conflict resolution from pre to post intervention and in comparison with non LCH participating students.

  7. Efficacy of Web-Based Instruction to Provide Training on Federal Motor Carrier Safety Regulations

    Science.gov (United States)

    2011-05-01

    This report presents an evaluation of the current state-of-the-art Web-based instruction (WBI), reviews the current computer platforms of potential users of WBI, reviews the current status of WBI applications for Federal Motor Carrier Safety Administ...

  8. Web-Based Time Entry Systems: Providing Greater Automation and Compliance

    Science.gov (United States)

    Williams, Tracy

    2005-01-01

    Time and resources are becoming increasingly scarce in most higher education institutions today. As a result, colleges and universities are looking to streamline and simplify many costly, labor-intensive administrative processes. In this article, Tracy Williams examines how Web-based time-entry systems can help institutions save valuable time and…

  9. ELLIPS: providing web-based language learning for Higher Education in the Netherlands

    NARCIS (Netherlands)

    Corda, A.; Jager, S.

    2004-01-01

    This paper presents the overall considerations and pedagogical approach which were at the basis of the development of an innovative web-based CALL application, Ellips (Electronic Language Learning Interactive Practising System). It describes the program’s most salient features, illustrating in

  10. Integration of an OWL-DL knowledge base with an EHR prototype and providing customized information.

    Science.gov (United States)

    Jing, Xia; Kay, Stephen; Marley, Tom; Hardiker, Nicholas R

    2014-09-01

    When clinicians use electronic health record (EHR) systems, their ability to obtain general knowledge is often an important contribution to their ability to make more informed decisions. In this paper we describe a method by which an external, formal representation of clinical and molecular genetic knowledge can be integrated into an EHR such that customized knowledge can be delivered to clinicians in a context-appropriate manner.Web Ontology Language-Description Logic (OWL-DL) is a formal knowledge representation language that is widely used for creating, organizing and managing biomedical knowledge through the use of explicit definitions, consistent structure and a computer-processable format, particularly in biomedical fields. In this paper we describe: 1) integration of an OWL-DL knowledge base with a standards-based EHR prototype, 2) presentation of customized information from the knowledge base via the EHR interface, and 3) lessons learned via the process. The integration was achieved through a combination of manual and automatic methods. Our method has advantages for scaling up to and maintaining knowledge bases of any size, with the goal of assisting clinicians and other EHR users in making better informed health care decisions.

  11. Fragment-based screening in tandem with phenotypic screening provides novel antiparasitic hits

    NARCIS (Netherlands)

    Blaazer, Antoni R; Orrling, Kristina M; Shanmugham, Anitha; Jansen, Chimed; Maes, Louis; Edink, Ewald; Sterk, Geert Jan; Siderius, Marco; England, Paul; Bailey, David; de Esch, Iwan J P; Leurs, Rob

    Methods to discover biologically active small molecules include target-based and phenotypic screening approaches. One of the main difficulties in drug discovery is elucidating and exploiting the relationship between drug activity at the protein target and disease modification, a phenotypic endpoint.

  12. Agent-based organizational modelling for analysis of safety culture at an air navigation service provider

    NARCIS (Netherlands)

    Stroeve, S.; Sharpanskykh, O.; Kirwan, B.

    2011-01-01

    Assessment of safety culture is done predominantly by questionnaire-based studies, which tend to reveal attitudes on immaterial characteristics (values, beliefs, norms). There is a need for a better understanding of the implications of the material aspects of an organization (structures, processes,

  13. [Hospital-based psychological first aid provided to patients injured in the Lushan earthquake].

    Science.gov (United States)

    Yin, Min; Li, Xiao-Lin; Li, Jing; Huang, Xue-Hua; Tao, Qing-Lan; Luo, Xi

    2015-04-01

    In the aftermath of the 7.0 earthquake that struck Lushan in China's Sichuan Province on April 20, 2013, a psychological crisis intervention working group was established in a hospital that was treating earthquake victims. Patients at this hospital received psychological first aid that was delivered in accordance with scientific, systematic, and standardized principles. This first aid employed a "rooting mode" methodology and was designed as a supportive psychological intervention. Mental assessment results showed that the general mental health, acute stress reactions, and anxiety and depression status of all of the 131 injured who received the psychological intervention had significantly improved (p first aid, the approach used to organize the working groups, the main contents of the intervention, specific methods used, and intervention outcomes. This information is provided as a reference for providing localized psychological assistance in the aftermath of a disaster incident.

  14. Health Promoting Schools Provide Community-Based Learning Opportunities Conducive to Careers in Rural Practice

    OpenAIRE

    Macnab, Andrew; Kasangaki, Arabat; Gagnon, Faith

    2011-01-01

    The World Health Organization conceived “health-promoting schools” as a means of providing the information and support systems necessary for the worldwide changes in behavior that are needed to improve health globally and decrease health care costs. We developed and evaluated a model of progressively implementing health-promoting schools with support from university medical school trainees in Canada and Uganda. The model uses oral health as a medium for establishing rapport and success around...

  15. Dementia incidence and mortality in middle-income countries, and associations with indicators of cognitive reserve: a 10/66 Dementia Research Group population-based cohort study.

    Science.gov (United States)

    Prince, Martin; Acosta, Daisy; Ferri, Cleusa P; Guerra, Mariella; Huang, Yueqin; Llibre Rodriguez, Juan J; Salas, Aquiles; Sosa, Ana Luisa; Williams, Joseph D; Dewey, Michael E; Acosta, Isaac; Jotheeswaran, Amuthavalli T; Liu, Zhaorui

    2012-07-07

    Results of the few cohort studies from countries with low incomes or middle incomes suggest a lower incidence of dementia than in high-income countries. We assessed incidence of dementia according to criteria from the 10/66 Dementia Research Group and Diagnostic and Statistical Manual of Mental Disorders (DSM) IV, the effect of dementia at baseline on mortality, and the independent effects of age, sex, socioeconomic position, and indicators of cognitive reserve. We did a population-based cohort study of all people aged 65 years and older living in urban sites in Cuba, the Dominican Republic, and Venezuela, and rural and urban sites in Peru, Mexico, and China, with ascertainment of incident 10/66 and DSM-IV dementia 3-5 years after cohort inception. We used questionnaires to obtain information about age in years, sex, educational level, literacy, occupational attainment, and number of household assets. We obtained information about mortality from all sites. For participants who had died, we interviewed a friend or relative to ascertain the likelihood that they had dementia before death. 12,887 participants were interviewed at baseline. 11,718 were free of dementia, of whom 8137 (69%) were reinterviewed, contributing 34,718 person-years of follow-up. Incidence for 10/66 dementia varied between 18·2 and 30·4 per 1000 person-years, and were 1·4-2·7 times higher than were those for DSM-IV dementia (9·9-15·7 per 1000 person-years). Mortality hazards were 1·56-5·69 times higher in individuals with dementia at baseline than in those who were dementia-free. Informant reports suggested a high incidence of dementia before death; overall incidence might be 4-19% higher if these data were included. 10/66 dementia incidence was independently associated with increased age (HR 1·67; 95% CI 1·56-1·79), female sex (0·72; 0·61-0·84), and low education (0·89; 0·81-0·97), but not with occupational attainment (1·04; 0·95-1·13). Our results provide supportive evidence

  16. SUIKERBOSRAND NATURE RESERVE

    African Journals Online (AJOL)

    Suikerbosrand Nature Reserve and fts educational facilities are run by the Transvaal. Division of. Nature Conservation. ... tion and the education facilities provided. The former are utilized mainly by the general public ... artist Paul Bosman (already reviewed in the EEASA newsletter). The co-founders of the Foundation are.

  17. Deep machine learning provides state-of-the-art performance in image-based plant phenotyping.

    Science.gov (United States)

    Pound, Michael P; Atkinson, Jonathan A; Townsend, Alexandra J; Wilson, Michael H; Griffiths, Marcus; Jackson, Aaron S; Bulat, Adrian; Tzimiropoulos, Georgios; Wells, Darren M; Murchie, Erik H; Pridmore, Tony P; French, Andrew P

    2017-10-01

    In plant phenotyping, it has become important to be able to measure many features on large image sets in order to aid genetic discovery. The size of the datasets, now often captured robotically, often precludes manual inspection, hence the motivation for finding a fully automated approach. Deep learning is an emerging field that promises unparalleled results on many data analysis problems. Building on artificial neural networks, deep approaches have many more hidden layers in the network, and hence have greater discriminative and predictive power. We demonstrate the use of such approaches as part of a plant phenotyping pipeline. We show the success offered by such techniques when applied to the challenging problem of image-based plant phenotyping and demonstrate state-of-the-art results (>97% accuracy) for root and shoot feature identification and localization. We use fully automated trait identification using deep learning to identify quantitative trait loci in root architecture datasets. The majority (12 out of 14) of manually identified quantitative trait loci were also discovered using our automated approach based on deep learning detection to locate plant features. We have shown deep learning-based phenotyping to have very good detection and localization accuracy in validation and testing image sets. We have shown that such features can be used to derive meaningful biological traits, which in turn can be used in quantitative trait loci discovery pipelines. This process can be completely automated. We predict a paradigm shift in image-based phenotyping bought about by such deep learning approaches, given sufficient training sets. © The Authors 2017. Published by Oxford University Press.

  18. Deep machine learning provides state-of-the-art performance in image-based plant phenotyping

    Science.gov (United States)

    Pound, Michael P.; Atkinson, Jonathan A.; Townsend, Alexandra J.; Wilson, Michael H.; Griffiths, Marcus; Jackson, Aaron S.; Bulat, Adrian; Tzimiropoulos, Georgios; Wells, Darren M.; Murchie, Erik H.; Pridmore, Tony P.

    2017-01-01

    Abstract In plant phenotyping, it has become important to be able to measure many features on large image sets in order to aid genetic discovery. The size of the datasets, now often captured robotically, often precludes manual inspection, hence the motivation for finding a fully automated approach. Deep learning is an emerging field that promises unparalleled results on many data analysis problems. Building on artificial neural networks, deep approaches have many more hidden layers in the network, and hence have greater discriminative and predictive power. We demonstrate the use of such approaches as part of a plant phenotyping pipeline. We show the success offered by such techniques when applied to the challenging problem of image-based plant phenotyping and demonstrate state-of-the-art results (>97% accuracy) for root and shoot feature identification and localization. We use fully automated trait identification using deep learning to identify quantitative trait loci in root architecture datasets. The majority (12 out of 14) of manually identified quantitative trait loci were also discovered using our automated approach based on deep learning detection to locate plant features. We have shown deep learning–based phenotyping to have very good detection and localization accuracy in validation and testing image sets. We have shown that such features can be used to derive meaningful biological traits, which in turn can be used in quantitative trait loci discovery pipelines. This process can be completely automated. We predict a paradigm shift in image-based phenotyping bought about by such deep learning approaches, given sufficient training sets. PMID:29020747

  19. A Fuzzy Logic-Based Quality Function Deployment for Selection of E-Learning Provider

    Science.gov (United States)

    Kazancoglu, Yigit; Aksoy, Murat

    2011-01-01

    According to the Internet World Stats (2010), the growth rate of internet usage in the world is 444.8 % from 2000 to 2010. Since the number of internet users is rapidly increasing with each passed year, e-learning is often identified with web-based learning. The institutions, which deliver e-learning service via the use of computer and internet,…

  20. Rectal cancer: An evidence-based update for primary care providers

    Science.gov (United States)

    Gaertner, Wolfgang B; Kwaan, Mary R; Madoff, Robert D; Melton, Genevieve B

    2015-01-01

    Rectal adenocarcinoma is an important cause of cancer-related deaths worldwide, and key anatomic differences between the rectum and the colon have significant implications for management of rectal cancer. Many advances have been made in the diagnosis and management of rectal cancer. These include clinical staging with imaging studies such as endorectal ultrasound and pelvic magnetic resonance imaging, operative approaches such as transanal endoscopic microsurgery and laparoscopic and robotic assisted proctectomy, as well as refined neoadjuvant and adjuvant therapies. For stage II and III rectal cancers, combined chemoradiotherapy offers the lowest rates of local and distant relapse, and is delivered neoadjuvantly to improve tolerability and optimize surgical outcomes, particularly when sphincter-sparing surgery is an endpoint. The goal in rectal cancer treatment is to optimize disease-free and overall survival while minimizing the risk of local recurrence and toxicity from both radiation and systemic therapy. Optimal patient outcomes depend on multidisciplinary involvement for tailored therapy. The successful management of rectal cancer requires a multidisciplinary approach, with the involvement of enterostomal nurses, gastroenterologists, medical and radiation oncologists, radiologists, pathologists and surgeons. The identification of patients who are candidates for combined modality treatment is particularly useful to optimize outcomes. This article provides an overview of the diagnosis, staging and multimodal therapy of patients with rectal cancer for primary care providers. PMID:26167068

  1. Hybrid Imaging Labels: Providing the Link Between Mass Spectrometry-Based Molecular Pathology and Theranostics

    Science.gov (United States)

    Buckle, Tessa; van der Wal, Steffen; van Malderen, Stijn J.M.; Müller, Larissa; Kuil, Joeri; van Unen, Vincent; Peters, Ruud J.B.; van Bemmel, Margaretha E.M.; McDonnell, Liam A.; Velders, Aldrik H.; Koning, Frits; Vanhaeke, Frank; van Leeuwen, Fijs W. B.

    2017-01-01

    Background: Development of theranostic concepts that include inductively coupled plasma mass spectrometry (ICP-MS) and laser ablation ICP-MS (LA-ICP-MS) imaging can be hindered by the lack of a direct comparison to more standardly used methods for in vitro and in vivo evaluation; e.g. fluorescence or nuclear medicine. In this study a bimodal (or rather, hybrid) tracer that contains both a fluorescent dye and a chelate was used to evaluate the existence of a direct link between mass spectrometry (MS) and in vitro and in vivo molecular imaging findings using fluorescence and radioisotopes. At the same time, the hybrid label was used to determine whether the use of a single isotope label would allow for MS-based diagnostics. Methods: A hybrid label that contained both a DTPA chelate (that was coordinated with either 165Ho or 111In) and a Cy5 fluorescent dye was coupled to the chemokine receptor 4 (CXCR4) targeting peptide Ac-TZ14011 (hybrid-Cy5-Ac-TZ4011). This receptor targeting tracer was used to 1) validate the efficacy of (165Ho-based) mass-cytometry in determining the receptor affinity via comparison with fluorescence-based flow cytometry (Cy5), 2) evaluate the microscopic binding pattern of the tracer in tumor cells using both fluorescence confocal imaging (Cy5) and LA-ICP-MS-imaging (165Ho), 3) compare in vivo biodistribution patterns obtained with ICP-MS (165Ho) and radiodetection (111In) after intravenous administration of hybrid-Cy5-Ac-TZ4011 in tumor-bearing mice. Finally, LA-ICP-MS-imaging (165Ho) was linked to fluorescence-based analysis of excised tissue samples (Cy5). Results: Analysis with both mass-cytometry and flow cytometry revealed a similar receptor affinity, respectively 352 ± 141 nM and 245 ± 65 nM (p = 0.08), but with a much lower detection sensitivity for the first modality. In vitro LA-ICP-MS imaging (165Ho) enabled clear discrimination between CXCR4 positive and negative cells, but fluorescence microscopy was required to determine the

  2. Contributions of separate reactions to the acid-base buffering of soils in brook floodplains (Central Forest State Reserve)

    Science.gov (United States)

    Sokolova, T. A.; Tolpeshta, I. I.; Rusakova, E. S.

    2016-04-01

    The acid-base buffering of gleyic gray-humus soils developed in brook floodplains and undisturbed southern-taiga landscapes has been characterized by the continuous potentiometric titration of soil water suspensions. During the interaction with an acid, the major amount of protons (>80%) is consumed for the displacement of exchangeable bases and the dissolution of Ca oxalates. In the O and AY horizons, Mn compounds make the major contribution (2-15%) to the acid buffering. The buffer reactions with the participation of Al compounds make up from 0.5 to 1-2% of the total buffering capacity, and the protonation of the surface OH groups of kaolinite consumes 2-3% of the total buffering capacity. The deprotonation of OH groups on the surface of Fe hydroxides (9-43%), the deprotonation of OH groups on the surface of illite crystals (3-19%), and the dissolution of unidentified aluminosilicates (9-14%) are the most significant buffer reactions whose contributions have been quantified during the interaction with a base. The contribution of the deprotonation of OH groups on the surface of kaolinite particles is lower (1-5%) because of the small specific surface area of this mineral, and that of the dissolution of Fe compounds is insignificant. In the AY horizon, the acid and base buffering of soil in the rhizosphere is higher than beyond the rhizosphere because of the higher contents of organic matter and nonsilicate Fe and Al compounds.

  3. Stationing a U.S. Army Reserve Black Hawk Helicopter Company at Joint Forces Training Base Los Alamitos, California

    Science.gov (United States)

    2011-03-01

    sacred sites as defined by EO 13007, to which access is provided under the American Indian Religious Freedom Act (AIRFA), significant paleontological...National Guard 2005-2009, there are no archaeological or sacred sites located on JFTB Los Alamitos (CAARNG, 2004). Neither Building 912 nor ECS 16 are...cracks to the canopy , and other damage to aircraft components. Damaging strikes have the potential to result in loss of life to aircrew, cost millions of

  4. Characterization of Patient Interest in Provider-Based Consumer Health Information Technology: Survey Study.

    Science.gov (United States)

    Featherall, Joseph; Lapin, Brittany; Chaitoff, Alexander; Havele, Sonia A; Thompson, Nicolas; Katzan, Irene

    2018-04-19

    Consumer health information technology can improve patient engagement in their health care and assist in navigating the complexities of health care delivery. However, the consumer health information technology offerings of health systems are often driven by provider rather than patient perspectives and inadequately address patient needs, thus limiting their adoption by patients. Consideration given to patients as stakeholders in the development of such technologies may improve adoption, efficacy, and consumer health information technology resource allocation. The aims of this paper were to measure patient interest in different health system consumer health information technology apps and determine the influence of patient characteristics on consumer health information technology interest. Patients seen at the Cleveland Clinic Neurological Institute were electronically surveyed on their interest in using different consumer health information technology apps. A self-efficacy scale, Patient Health Questionnaire-9 depression screen, and EuroQol 5 dimensions health-related quality of life scale were also completed by patients. Logistic regression was used to determine the influence of patient characteristics on interest in consumer health information technology in the categories of self-management, education, and communication. The majority of 3852 patient respondents had an interest in all technology categories assessed in the survey. The highest interest was in apps that allow patients to ask questions of providers (3476/3852, 90.24%) and to schedule appointments (3211/3839, 83.64%). Patient interest in consumer health information technology was significantly associated with greater depression symptoms, worse quality of life, greater health self-efficacy, and smartphone ownership (Pinformation technology development and their perspectives should consistently guide development efforts. Health systems should consider focusing on consumer health information technologies

  5. Alamos: An International Collaboration to Provide a Space Based Environmental Monitoring Solution for the Deep Space Network

    Science.gov (United States)

    Kennedy, S. O.; Dunn, A.; Lecomte, J.; Buchheim, K.; Johansson, E.; Berger, T.

    2018-02-01

    This abstract proposes the advantages of an externally mounted instrument in support of the human physiology, space biology, and human health and performance key science area. Alamos provides Space-Based Environmental Monitoring capabilities.

  6. Using Model-Based System Engineering to Provide Artifacts for NASA Project Life-Cycle and Technical Reviews Presentation

    Science.gov (United States)

    Parrott, Edith L.; Weiland, Karen J.

    2017-01-01

    This is the presentation for the AIAA Space conference in September 2017. It highlights key information from Using Model-Based Systems Engineering to Provide Artifacts for NASA Project Life-cycle and Technical Reviews paper.

  7. Closed loop stimulation and accelerometer-based rate adaptation: results of the PROVIDE study.

    Science.gov (United States)

    Coenen, Martin; Malinowski, Klaus; Spitzer, Wilhelm; Schuchert, Andreas; Schmitz, Dietmar; Anelli-Monti, Michael; Maier, Sebastian K G; Estlinbaum, Werner; Bauer, Alexander; Muehling, Holger; Kalscheur, Franz; Puerner, Klaus; Boergel, Jan; Osswald, Stefan

    2008-03-01

    We compared pacing rate adaptation based on closed loop stimulation (CLS) or accelerometer sensor (AS) during acute mental and physical stress in the same patient. One month after Protos (Biotronik, Germany) pacemaker implantation, 131 chronotropically incompetent patients were randomized to AS or CLS for 3 months with crossover. Arithmetic and 6 min walk tests were performed in the non-rate-adaptive mode and AS and CLS rate-adaptive modes, respectively. At the end, patients had to select the individually preferred pacemaker sensor. Heart rate during mental stress was higher (3.0 +/- 9.2 bpm) in the CLS than in the AS mode (P = 0.004). Benefit in the walking distance compared with non-rate-adaptive pacing was similar for the two modes: added 27 +/- 96 m (AS, P = 0.013) and 30 +/- 116 m (CLS, P = 0.025). At the end of the walk, heart rate was higher by 4.8 +/- 21.4 bpm in AS than in CLS (P = 0.049). Twice as many patients preferred CLS over AS (P < 0.01). The arithmetic test was associated with a significantly higher heart rate for CLS than for AS, showing a greater sensitivity of CLS-based rate adaptation to mental stress. Performance during physical stress was comparable. Patients preferred CLS.

  8. Global quantitative indices reflecting provider process-of-care: data-base derivation

    Directory of Open Access Journals (Sweden)

    Solomon Patricia J

    2010-04-01

    Full Text Available Abstract Background Controversy has attended the relationship between risk-adjusted mortality and process-of-care. There would be advantage in the establishment, at the data-base level, of global quantitative indices subsuming the diversity of process-of-care. Methods A retrospective, cohort study of patients identified in the Australian and New Zealand Intensive Care Society Adult Patient Database, 1993-2003, at the level of geographic and ICU-level descriptors (n = 35, for both hospital survivors and non-survivors. Process-of-care indices were established by analysis of: (i the smoothed time-hazard curve of individual patient discharge and determined by pharmaco-kinetic methods as area under the hazard-curve (AUC, reflecting the integrated experience of the discharge process, and time-to-peak-hazard (TMAX, in days, reflecting the time to maximum rate of hospital discharge; and (ii individual patient ability to optimize output (as length-of-stay for recorded data-base physiological inputs; estimated as a technical production-efficiency (TE, scaled [0,(maximum1], via the econometric technique of stochastic frontier analysis. For each descriptor, multivariate correlation-relationships between indices and summed mortality probability were determined. Results The data-set consisted of 223129 patients from 99 ICUs with mean (SD age and APACHE III score of 59.2(18.9 years and 52.7(30.6 respectively; 41.7% were female and 45.7% were mechanically ventilated within the first 24 hours post-admission. For survivors, AUC was maximal in rural and for-profit ICUs, whereas TMAX (≥ 7.8 days and TE (≥ 0.74 were maximal in tertiary-ICUs. For non-survivors, AUC was maximal in tertiary-ICUs, but TMAX (≥ 4.2 days and TE (≥ 0.69 were maximal in for-profit ICUs. Across descriptors, significant differences in indices were demonstrated (analysis-of-variance, P ≤ 0.0001. Total explained variance, for survivors (0.89 and non-survivors (0.89, was maximized by

  9. Epidemiology of asthma in Poland in urban and rural areas, based on provided health care services.

    Science.gov (United States)

    Śliwczyński, Andrzej; Brzozowska, Melania; Iltchew, Petre; Czeleko, Tomasz; Kucharczyk, Aleksandra; Jędrzejczyk, Tadeusz; Jahnz-Różyk, Karina; Marczak, Michał

    2015-01-01

    Asthma is a serious health and social problem, also in Poland. The epidemiological data indicate that the problem of asthma concerns approximately 4 million people in Poland, whereas almost approximately 70% of them have no diagnosis and are not aware of their illness, and on the other hand in 39% of persons who declared the diagnosis of asthma in a survey the diagnosis was negatively verified (overdiagnosis of asthma). So far, no detailed comparative studies for asthma incidence rate in urban and rural areas were conducted in Poland. The aim of the study was to analyze patients with asthma in Poland in the years 2008-2012, with regard to province and type of commune (rural/urban). The study used data from National Health Fund (NFZ) - reported by health care providers regarding the patients diagnosed with asthma. Using structured query language (SQL) a set of patients was selected and created, for whom at the same time ICD-10 code: J45.X-bronchial asthma was reported. In order to estimate the number of patients with asthma we used the PESEL social security number as a unique identifier of the patient. Code of the patient's commune of residence in conjunction with the Central Statistical Office data formed the basis for the division of municipalities into urban and rural areas. The analysis of asthma incidence trends in Poland was performed on the basis of health services provided to patients. The analysis was performed by using the Statistica 10 software using a negative binomial regression model. In 2009 a significant increase in the number of patients with asthma was observed compared with the previous year, whereas after 2009 the number of patients diagnosed with asthma remained relatively constant. A significant increase of predominance of women among asthma patients in recent years can be noticed: from 107% in 2008 to almost 115% in 2012 (F:M ratio). Regardless of the analyzed year and the diagnosis the incidence rate remained constant: approximately 55

  10. Space-Based Sensor Web for Earth Science Applications: An Integrated Architecture for Providing Societal Benefits

    Science.gov (United States)

    Habib, Shahid; Talabac, Stephen J.

    2004-01-01

    There is a significant interest in the Earth Science research and user remote sensing community to substantially increase the number of useful observations relative to the current frequency of collection. The obvious reason for such a push is to improve the temporal, spectral, and spatial coverage of the area(s) under investigation. However, there is little analysis available in terms of the benefits, costs and the optimal set of sensors needed to make the necessary observations. Classic observing system solutions may no longer be applicable because of their point design philosophy. Instead, a new intelligent data collection system paradigm employing both reactive and proactive measurement strategies with adaptability to the dynamics of the phenomena should be developed. This is a complex problem that should be carefully studied and balanced across various boundaries including: science, modeling, applications, and technology. Modeling plays a crucial role in making useful predictions about naturally occurring or human-induced phenomena In particular, modeling can serve to mitigate the potentially deleterious impacts a phenomenon may have on human life, property, and the economy. This is especially significant when one is interested in learning about the dynamics of, for example, the spread of forest fires, regional to large-scale air quality issues, the spread of the harmful invasive species, or the atmospheric transport of volcanic plumes and ash. This paper identifies and examines these challenging issues and presents architectural alternatives for an integrated sensor web to provide observing scenarios driving the requisite dynamic spatial, spectral, and temporal characteristics to address these key application areas. A special emphasis is placed on the observing systems and its operational aspects in serving the multiple users and stakeholders in providing societal benefits. We also address how such systems will take advantage of technological advancement in

  11. Using Web-Based Technologies to Increase Evaluation Capacity in Organizations Providing Child and Youth Mental Health Services

    Science.gov (United States)

    Sundar, Purnima; Kasprzak, Susan; Halsall, Tanya; Woltman, Heather

    2010-01-01

    Given today's climate of economic uncertainty and fiscal restraint, organizations providing child and youth mental health services are required to do so with limited resources. Within this context, service providers face added pressure to deliver evidence-based programs and demonstrate program effectiveness. The Ontario Centre of Excellence for…

  12. Using e-Coaching to Support an Early Intervention Provider's Implementation of a Functional Assessment-Based Intervention

    Science.gov (United States)

    Fettig, Angel; Barton, Erin E.; Carter, Alice S.; Eisenhower, Abbey S.

    2016-01-01

    This study examined the effects of e-coaching on the implementation of a functional assessment-based intervention delivered by an early intervention provider in reducing challenging behaviors during home visits. A multiple baseline design across behavior support plan components was used with a provider-child dyad. The e-coaching intervention…

  13. A ferrite LTCC based dual purpose helical antenna providing bias for tunability

    KAUST Repository

    Ghaffar, Farhan A.

    2015-03-30

    Typically, magnetically tunable antennas utilize large external magnets or coils to provide the magneto-static bias. In this work, we present a novel concept of combining the antenna and the bias coil in one structure. A helical antenna has been optimized to act as the bias coil in a ten layer ferrite LTCC package, thus performing two functions. This not only reduces the overall size of the system by getting rid of the external bias source but also eliminates demagnetization effect (fields lost at air-to-substrate interface), which reduces the required magneto-static field strength and makes the design efficient. RF choking inductor and DC blocking capacitor have been monolithically integrated as package elements to allow the magnetostatic and microwave excitation at the same time. The design has been optimized for its low frequency and high frequency performance in two different simulators. A measured tuning range of 10% is achieved at a center frequency of 13 GHz. The design is highly suitable for low cost, compact, light-weight and tunable microwave systems. © 2002-2011 IEEE.

  14. PVC-based synthetic leather to provide more comfortable and sustainable vehicles

    Science.gov (United States)

    Maia, I.; Santos, J.; Abreu, MJ; Miranda, T.; Carneiro, N.; Soares, GMB

    2017-10-01

    Consumers are increasingly demanding the interior of cars to be comfortable even in the case of more economic commercial segments. Thus, the development of materials with thermoregulation properties has assumed renewed interest for these particular applications. An attempt has been made to prepare a multilayer PVC-based synthetic leather with paraffinic PCMs to be applied on a car seat. The thermal behaviour of the material was analysed using Alambeta apparatus, a thermo-camera and a thermal manikin. The results obtained show that the synthetic leather with incorporated PCMs gives cooler feeling and has higher reaction times regarding environmental temperature variations than the material without PCMs incorporation. Globally, the new designed material allowed greater thermal comfort to the cars´ inhabitants. In addition, the material quality was evaluated according to the standard of the customer, BMW 9,210,275; Edition / Version 4, 2010-10-01 revealing that the material meets all the requirements under test, except for the performance in terms of flexibility.

  15. Using Videoconferencing to Provide Mentorship in Inquiry-Based Urban and Rural Secondary Classrooms

    Directory of Open Access Journals (Sweden)

    Qing Li

    2010-07-01

    Full Text Available The main purpose of this design-based research study is to examine the effects of an inquiry-based learning environment, with the support of videoconferencing, on both rural and urban secondary students’ mathematics and science learning. An important aspect of this learning environment is the use of videoconferencing to connect classes with mathematicians/ scientists (as e-mentors. Specifically, the following two research questions guide this study: (1 In what ways, if any, does the inquiry-based learning environment impact student beliefs and learning outcomes? (2 What challenges emerge in the development of an inquiry-based learning environment with secondary students in both rural and urban schools? Using a mixed methods approach, this study focuses on two grade 9 classes in an urban school and three Grade 8 classes in a rural school. The results suggest positive effects of this learning environment on student learning of math and science. In particular, both urban and rural students showed significant gains in their achievement. In addition, students showed an increased interest and heightened confidence in math and science. As well, the results point to issues arising from the process, suggesting useful guidelines for the development of such environments. Résumé : L’objectif principal de cette étude de recherche axée sur la conception est d’examiner les effets d’un environnement d’apprentissage basé sur le processus d’enquête et utilisant le soutien de la vidéoconférence sur l’apprentissage des mathématiques et des sciences auprès d’élèves du secondaire en milieux ruraux et urbains. L’utilisation de la vidéoconférence pour mettre les classes en lien avec des mathématiciens et des scientifiques (en tant que cybermentors constitue un aspect important de cet environnement d’apprentissage. Plus précisément, les deux questions suivantes orientent la présente étude : (1 De quelle manière, le cas

  16. Postpartum Teenagers' Views on Providing Contraception in School-Based Health Clinics.

    Science.gov (United States)

    Patel, Pooja R; Huynh, Michaela T; Alvarez, Crystal A; Jones, DaJonitta; Jennings, Kristofer; Snyder, Russell R

    2016-01-01

    To determine characteristics of teen pregnancies in southeast Texas and the opinions of postpartum teenagers with regard to having contraceptive services available in high school clinics. A cross-sectional study of postpartum teenagers interviewed during their hospital stay. Of 404 postpartum teenagers interviewed, 86% had unplanned pregnancies. Approximately 53% of respondents first had intercourse at less than 16 years of age. Of the 130 teenagers who had used contraception prior to pregnancy, 85% became pregnant because they were unable to visit the clinic to obtain a contraceptive refill or replacement. In multivariate modeling, factors associated with using contraceptives prior to pregnancy included black race (p teenagers surveyed, 223 (82%) were in favor of having contraceptive services offered in high school clinics. Contraceptive education is not sufficient to prevent teenage pregnancy. Increase in access is critical as teenagers with previous pregnancies were more likely to use contraception, likely due to their interaction with the medical community during the antecedent pregnancy. One possible solution is to bring contraceptive services to the teenagers, by offering them at school based health systems. A majority of teenagers surveyed in this study supported this proposal.

  17. A nonintegrative lentiviral vector-based vaccine provides long-term sterile protection against malaria.

    Directory of Open Access Journals (Sweden)

    Frédéric Coutant

    Full Text Available Trials testing the RTS,S candidate malaria vaccine and radiation-attenuated sporozoites (RAS have shown that protective immunity against malaria can be induced and that an effective vaccine is not out of reach. However, longer-term protection and higher protection rates are required to eradicate malaria from the endemic regions. It implies that there is still a need to explore new vaccine strategies. Lentiviral vectors are very potent at inducing strong immunological memory. However their integrative status challenges their safety profile. Eliminating the integration step obviates the risk of insertional oncogenesis. Providing they confer sterile immunity, nonintegrative lentiviral vectors (NILV hold promise as mass pediatric vaccine by meeting high safety standards. In this study, we have assessed the protective efficacy of NILV against malaria in a robust pre-clinical model. Mice were immunized with NILV encoding Plasmodium yoelii Circumsporozoite Protein (Py CSP and challenged with sporozoites one month later. In two independent protective efficacy studies, 50% (37.5-62.5 of the animals were fully protected (p = 0.0072 and p = 0.0008 respectively when compared to naive mice. The remaining mice with detectable parasitized red blood cells exhibited a prolonged patency and reduced parasitemia. Moreover, protection was long-lasting with 42.8% sterile protection six months after the last immunization (p = 0.0042. Post-challenge CD8+ T cells to CSP, in contrast to anti-CSP antibodies, were associated with protection (r = -0.6615 and p = 0.0004 between the frequency of IFN-g secreting specific T cells in spleen and parasitemia. However, while NILV and RAS immunizations elicited comparable immunity to CSP, only RAS conferred 100% of sterile protection. Given that a better protection can be anticipated from a multi-antigen vaccine and an optimized vector design, NILV appear as a promising malaria vaccine.

  18. Subdivisions of the adult zebrafish pallium based on molecular marker analysis [version 2; referees: 2 approved, 1 approved with reservations

    Directory of Open Access Journals (Sweden)

    Julia Ganz

    2015-11-01

    Full Text Available Background: The telencephalon shows a remarkable structural diversity among vertebrates. In particular, the everted telencephalon of ray-finned fishes has a markedly different morphology compared to the evaginated telencephalon of all other vertebrates. This difference in development has hampered the comparison between different areas of the pallium of ray-finned fishes and the pallial nuclei of all other vertebrates. Various models of homology between pallial subdivisions in ray-finned fishes and the pallial nuclei in tetrapods have been proposed based on connectional, neurochemical, gene expression and functional data. However, no consensus has been reached so far. In recent years, the analysis of conserved developmental marker genes has assisted the identification of homologies for different parts of the telencephalon among several tetrapod species. Results: We have investigated the gene expression pattern of conserved marker genes in the adult zebrafish (Danio rerio pallium to identify pallial subdivisions and their homology to pallial nuclei in tetrapods. Combinatorial expression analysis of ascl1a, eomesa, emx1, emx2, emx3, and Prox1 identifies four main divisions in the adult zebrafish pallium. Within these subdivisions, we propose that Dm is homologous to the pallial amygdala in tetrapods and that the dorsal subdivision of Dl is homologous to part of the hippocampal formation in mouse. We have complemented this analysis be examining the gene expression of emx1, emx2 and emx3 in the zebrafish larval brain. Conclusions: Based on our gene expression data, we propose a new model of subdivisions in the adult zebrafish pallium and their putative homologies to pallial nuclei in tetrapods. Pallial nuclei control sensory, motor, and cognitive functions, like memory, learning and emotion. The identification of pallial subdivisions in the adult zebrafish and their homologies to pallial nuclei in tetrapods will contribute to the use of the zebrafish

  19. Dementia incidence and mortality in middle-income countries, and associations with indicators of cognitive reserve: a 10/66 Dementia Research Group population-based cohort study

    Science.gov (United States)

    Prince, Martin; Acosta, Daisy; Ferri, Cleusa P; Guerra, Mariella; Huang, Yueqin; Rodriguez, Juan J Llibre; Salas, Aquiles; Sosa, Ana Luisa; Williams, Joseph D; Dewey, Michael E; Acosta, Isaac; Jotheeswaran, Amuthavalli T; Liu, Zhaorui

    2012-01-01

    Summary Background Results of the few cohort studies from countries with low incomes or middle incomes suggest a lower incidence of dementia than in high-income countries. We assessed incidence of dementia according to criteria from the 10/66 Dementia Research Group and Diagnostic and Statistical Manual of Mental Disorders (DSM) IV, the effect of dementia at baseline on mortality, and the independent effects of age, sex, socioeconomic position, and indicators of cognitive reserve. Methods We did a population-based cohort study of all people aged 65 years and older living in urban sites in Cuba, the Dominican Republic, and Venezuela, and rural and urban sites in Peru, Mexico, and China, with ascertainment of incident 10/66 and DSM-IV dementia 3–5 years after cohort inception. We used questionnaires to obtain information about age in years, sex, educational level, literacy, occupational attainment, and number of household assets. We obtained information about mortality from all sites. For participants who had died, we interviewed a friend or relative to ascertain the likelihood that they had dementia before death. Findings 12 887 participants were interviewed at baseline. 11 718 were free of dementia, of whom 8137 (69%) were reinterviewed, contributing 34 718 person-years of follow-up. Incidence for 10/66 dementia varied between 18·2 and 30·4 per 1000 person-years, and were 1·4–2·7 times higher than were those for DSM-IV dementia (9·9–15·7 per 1000 person-years). Mortality hazards were 1·56–5·69 times higher in individuals with dementia at baseline than in those who were dementia-free. Informant reports suggested a high incidence of dementia before death; overall incidence might be 4–19% higher if these data were included. 10/66 dementia incidence was independently associated with increased age (HR 1·67; 95% CI 1·56–1·79), female sex (0·72; 0·61–0·84), and low education (0·89; 0·81–0·97), but not with occupational attainment (1

  20. Appraisement and benchmarking of third-party logistic service provider by exploration of risk-based approach

    Directory of Open Access Journals (Sweden)

    Nitin Kumar Sahu

    2015-12-01

    Full Text Available In the present era, Reverse Logistics Support has monitored as a momentous realm, where stuffs are transferred from point of consumption to origin. The companies who provide the logistic equipments, i.e. Truck, Joseph Cyril Bomford, and Shipment, etc. to its partner’s firms called Third-Party Logistics (3PL service provider. Today, the feasible 3PL service provider evaluation-opt problem is yet an amorous dilemma. The appraisement and benchmarking of logistics service providers in extent of index; allied risk-based indices and their interrelated metrics; outlooked as a great tool for each international firm, in order that firm could obtain their core goals. The novelty of manuscript is that here, a hairy-based approach has been integrated and then implemented upon a novel developed multi hierarchical third-party logistics (3PL service providers appraisement index in purpose to umpire the 3PL provider for their strong and ill’s core indices. Moreover, the overall score (Si system has also been carried out for benchmarking the 3PL provider companies, where s1 has been found as the best 3PL service provider. The developed approach enabled the manager of firms to make the verdict towards the best inclusive evaluation process of 3PL performance appraisement and benchmarking. A numerical illustration has also been provided to validate the verdict support system.

  1. Gas and electricity providers. Offensive of alternate providers, launching of green offers, price-based conquest: which perspectives for the market and the competitive game by 2019?

    International Nuclear Information System (INIS)

    2017-02-01

    As the end of regulated tariffs for industries and local communities resulted in a total new deal on the electric power and gas providing market, notably with newcomers who decided to cut prices, this study aims at identifying actual perspectives for the power and gas markets by 2019, and actual levers of action for providers to gain market shares. After a synthesis and a proposal of some strategic conclusions, the report proposes an analysis of the activity and of its perspectives: determining factors, overview of the activity until 2016 (power and gas provisions in France, production and consumption prices for gas and for electric power, regulated tariffs), and provisional scenario by 2019 regarding electricity and gas provisions in France. A second part analyses the external environment through a discussion of external drivers and brakes, and an analysis of demand. The third part reports an analysis of the competitive landscape (market shares per strategic groups, in power providing and in gas providing, and switch rate between residential and non-residential customers). The last part addresses development axes and proposes a discussion of offensive conquest strategies, a discussion of actor positioning on green energies, a discussion of supply adaptation and targeting depending on customers with an analysis of three specific segments (mobility, data centres, and self-consumption), and a discussion of the diversification of services

  2. Fractional Reserve in Banking System

    OpenAIRE

    Valkonen, Maria

    2016-01-01

    This thesis is aimed to provide understanding of the role of the fractional reserve in the mod-ern banking system worldwide and particularly in Finland. The fractional reserve banking is used worldwide, but the benefits of this system are very disputable. On the one hand, experts say that the fractional reserve is a necessary instrument for the normal business and profit making. On the other hand, sceptics openly criticize the fractional reserve system and blame it for fiat money (money n...

  3. A framework of lessons learned from community-based marine reserves and its effectiveness in guiding a new coastal management initiative in the Philippines.

    Science.gov (United States)

    Beger, Maria; Harborne, Alastair R; Dacles, Terence P; Solandt, Jean-Luc; Ledesma, Gerardo L

    2004-12-01

    Community-based coastal resource management has been widely applied within the Philippines. However, small-scale community-based reserves are often inefficient owing to management inadequacies arising because of a lack of local support or enforcement or poor design. Because there are many potential pitfalls during the establishment of even small community-based reserves, it is important for coastal managers, communities, and facilitating institutions to have access to a summary of the key factors for success. Reviewing relevant literature, we present a framework of "lessons learned" during the establishment of protected areas, mainly in the Philippines. The framework contains summary guidance on the importance of (1) an island location, (2) small community population size, (3) minimal effect of land-based development, (4) application of a bottom-up approach, (5) an external facilitating institution, (6) acquisition of title, (7) use of a scientific information database, (8) stakeholder involvement, (9) the establishment of legislation, (10) community empowerment, (11) alternative livelihood schemes, (12) surveillance, (13) tangible management results, (14) continued involvement of external groups after reserve establishment, and (15) small-scale project expansion.These framework components guided the establishment of a community-based protected area at Danjugan Island, Negros Occidental, Philippines. This case study showed that the framework was a useful guide that led to establishing and implementing a community-based marine reserve. Evaluation of the reserve using standard criteria developed for the Philippines shows that the Danjugan Island protected area can be considered successful and sustainable. At Danjugan Island, all of the lessons synthesized in the framework were important and should be considered elsewhere, even for relatively small projects. As shown in previous projects in the Philippines, local involvement and stewardship of the protected area

  4. Training Providers in the Use of Evidence-Based Treatments: A Comparison of In-Person and Online Delivery Modes

    Science.gov (United States)

    Mallonee, Sybil; Phillips, Jennifer; Holloway, Kevin; Riggs, David

    2018-01-01

    Evidenced-based psychotherapies (EBPs) are primarily disseminated via in-person workshops, which have been shown to be effective in training clinicians. However, there is limited space at these workshops, they occur in limited locations, and the time and money required to travel to these workshops is limiting for many providers. An online virtual…

  5. Providing satellite-based early warnings of fires to reduce fire flashovers on South Africa’s transmission lines

    CSIR Research Space (South Africa)

    Frost, PE

    2007-07-01

    Full Text Available The Advanced Fire Information System (AFIS) is the first near real time operational satellite-based fire monitoring system of its kind in Africa. The main aim of AFIS is to provide information regarding the prediction, detection and assessment...

  6. Problem Based Learning: Does It Provide Appropriate Levels of Guidance and Flexibility for Use in Police Recruit Education?

    Science.gov (United States)

    Shipton, Brett

    2009-01-01

    Education programs for police recruits have often been criticised for their over-reliance on teacher-centred approaches that are less than ideal for promoting functional knowledge and critical thinking skills. Problem-Based Learning (PBL), which is suggested as an alternative, has been criticised for not providing novice learners with appropriate…

  7. An ethnographic investigation of healthcare providers' approaches to facilitating person-centredness in group-based diabetes education

    DEFF Research Database (Denmark)

    Stenov, Vibeke; Hempler, Nana Folmann; Reventlow, Susanne

    2017-01-01

    AIM: To investigate approaches among healthcare providers (HCPs) that support or hinder person-centredness in group-based diabetes education programmes targeting persons with type 2 diabetes. METHODS: Ethnographic fieldwork in a municipal and a hospital setting in Denmark. The two programmes incl...

  8. Network Physics - the only company to provide physics-based network management - secures additional funding and new executives

    CERN Multimedia

    2003-01-01

    "Network Physics, the only provider of physics-based network management products, today announced an additional venture round of $6 million in funding, as well as the addition of David Jones as president and CEO and Tom Dunn as vice president of sales and business development" (1 page).

  9. Nuclear, uranium, reserves, sustainability, independence; Nucleaire, Uranium, reserves, durabilite, independance

    Energy Technology Data Exchange (ETDEWEB)

    Acket, C

    2007-06-15

    In order to evaluate the energy independence concerning the nuclear energy, the author takes the state of the art about the uranium. He details the fuel needs, the reserves on the base of the today available techniques, the reserves on the base of the future techniques and concludes positively on the energy independence for the nuclear. (A.L.B.)

  10. An agent-based simulation model of patient choice of health care providers in accountable care organizations.

    Science.gov (United States)

    Alibrahim, Abdullah; Wu, Shinyi

    2018-03-01

    Accountable care organizations (ACO) in the United States show promise in controlling health care costs while preserving patients' choice of providers. Understanding the effects of patient choice is critical in novel payment and delivery models like ACO that depend on continuity of care and accountability. The financial, utilization, and behavioral implications associated with a patient's decision to forego local health care providers for more distant ones to access higher quality care remain unknown. To study this question, we used an agent-based simulation model of a health care market composed of providers able to form ACO serving patients and embedded it in a conditional logit decision model to examine patients capable of choosing their care providers. This simulation focuses on Medicare beneficiaries and their congestive heart failure (CHF) outcomes. We place the patient agents in an ACO delivery system model in which provider agents decide if they remain in an ACO and perform a quality improving CHF disease management intervention. Illustrative results show that allowing patients to choose their providers reduces the yearly payment per CHF patient by $320, reduces mortality rates by 0.12 percentage points and hospitalization rates by 0.44 percentage points, and marginally increases provider participation in ACO. This study demonstrates a model capable of quantifying the effects of patient choice in a theoretical ACO system and provides a potential tool for policymakers to understand implications of patient choice and assess potential policy controls.

  11. Management reference for nature reserve networks based on MaxEnt modeling and gap analysis: a case study of the brown–eared pheasant in China

    Energy Technology Data Exchange (ETDEWEB)

    Li, Y.; Cui, B.; Qiu, X.; Ding, C.; Batool, I.

    2016-07-01

    Nature reserve designs and networks are important for wildlife and habitat conservation. Gap analyses are efficient and reliable tools for prioritizing habitat conservation efforts, especially when considering endangered species. We propose a conservation plan for the brown–eared pheasant, Crossoptilon mantchuricum, by identifying protection gap areas based on 14 existing nature reserves. A total of 45 locality sites and 11 environmental variables were selected according to the characteristics of habitat use of the brown–eared pheasant and applied to a maximum entropy (MaxEnt) model to obtain the species distribution. The MaxEnt model results showed a high prediction accuracy. The gap analysis results revealed that the Luliang Mountains in Shanxi and the Xiaowutai Mountains in Hebei had protection gaps. We found 458 km2 of optimum habitat and 1,390 km2 of moderately suitable habitat within the national nature reserve range. However, almost 1,861 km2 of the optimum habitat and 17,035 km2 of the moderately suitable habitat were unprotected, equivalent to 9.0% and 82.1%, respectively, of the total suitable habitat. Most of the unprotected area comprised moderately suitable habitat for brown–eared pheasant and should be prioritized in future conservation efforts. There are nine nature reserves along a north–to–south range in the Luliang Mountains that form a wildlife habitat corridor. To maintain the integrity, originality, and continuity of these habitats and thus protect brown–eared pheasants, local conservation departments should be strengthened to improve provincial nature reserve management and successfully carry out conservation efforts. (Author)

  12. Management reference for nature reserve networks based on MaxEnt modeling and gap analysis: a case study of the brown–eared pheasant in China

    Directory of Open Access Journals (Sweden)

    Li, Y.

    2016-07-01

    Full Text Available Nature reserve designs and networks are important for wildlife and habitat conservation. Gap analyses are efficient and reliable tools for prioritizing habitat conservation efforts, especially when considering endangered species. We propose a conservation plan for the brown–eared pheasant, Crossoptilon mantchuricum, by identifying protection gap areas based on 14 existing nature reserves. A total of 45 locality sites and 11 environmental variables were selected according to the characteristics of habitat use of the brown–eared pheasant and applied to a maximum entropy (MaxEnt model to obtain the species distribution. The MaxEnt model results showed a high prediction accuracy. The gap analysis results revealed that the Luliang Mountains in Shanxi and the Xiaowutai Mountains in Hebei had protection gaps. We found 458 km2 of optimum habitat and 1,390 km2 of moderately suitable habitat within the national nature reserve range. However, almost 1,861 km2 of the optimum habitat and 17,035 km2 of the moderately suitable habitat were unprotected, equivalent to 9.0% and 82.1%, respectively, of the total suitable habitat. Most of the unprotected area comprised moderately suitable habitat for brown–eared pheasant and should be prioritized in future conservation efforts. There are nine nature reserves along a north–to–south range in the Luliang Mountains that form a wildlife habitat corridor. To maintain the integrity, originality, and continuity of these habitats and thus protect brown–eared pheasants, local conservation departments should be strengthened to improve provincial nature reserve management and successfully carry out conservation efforts.

  13. Fast Virtual Fractional Flow Reserve Based Upon Steady-State Computational Fluid Dynamics Analysis: Results From the VIRTU-Fast Study.

    Science.gov (United States)

    Morris, Paul D; Silva Soto, Daniel Alejandro; Feher, Jeroen F A; Rafiroiu, Dan; Lungu, Angela; Varma, Susheel; Lawford, Patricia V; Hose, D Rodney; Gunn, Julian P

    2017-08-01

    Fractional flow reserve (FFR)-guided percutaneous intervention is superior to standard assessment but remains underused. The authors have developed a novel "pseudotransient" analysis protocol for computing virtual fractional flow reserve (vFFR) based upon angiographic images and steady-state computational fluid dynamics. This protocol generates vFFR results in 189 s (cf >24 h for transient analysis) using a desktop PC, with fluid dynamics analysis. Sensitivity analysis demonstrated that physiological lesion significance was influenced less by coronary or lesion anatomy (33%) and more by microvascular physiology (59%). If coronary microvascular resistance can be estimated, vFFR can be accurately computed in less time than it takes to make invasive measurements.

  14. Study of the Effect of Time-Based Rate Demand Response Programs on Stochastic Day-Ahead Energy and Reserve Scheduling in Islanded Residential Microgrids

    DEFF Research Database (Denmark)

    Vahedipour-Dahraie, Mostafa; Najafi, Hamid Reza; Anvari-Moghaddam, Amjad

    2017-01-01

    In recent deregulated power systems, demand response (DR) has become one of the most cost-effective and efficient solutions for smoothing the load profile when the system is under stress. By participating in DR programs, customers are able to change their energy consumption habits in response...... to energy price changes and get incentives in return. In this paper, we study the effect of various time-based rate (TBR) programs on the stochastic day-ahead energy and reserve scheduling in residential islanded microgrids (MGs). An effective approach is presented to schedule both energy and reserve...... in presence of renewable energy resources (RESs) and electric vehicles (EVs). An economic model of responsive load is also proposed on the basis of elasticity factor to model the behavior of customers participating in various DR programs. A two-stage stochastic programming model is developed accordingly...

  15. Evidence-based practice beliefs and behaviors of nurses providing cancer pain management: a mixed-methods approach.

    Science.gov (United States)

    Eaton, Linda H; Meins, Alexa R; Mitchell, Pamela H; Voss, Joachim; Doorenbos, Ardith Z

    2015-03-01

    To describe evidence-based practice (EBP) beliefs and behaviors of nurses who provide cancer pain management. Descriptive, cross-sectional with a mixed-methods approach. Two inpatient oncology units in the Pacific Northwest. 40 RNs.
 Data collected by interviews and web-based surveys. EBP beliefs, EBP implementation, evidence-based pain management. Nurses agreed with the positive aspects of EBP and their implementation ability, although implementation level was low. They were satisfied with their pain management practices. Oncology nursing certification was associated with innovativeness, and innovativeness was associated with EBP beliefs. Themes identified were (a) limited definition of EBP, (b) varied evidence-based pain management decision making, (c) limited identification of evidence-based pain management practices, and (d) integration of nonpharmacologic interventions into patient care. Nurses' low level of EBP implementation in the context of pain management was explained by their trust that standards of care and medical orders were evidence-based. Nurses' EBP beliefs and behaviors should be considered when developing strategies for sustaining evidence-based pain management practices. Implementation of the EBP process by nurses may not be realistic in the inpatient setting; therefore, hospital pain management policies need to be evidence-based and reinforced with nurses.

  16. EXPENSES ANALYSIS BASED ON INFORMATION PROVIDED BY THE PROFIT AND LOSS ACCOUNT –COMPANY PERFORMANCE DIAGNOSIS STAGE

    Directory of Open Access Journals (Sweden)

    MARIA DANIELA BONDOC

    2013-10-01

    Full Text Available Expenses represent one component of the binomial that determines a company’s financial performance, the other component being the incomes. Diagnosing performance as part of the performance management has the purpose of providing managers with a feedback on previous actions and it acts as a basis for future decisions. Profit and loss account through its format, offers the possibility to analyze changes at expenses level and the evolution of their structure. This paper aims the analysis of the expenses of a dairy company based on information provided by the profit and loss account followed by the formulation of proposals and conclusions.

  17. Development of a Web-based educational intervention to improve cross-cultural communication among hospice providers.

    Science.gov (United States)

    Doorenbos, Ardith Z; Lindhorst, Taryn; Schim, Stephanie Myers; Van Schaik, Eileen; Demiris, George; Wechkin, Hope A; Curtis, J Randall

    2010-01-01

    In this article, the authors describe the theoretical foundation, development, and content of a Web-based educational intervention to improve cross-cultural communication about end-of-life concerns and report on the preliminary evaluation of this intervention using a qualitative study design. The data were collected with non-structured questions in a convenience sample of 21 hospice providers. Participants reported that they found the training appropriate and useful. Participants also reported finding the online delivery convenient and the interactive format valuable. Improving the quality of cross-cultural patient-provider communication can contribute to reducing disparities at end-of-life.

  18. Provider Training to Screen and Initiate Evidence-Based Pediatric Obesity Treatment in Routine Practice Settings: A Randomized Pilot Trial.

    Science.gov (United States)

    Kolko, Rachel P; Kass, Andrea E; Hayes, Jacqueline F; Levine, Michele D; Garbutt, Jane M; Proctor, Enola K; Wilfley, Denise E

    This randomized pilot trial evaluated two training modalities for first-line, evidence-based pediatric obesity services (screening and goal setting) among nursing students. Participants (N = 63) were randomized to live interactive training or Web-facilitated self-study training. Pretraining, post-training, and 1-month follow-up assessments evaluated training feasibility, acceptability, and impact (knowledge and skill via simulation). Moderator (previous experience) and predictor (content engagement) analyses were conducted. Nearly all participants (98%) completed assessments. Both types of training were acceptable, with higher ratings for live training and participants with previous experience (ps pediatric obesity services. Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

  19. The development and implementation of an inter-professional simulation based pediatric acute care curriculum for ward health care providers.

    Science.gov (United States)

    Kotsakis, Afrothite; Mercer, Karen; Mohseni-Bod, Hadi; Gaiteiro, Rose; Agbeko, Rachel

    2015-01-01

    An interprofessional, simulation based, acute care course for ward health care providers was developed and implemented with the objectives of teaching identification of deteriorating patients, practicing crisis resource management and basic life support skills, and using the SBAR (Situation Background Assessment Recommendation) communication tool. Thirty-eight physicians and 51 nurses attended the four separate courses. Nine questions on a 5-point Likert scale and two open-ended questions revealed that over 95% of respondents strongly agreed/agreed that facilitators encouraged active participation, lectures were presented in an interesting manner, and that simulations were useful for practical skills and for practicing communication. Open-ended questions revealed that participants felt more confident, understood the importance of communication, roles, teamwork and valued the day. Based on this evaluation, the program was regarded as feasible and acceptable to all health care providers.

  20. CONCEPTUAL BASES OF FORMING THE SYSTEM OF FINANCIAL AND ECONOMIC PROVIDING SOCIAL PROTECTION INVOLUNTARILY DISPLACED PERSONS WITH CLUSTER APPROACH

    Directory of Open Access Journals (Sweden)

    Svitlana Kropelnytska

    2017-08-01

    Full Text Available The article systematizes approaches to financial support and social adaptation of internally displaced persons (IDPs as well as their social protection, that is based on the analysis of legal framework, situation and sources of financial and social support to the EU member states of the IDPs in Ukraine and their social security. The study of the IDPs situation and the assessment of the required resources are based on a cluster approach, which defines optimal set of problem areas requiring priority social and financial support. This allowed to develop practical recommendations for the development of a comprehensive, transparent and unified policy of social protection through the development of a conceptual framework for the financial and economic provision of social protection IDPs, which will be the basic solution to the problems of social and financial provision forced migrants in Ukraine. Key words: forced migrants, internally displaced persons, cluster, social policy, social protection, social providing, financial providing.

  1. Health care providers and adolescents' perspectives towards adolescents' health education needs: a need assessment based on comparative approach.

    Science.gov (United States)

    Shahhosseini, Zohreh; Abedian, Kobra

    2015-02-01

    Health care providers have considerable influence on adolescents' health promotion. Thus, it is important to focus on the views of this group as one of the most reliable sources in the evaluation of teenagers' health needs. The aim of this study was to compare the attitudes of Iranian health care providers and adolescents towards the latter's health education needs. A quantitative cross-sectional survey, including 72 health care providers and 402 female students from 14 high schools in northern Iran, was carried out in 2011. Topics in a self-administrated questionnaire covered the participants' perspectives towards the educational health needs of adolescents in a five-point Likert scale. Findings revealed from health care providers' views indicate that the highest mean score was assigned to "Education about prevention of sexual high risk behavior", which was significantly different from adolescents' perspective (t=8.42, pcare providers and adolescents both emphasized on the mothers' role as the most reliable source of adolescents' education (t=1.85, p>0.05). Provision of health education programs for adolescents, which are based on integration of health care providers' perspectives and the adolescents' views, are essential in meeting adolescents' educational health needs.

  2. Provider-based research networks and diffusion of surgical technologies among patients with early-stage kidney cancer.

    Science.gov (United States)

    Tan, Hung-Jui; Meyer, Anne-Marie; Kuo, Tzy-Mey; Smith, Angela B; Wheeler, Stephanie B; Carpenter, William R; Nielsen, Matthew E

    2015-03-15

    Provider-based research networks such as the National Cancer Institute's Community Clinical Oncology Program (CCOP) have been shown to facilitate the translation of evidence-based cancer care into clinical practice. This study compared the utilization of laparoscopy and partial nephrectomy among patients with early-stage kidney cancer according to their exposure to CCOP-affiliated providers. With linked Surveillance, Epidemiology, and End Results-Medicare data, patients with T1aN0M0 kidney cancer who had been treated with nephrectomy from 2000 to 2007 were identified. For each patient, the receipt of care from a CCOP physician or hospital and treatment with laparoscopy or partial nephrectomy were determined. Adjusted for patient characteristics (eg, age, sex, and marital status) and other organizational features (eg, community hospital and National Cancer Institute-designated cancer center), multivariate logistic regression was used to estimate the association between each surgical innovation and CCOP affiliation. During the study interval, 1578 patients (26.8%) were treated by a provider with a CCOP affiliation. Trends in the utilization of laparoscopy and partial nephrectomy remained similar between affiliated and nonaffiliated providers (P ≥ .05). With adjustments for patient characteristics, organizational features, and clustering, no association was noted between CCOP affiliation and the use of laparoscopy (odds ratio [OR], 1.11; 95% confidence interval [CI], 0.81-1.53) or partial nephrectomy (OR, 1.04; 95% CI, 0.82-1.32) despite the more frequent receipt of these treatments in academic settings (P kidney cancer, indicating perhaps a more limited scope to provider-based research networks as they pertain to translational efforts in cancer care. © 2014 American Cancer Society.

  3. Impact of office-based intravenous deep sedation providers upon traditional sedation practices employed in pediatric dentistry.

    Science.gov (United States)

    Tarver, Michael; Guelmann, Marcio; Primosch, Robert

    2012-01-01

    This survey intended to determine how the implementation of office-based IV deep sedation by a third party provider (OIVSED) impacted the traditional sedation practices employed in pediatric dentistry private practice settings. A digital survey was e-mailed to 924 members of the American Academy of Pediatric Dentistry practicing in California, Florida, and New York, chosen because these states had large samples of practicing pediatric dentists in geographically disparate locations. 151 pediatric dentists using OIVSED responded to the survey. Improved efficiency, safety and quality of care provided, and increased parental acceptance were reported advantages of this service. Although less costly than hospital-based general anesthesia, the average fee for this service was a deterrent to some parents considering this option. Sixty-four percent of respondents continued to provide traditional sedation modalities, mostly oral sedation, in their offices, as parenteral routes taught in their training programs were less often selected. OIVSED users reported both a reduction in the use of traditional sedation modalities in their offices and use of hospital-based GA services in exchange for perceived improvements in efficiency, safety and quality of care delivered. Patient costs, in the absence of available health insurance coverage, inhibited accessing this service by some parents.

  4. Some administrative features for maintaining the material and technical base of medical centers providing transplant care to Russian citizens

    Directory of Open Access Journals (Sweden)

    I. I. Antoshina

    2017-01-01

    Full Text Available In this article, the authors defined the procedure for maintaining the material and technical base of medical centers providing high-tech assistance (especially, transplant care to Russian citizens. The current regulatory and methodological base determining the procedure for repairs of fixed assets is evaluated, the main issues of capital repair planning in budgetary medical centers providing high-tech medical care are considered. The innovations introduced at the present time into the legislation determining the procedure for capital repairs are defined; the applicable concepts and scope of regulation are disclosed; the procedure for the implementation of major repairs in accordance with the current regulations is considered; the key issues that make it difficult to start capital repairs of the premises in budgetary medical centers providing high-tech medical care to Russian citizens are identified. Administrative and financial discipline while ensuring the working conditions of the material and technical base has been strengthened. Considerable attention should be paid to the medium-term planning of works, preparation of technical documentation, and procurement of funds for preparatory works. Whereas it is necessary to coordinate such decisions with the Ministry of Healthcare of Russia and other governmental institutions in Russia the timing of the implementation of such projects has significantly increased.

  5. Implementation of a Family Planning Clinic-Based Partner Violence and Reproductive Coercion Intervention: Provider and Patient Perspectives.

    Science.gov (United States)

    Miller, Elizabeth; McCauley, Heather L; Decker, Michele R; Levenson, Rebecca; Zelazny, Sarah; Jones, Kelley A; Anderson, Heather; Silverman, Jay G

    2017-06-01

    Despite multiple calls for clinic-based services to identify and support women victimized by partner violence, screening remains uncommon in family planning clinics. Furthermore, traditional screening, based on disclosure of violence, may miss women who fear reporting their experiences. Strategies that are sensitive to the signs, symptoms and impact of trauma require exploration. In 2011, as part of a cluster randomized controlled trial, staff at 11 Pennsylvania family planning clinics were trained to offer a trauma-informed intervention addressing intimate partner violence and reproductive coercion to all women seeking care, regardless of exposure to violence. The intervention sought to educate women about available resources and harm reduction strategies. In 2013, at the conclusion of the trial, 18 providers, five administrators and 49 patients completed semistructured interviews exploring acceptability of the intervention and barriers to implementation. Consensus and open coding strategies were used to analyze the data. Providers reported that the intervention increased their confidence in discussing intimate partner violence and reproductive coercion. They noted that asking patients to share the educational information with other women facilitated the conversation. Barriers to implementation included lack of time and not having routine reminders to offer the intervention. Patients described how receiving the intervention gave them important information, made them feel supported and less isolated, and empowered them to help others. A universal intervention may be acceptable to providers and patients. However, successful implementation in family planning settings may require attention to system-level factors that providers view as barriers. Copyright © 2017 by the Guttmacher Institute.

  6. Providing Doctors With High-Quality Information: An Updated Evaluation of Web-Based Point-of-Care Information Summaries.

    Science.gov (United States)

    Kwag, Koren Hyogene; González-Lorenzo, Marien; Banzi, Rita; Bonovas, Stefanos; Moja, Lorenzo

    2016-01-19

    The complexity of modern practice requires health professionals to be active information-seekers. Our aim was to review the quality and progress of point-of-care information summaries-Web-based medical compendia that are specifically designed to deliver pre-digested, rapidly accessible, comprehensive, and periodically updated information to health care providers. We aimed to evaluate product claims of being evidence-based. We updated our previous evaluations by searching Medline, Google, librarian association websites, and conference proceedings from August 2012 to December 2014. We included Web-based, regularly updated point-of-care information summaries with claims of being evidence-based. We extracted data on the general characteristics and content presentation of products, and we quantitatively assessed their breadth of disease coverage, editorial quality, and evidence-based methodology. We assessed potential relationships between these dimensions and compared them with our 2008 assessment. We screened 58 products; 26 met our inclusion criteria. Nearly a quarter (6/26, 23%) were newly identified in 2014. We accessed and analyzed 23 products for content presentation and quantitative dimensions. Most summaries were developed by major publishers in the United States and the United Kingdom; no products derived from low- and middle-income countries. The main target audience remained physicians, although nurses and physiotherapists were increasingly represented. Best Practice, Dynamed, and UptoDate scored the highest across all dimensions. The majority of products did not excel across all dimensions: we found only a moderate positive correlation between editorial quality and evidence-based methodology (r=.41, P=.0496). However, all dimensions improved from 2008: editorial quality (P=.01), evidence-based methodology (P=.015), and volume of diseases and medical conditions (PUptoDate scored the highest across all dimensions, while others that were marketed as evidence-based

  7. Instantaneous Wave-Free Ratio versus Fractional Flow Reserve guided intervention (iFR-SWEDEHEART): Rationale and design of a multicenter, prospective, registry-based randomized clinical trial.

    Science.gov (United States)

    Götberg, Matthias; Christiansen, Evald H; Gudmundsdottir, Ingibjörg; Sandhall, Lennart; Omerovic, Elmir; James, Stefan K; Erlinge, David; Fröbert, Ole

    2015-11-01

    Instantaneous wave-free ratio (iFR) is a new hemodynamic resting index for assessment of coronary artery stenosis severity. iFR uses high frequency sampling to calculate a gradient across a coronary lesion during a period of diastole. The index has been tested against fractional flow reserve (FFR) and found to have an overall classification agreement of 80% to 85%. Whether the level of disagreement is clinically relevant is unknown. Clinical outcome data on iFR are scarce. This study is a registry-based randomized clinical trial, which is a novel strategy using health quality registries as on-line platforms for randomization, case record forms, and follow-up. iFR-SWEDEHEART is a multicenter, prospective, randomized, controlled, clinical open-label clinical trial. Two thousand patients with stable angina or acute coronary syndrome and an indication for physiology-guided assessment of one or more coronary stenoses will be randomized 1:1 to either iFR- or FFR-guided intervention. The randomization will be conducted online in the Swedish web-based system for enhancement and development of evidence-based care in heart disease evaluated according to recommended therapies (SWEDEHEART) registry. The trial has a non-inferiority design, with a primary combined end point of all-cause death, non-fatal myocardial infarction, and unplanned revascularization at 12 months. End points will be identified through national registries and undergo central blind adjudication to ensure data quality. The iFR-SWEDEHEART trial is an registry-based randomized clinical trial evaluating the safety and efficacy of the diagnostic method iFR compared to FFR. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Providing guidance for genomics-based cancer treatment decisions: insights from stakeholder engagement for post-prostatectomy radiation therapy.

    Science.gov (United States)

    Abe, James; Lobo, Jennifer M; Trifiletti, Daniel M; Showalter, Timothy N

    2017-08-24

    Despite the emergence of genomics-based risk prediction tools in oncology, there is not yet an established framework for communication of test results to cancer patients to support shared decision-making. We report findings from a stakeholder engagement program that aimed to develop a framework for using Markov models with individualized model inputs, including genomics-based estimates of cancer recurrence probability, to generate personalized decision aids for prostate cancer patients faced with radiation therapy treatment decisions after prostatectomy. We engaged a total of 22 stakeholders, including: prostate cancer patients, urological surgeons, radiation oncologists, genomic testing industry representatives, and biomedical informatics faculty. Slides were at each meeting to provide background information regarding the analytical framework. Participants were invited to provide feedback during the meeting, including revising the overall project aims. Stakeholder meeting content was reviewed and summarized by stakeholder group and by theme. The majority of stakeholder suggestions focused on aspects of decision aid design and formatting. Stakeholders were enthusiastic about the potential value of using decision analysis modeling with personalized model inputs for cancer recurrence risk, as well as competing risks from age and comorbidities, to generate a patient-centered tool to assist decision-making. Stakeholders did not view privacy considerations as a major barrier to the proposed decision aid program. A common theme was that decision aids should be portable across multiple platforms (electronic and paper), should allow for interaction by the user to adjust model inputs iteratively, and available to patients both before and during consult appointments. Emphasis was placed on the challenge of explaining the model's composite result of quality-adjusted life years. A range of stakeholders provided valuable insights regarding the design of a personalized decision

  9. Development of Thin Film Amorphous Silicon Tandem Junction Based Photocathodes Providing High Open-Circuit Voltages for Hydrogen Production

    Directory of Open Access Journals (Sweden)

    F. Urbain

    2014-01-01

    Full Text Available Hydrogenated amorphous silicon thin film tandem solar cells (a-Si:H/a-Si:H have been developed with focus on high open-circuit voltages for the direct application as photocathodes in photoelectrochemical water splitting devices. By temperature variation during deposition of the intrinsic a-Si:H absorber layers the band gap energy of a-Si:H absorber layers, correlating with the hydrogen content of the material, can be adjusted and combined in a way that a-Si:H/a-Si:H tandem solar cells provide open-circuit voltages up to 1.87 V. The applicability of the tandem solar cells as photocathodes was investigated in a photoelectrochemical cell (PEC measurement set-up. With platinum as a catalyst, the a-Si:H/a-Si:H based photocathodes exhibit a high photocurrent onset potential of 1.76 V versus the reversible hydrogen electrode (RHE and a photocurrent of 5.3 mA/cm2 at 0 V versus RHE (under halogen lamp illumination. Our results provide evidence that a direct application of thin film silicon based photocathodes fulfills the main thermodynamic requirements to generate hydrogen. Furthermore, the presented approach may provide an efficient and low-cost route to solar hydrogen production.

  10. A diode laser-based velocimeter providing point measurements in unseeded flows using modulated filtered Rayleigh scattering (MFRS)

    Science.gov (United States)

    Jagodzinski, Jeremy James

    2007-12-01

    The development to date of a diode-laser based velocimeter providing point-velocity-measurements in unseeded flows using molecular Rayleigh scattering is discussed. The velocimeter is based on modulated filtered Rayleigh scattering (MFRS), a novel variation of filtered Rayleigh scattering (FRS), utilizing modulated absorption spectroscopy techniques to detect a strong absorption of a relatively weak Rayleigh scattered signal. A rubidium (Rb) vapor filter is used to provide the relatively strong absorption; alkali metal vapors have a high optical depth at modest vapor pressures, and their narrow linewidth is ideally suited for high-resolution velocimetry. Semiconductor diode lasers are used to generate the relatively weak Rayleigh scattered signal; due to their compact, rugged construction diode lasers are ideally suited for the environmental extremes encountered in many experiments. The MFRS technique utilizes the frequency-tuning capability of diode lasers to implement a homodyne detection scheme using lock-in amplifiers. The optical frequency of the diode-based laser system used to interrogate the flow is rapidly modulated about a reference frequency in the D2-line of Rb. The frequency modulation is imposed on the Rayleigh scattered light that is collected from the probe volume in the flow under investigation. The collected frequency modulating Rayleigh scattered light is transmitted through a Rb vapor filter before being detected. The detected modulated absorption signal is fed to two lock-in amplifers synchronized with the modulation frequency of the source laser. High levels of background rejection are attained since the lock-ins are both frequency and phase selective. The two lock-in amplifiers extract different Fourier components of the detected modulated absorption signal, which are ratioed to provide an intensity normalized frequency dependent signal from a single detector. A Doppler frequency shift in the collected Rayleigh scattered light due to a change

  11. Development and evaluation of a web-based breast cancer cultural competency course for primary healthcare providers

    Directory of Open Access Journals (Sweden)

    Triantis Maria

    2011-08-01

    Full Text Available Abstract Background To develop and evaluate a continuing medical education (CME course aimed at improving healthcare provider knowledge about breast cancer health disparities and the importance of cross-cultural communication in provider-patient interactions about breast cancer screening. Methods An interactive web-based CME course was developed and contained information about breast cancer disparities, the role of culture in healthcare decision making, and demonstrated a model of cross-cultural communication. A single group pre-/post-test design was used to assess knowledge changes. Data on user satisfaction was also collected. Results In all, 132 participants registered for the CME with 103 completing both assessments. Differences between pre-/post-test show a significant increase in knowledge (70% vs. 94%; p Conclusion There was an overall high level of satisfaction among all users. Users felt that learning objectives were met and the web-based format was appropriate and easy to use and suggests that web-based CME formats are an appropriate tool to teach cultural competency skills. However, more information is needed to understand how the CME impacted practice behaviors.

  12. Porous TiO2-Based Gas Sensors for Cyber Chemical Systems to Provide Security and Medical Diagnosis

    Directory of Open Access Journals (Sweden)

    Vardan Galstyan

    2017-12-01

    Full Text Available Gas sensors play an important role in our life, providing control and security of technical processes, environment, transportation and healthcare. Consequently, the development of high performance gas sensor devices is the subject of intense research. TiO2, with its excellent physical and chemical properties, is a very attractive material for the fabrication of chemical sensors. Meanwhile, the emerging technologies are focused on the fabrication of more flexible and smart systems for precise monitoring and diagnosis in real-time. The proposed cyber chemical systems in this paper are based on the integration of cyber elements with the chemical sensor devices. These systems may have a crucial effect on the environmental and industrial safety, control of carriage of dangerous goods and medicine. This review highlights the recent developments on fabrication of porous TiO2-based chemical gas sensors for their application in cyber chemical system showing the convenience and feasibility of such a model to provide the security and to perform the diagnostics. The most of reports have demonstrated that the fabrication of doped, mixed and composite structures based on porous TiO2 may drastically improve its sensing performance. In addition, each component has its unique effect on the sensing properties of material.

  13. Porous TiO₂-Based Gas Sensors for Cyber Chemical Systems to Provide Security and Medical Diagnosis.

    Science.gov (United States)

    Galstyan, Vardan

    2017-12-19

    Gas sensors play an important role in our life, providing control and security of technical processes, environment, transportation and healthcare. Consequently, the development of high performance gas sensor devices is the subject of intense research. TiO₂, with its excellent physical and chemical properties, is a very attractive material for the fabrication of chemical sensors. Meanwhile, the emerging technologies are focused on the fabrication of more flexible and smart systems for precise monitoring and diagnosis in real-time. The proposed cyber chemical systems in this paper are based on the integration of cyber elements with the chemical sensor devices. These systems may have a crucial effect on the environmental and industrial safety, control of carriage of dangerous goods and medicine. This review highlights the recent developments on fabrication of porous TiO₂-based chemical gas sensors for their application in cyber chemical system showing the convenience and feasibility of such a model to provide the security and to perform the diagnostics. The most of reports have demonstrated that the fabrication of doped, mixed and composite structures based on porous TiO₂ may drastically improve its sensing performance. In addition, each component has its unique effect on the sensing properties of material.

  14. Porous TiO2-Based Gas Sensors for Cyber Chemical Systems to Provide Security and Medical Diagnosis

    Science.gov (United States)

    2017-01-01

    Gas sensors play an important role in our life, providing control and security of technical processes, environment, transportation and healthcare. Consequently, the development of high performance gas sensor devices is the subject of intense research. TiO2, with its excellent physical and chemical properties, is a very attractive material for the fabrication of chemical sensors. Meanwhile, the emerging technologies are focused on the fabrication of more flexible and smart systems for precise monitoring and diagnosis in real-time. The proposed cyber chemical systems in this paper are based on the integration of cyber elements with the chemical sensor devices. These systems may have a crucial effect on the environmental and industrial safety, control of carriage of dangerous goods and medicine. This review highlights the recent developments on fabrication of porous TiO2-based chemical gas sensors for their application in cyber chemical system showing the convenience and feasibility of such a model to provide the security and to perform the diagnostics. The most of reports have demonstrated that the fabrication of doped, mixed and composite structures based on porous TiO2 may drastically improve its sensing performance. In addition, each component has its unique effect on the sensing properties of material. PMID:29257076

  15. Bibliotherapy-based Wellness Program for Healthcare Providers: Using Books and Reading to Create a Healthy Workplace

    Directory of Open Access Journals (Sweden)

    Natalia Tukhareli

    2017-08-01

    Full Text Available Within the context of benefits of a healthy workplace, bibliotherapy is seen as an effective way of promoting health and wellness to hospital employees. The paper will present a detailed description of an innovative informational and recreational bibliotherapy-based reading program for healthcare providers developed and implemented by a Health Sciences library, in collaboration with the Occupational Health department. The methodology involved an extensive review of the bibliotherapy research and best practices in the UK and North America. The mechanics, benefits, and challenges of the program will be discussed. The program evaluation included an internal survey to the hospital employees. The evaluation results show that the bibliotherapy program has provided a new venue to address work-related stress and promote health, well-being, and resilience within the organization. Moreover, it helped to expand opportunities for collaborative projects and partnerships for the library as well as increase visibility of the library within the organization.

  16. A case study of a team-based, quality-focused compensation model for primary care providers.

    Science.gov (United States)

    Greene, Jessica; Hibbard, Judith H; Overton, Valerie

    2014-06-01

    In 2011, Fairview Health Services began replacing their fee-for-service compensation model for primary care providers (PCPs), which included an annual pay-for-performance bonus, with a team-based model designed to improve quality of care, patient experience, and (eventually) cost containment. In-depth interviews and an online survey of PCPs early after implementation of the new model suggest that it quickly changed the way many PCPs practiced. Most PCPs reported a shift in orientation toward quality of care, working more collaboratively with their colleagues and focusing on their full panel of patients. The majority reported that their quality of care had improved because of the model and that their colleagues' quality had to. The comprehensive change did, however, result in lower fee-for-service billing and reductions in PCP satisfaction. While Fairview's compensation model is still a work in progress, their early experiences can provide lessons for other delivery systems seeking to reform PCP compensation.

  17. Incentive-based demand response programs designed by asset-light retail electricity providers for the day-ahead market

    International Nuclear Information System (INIS)

    Fotouhi Ghazvini, Mohammad Ali; Faria, Pedro; Ramos, Sergio; Morais, Hugo; Vale, Zita

    2015-01-01

    Following the deregulation experience of retail electricity markets in most countries, the majority of the new entrants of the liberalized retail market were pure REP (retail electricity providers). These entities were subject to financial risks because of the unexpected price variations, price spikes, volatile loads and the potential for market power exertion by GENCO (generation companies). A REP can manage the market risks by employing the DR (demand response) programs and using its' generation and storage assets at the distribution network to serve the customers. The proposed model suggests how a REP with light physical assets, such as DG (distributed generation) units and ESS (energy storage systems), can survive in a competitive retail market. The paper discusses the effective risk management strategies for the REPs to deal with the uncertainties of the DAM (day-ahead market) and how to hedge the financial losses in the market. A two-stage stochastic programming problem is formulated. It aims to establish the financial incentive-based DR programs and the optimal dispatch of the DG units and ESSs. The uncertainty of the forecasted day-ahead load demand and electricity price is also taken into account with a scenario-based approach. The principal advantage of this model for REPs is reducing the risk of financial losses in DAMs, and the main benefit for the whole system is market power mitigation by virtually increasing the price elasticity of demand and reducing the peak demand. - Highlights: • Asset-light electricity retail providers subject to financial risks. • Incentive-based demand response program to manage the financial risks. • Maximizing the payoff of electricity retail providers in day-ahead market. • Mixed integer nonlinear programming to manage the risks

  18. The Association Between Immigration Status and Office-based Medical Provider Visits for Cancer Patients in the United States.

    Science.gov (United States)

    Wang, Yang; Wilson, Fernando A; Chen, Li-Wu

    2017-06-01

    We examined differences in cancer-related office-based provider visits associated with immigration status in the United States. Data from the 2007-2012 Medical Expenditure Panel Survey and National Health Interview Survey included adult patients diagnosed with cancer. Univariate analyses described distributions of cancer-related office-based provider visits received, expenditures, visit characteristics, as well as demographic, socioeconomic, and health covariates, across immigration groups. We measured the relationships of immigrant status to number of visits and associated expenditure within the past 12 months, adjusting for age, sex, educational attainment, race/ethnicity, self-reported health status, time since cancer diagnosis, cancer remission status, marital status, poverty status, insurance status, and usual source of care. We finally performed sensitivity analyses for regression results by using the propensity score matching method to adjust for potential selection bias. Noncitizens had about 2 fewer visits in a 12-month period in comparison to US-born citizens (4.0 vs. 5.9). Total expenditure per patient was higher for US-born citizens than immigrants (not statistically significant). Noncitizens (88.3%) were more likely than US-born citizens (76.6%) to be seen by a medical doctor during a visit. Multivariate regression results showed that noncitizens had 42% lower number of visiting medical providers at office-based settings for cancer care than US-born citizens, after adjusting for all the other covariates. There were no significant differences in expenditures across immigration groups. The propensity score matching results were largely consistent with those in multivariate-adjusted regressions. Results suggest targeted interventions are needed to reduce disparities in utilization between immigrants and US-born citizen cancer patients.

  19. Care Provided by Students in Community-Based Dental Education: Helping Meet Oral Health Needs in Underserved Communities.

    Science.gov (United States)

    Mays, Keith A; Maguire, Meghan

    2018-01-01

    Since 2000, reports have documented the challenges faced by many Americans in receiving oral health care and the consequences of inadequate care such as high levels of dental caries among many U.S. children. To help address this problem, many dental schools now include community-based dental education (CBDE) in their curricula, placing students in extramural clinics where they provide care in underserved communities. CBDE is intended to both broaden the education of future oral health professionals and expand care for patients in community clinics. The aim of this study was to develop a three-year profile of the patients seen and the care provided by students at extramural clinics associated with one U.S. dental school. Three student cohorts participated in the rotations: final-year students in the Doctor of Dental Surgery, Bachelor of Science in Dental Hygiene, and Master of Dental Therapy programs. The study was a retrospective analysis of data retrieved from the school's database for three consecutive academic years. The data included patients' demographics and special health care needs status (based on information collected by students from their patients) and procedures students performed while on rotations. For the three-year period, the results showed a total of 43,128 patients were treated by 418 student providers. Approximately 25% of all encounters were with pediatric patients. Students completed 5,908 child prophylaxis, 5,386 topical fluoride varnish, and 7,678 sealant procedures on pediatric patients. Annually, 7% of the total patients treated had special health care needs. The results show that these students in CBDE rotations provided a substantial amount of oral health care at extramural sites and gained additional experience in caring for a diverse population of patients and performing a wide range of procedures.

  20. Development of a Website Providing Evidence-Based Information About Nutrition and Cancer: Fighting Fiction and Supporting Facts Online.

    Science.gov (United States)

    van Veen, Merel Rebecca; Beijer, Sandra; Adriaans, Anika Maria Alberdina; Vogel-Boezeman, Jeanne; Kampman, Ellen

    2015-09-08

    Although widely available, the general public, cancer patients, and cancer survivors have difficulties accessing evidence-based information on nutrition and cancer. It is challenging to distinguish myths from facts, and sometimes conflicting information can be found in different places. The public and patients would benefit from evidence-based, correct, and clear information from an easily recognizable source. The aim of this project is to make scientific information available for the general public, cancer patients, and cancer survivors through a website. The aim of this paper is to describe and evaluate the development of the website as well as related statistics 1st year after its launch. To develop the initial content for the website, the website was filled with answers to frequently asked questions provided by cancer organizations and the Dutch Dietetic Oncology Group, and by responding to various fiction and facts published in the media. The website was organized into 3 parts, namely, nutrition before (prevention), during, and after cancer therapy; an opportunity for visitors to submit specific questions regarding nutrition and cancer was included. The website was pretested by patients, health care professionals, and communication experts. After launching the website, visitors' questions were answered by nutritional scientists and dieticians with evidence- or eminence-based information on nutrition and cancer. Once the website was live, question categories and website statistics were recorded. Before launch, the key areas for improvement, such as navigation, categorization, and missing information, were identified and adjusted. In the 1st year after the launch, 90,111 individuals visited the website, and 404 questions were submitted on nutrition and cancer. Most of the questions were on cancer prevention and nutrition during the treatment of cancer. The website provides access to evidence- and eminence-based information on nutrition and cancer. As can be

  1. Conversion technique from paper-based seismic profiles to SEG-Y degital data, provided by free softwares

    Science.gov (United States)

    Tuzino, Taqumi

    This article introduces a conversion method from paper-based seismic profiles to SEG-Y formatted degital data. This method employs two free software, NetPBM and Seismic Unix which work on Unix-like OS. The principle is 1) scanning paper-based profiles to obtain pixel images conposed of 8 bit charactor, 2) conversion of trace data format from character to floating and 3) paste of SEG-Y header to floating trace data. Paper-based profiles drown by line scan recorder were successfully converted to trace-by-pixel SEG-Y data. Paper based wiggle profiles were converted firstly to trace-by-pixel SEG-Y data, and then to trace-by-trace SEG-Y data, by using horizontal trace sum of trace-by-pixel data. Quality of these data was examined and proofed that they are tolerable to be used, though they have restriction of paper. SEG-Y convertied data would provide additional analyses; deconvolution, migration, seismic attribute analyses, and would be ready for interpretation softwares.

  2. The novel primers for mammal species identification-based mitochondrial cytochrome b sequence: implication for reserved wild animals in Thailand and endangered mammal species in Southeast Asia.

    Science.gov (United States)

    Muangkram, Yuttamol; Wajjwalku, Worawidh; Amano, Akira; Sukmak, Manakorn

    2018-01-01

    We presented the powerful techniques for species identification using the short amplicon of mitochondrial cytochrome b gene sequence. Two faecal samples and one single hair sample of the Asian tapir were tested using the new cytochrome b primers. The results showed a high sequence similarity with the mainland Asian tapir group. The comparative sequence analysis of the reserved wild mammals in Thailand and the other endangered mammal species from Southeast Asia comprehensibly verified the potential of our novel primers. The forward and reverse primers were 94.2 and 93.2%, respectively, by the average value of the sequence identity among 77 species sequences, and the overall mean distance was 35.9%. This development technique could provide rapid, simple, and reliable tools for species confirmation. Especially, it could recognize the problematic biological specimens contained less DNA material from illegal products and assist with wildlife crime investigation of threatened species and related forensic casework.

  3. Genetic and subunit vaccines based on the stem domain of the equine influenza hemagglutinin provide homosubtypic protection against heterologous strains.

    Science.gov (United States)

    Ibañez, Lorena Itatí; Caldevilla, Cecilia Andrea; Paredes Rojas, Yesica; Mattion, Nora

    2018-03-14

    H3N8 influenza virus strains have been associated with infectious disease in equine populations throughout the world. Although current vaccines for equine influenza stimulate a protective humoral immune response against the surface glycoproteins, disease in vaccinated horses has been frequently reported, probably due to poor induction of cross-reactive antibodies against non-matching strains. This work describes the performance of a recombinant protein vaccine expressed in prokaryotic cells (ΔHAp) and of a genetic vaccine (ΔHAe), both based on the conserved stem region of influenza hemagglutinin (HA) derived from A/equine/Argentina/1/93 (H3N8) virus. Sera from mice inoculated with these immunogens in different combinations and regimes presented reactivity in vitro against highly divergent influenza virus strains belonging to phylogenetic groups 1 and 2 (H1 and H3 subtypes, respectively), and conferred robust protection against a lethal challenge with both the homologous equine strain (100%) and the homosubtypic human strain A/Victoria/3/75 (H3N2) (70-100%). Animals vaccinated with the same antigens but challenged with the human strain A/PR/8/34 (H1N1), belonging to the phylogenetic group 1, were not protected (0-33%). Combination of protein and DNA immunogens showed higher reactivity to non-homologous strains than protein alone, although all vaccines were permissive for lung infection. Copyright © 2018 Elsevier Ltd. All rights reserved.

  4. Time-driven activity-based costing: a driver for provider engagement in costing activities and redesign initiatives.

    Science.gov (United States)

    McLaughlin, Nancy; Burke, Michael A; Setlur, Nisheeta P; Niedzwiecki, Douglas R; Kaplan, Alan L; Saigal, Christopher; Mahajan, Aman; Martin, Neil A; Kaplan, Robert S

    2014-11-01

    To date, health care providers have devoted significant efforts to improve performance regarding patient safety and quality of care. To address the lagging involvement of health care providers in the cost component of the value equation, UCLA Health piloted the implementation of time-driven activity-based costing (TDABC). Here, the authors describe the implementation experiment, share lessons learned across the care continuum, and report how TDABC has actively engaged health care providers in costing activities and care redesign. After the selection of pilots in neurosurgery and urology and the creation of the TDABC team, multidisciplinary process mapping sessions, capacity-cost calculations, and model integration were coordinated and offered to engage care providers at each phase. Reviewing the maps for the entire episode of care, varying types of personnel involved in the delivery of care were noted: 63 for the neurosurgery pilot and 61 for the urology pilot. The average cost capacities for care coordinators, nurses, residents, and faculty were $0.70 (range $0.63-$0.75), $1.55 (range $1.28-$2.04), $0.58 (range $0.56-$0.62), and $3.54 (range $2.29-$4.52), across both pilots. After calculating the costs for material, equipment, and space, the TDABC model enabled the linking of a specific step of the care cycle (who performed the step and its duration) and its associated costs. Both pilots identified important opportunities to redesign care delivery in a costconscious fashion. The experimentation and implementation phases of the TDABC model have succeeded in engaging health care providers in process assessment and costing activities. The TDABC model proved to be a catalyzing agent for cost-conscious care redesign.

  5. Mobile-based patient-provider communication in cancer survivors: The roles of health literacy and patient activation.

    Science.gov (United States)

    Jiang, Shaohai; Hong, Y Alicia

    2018-03-01

    Thanks to rapid penetration of mobile tools, more and more cancer survivors have adopted mobile-based patient-provider communication (MBPPC). The relationship between MBPPC and patients' health outcomes, however, remains unclear; how health literacy and patient activation interact with such relationship is unexplored. Data were drawn from National Cancer Institute's Health Information National Trends Survey 4 Cycle 3. A sample of 459 cancer survivors were included in the analysis. Based on the 3-stage model of health promotion using interactive media, this study empirically tested a moderated mediation model. MBPPC (eg, patient use of email, text message, mobile app, and social media to communicate with providers) had no direct effect on cancer survivors' emotional health. Instead, health literacy completely mediated this path. Patient activation positively moderated the effect of health literacy on emotional health and further increased the indirect effect of MBPPC on emotional health. MBPPC alone does not directly result in better emotional health outcomes; health literacy is the key to realize its health benefits; patient activation significantly strengthens the effects of MBPPC. As we embrace the mHealth movement, innovative programs are needed to promote MBPPC, and improve health literacy and activation of cancer survivors, particularly in underserved communities, to reduce health disparities. Copyright © 2017 John Wiley & Sons, Ltd.

  6. The adoption of provider-based rural health clinics by rural hospitals: a study of market and institutional forces.

    Science.gov (United States)

    Krein, S L

    1999-01-01

    OBJECTIVE: To examine the response of rural hospitals to various market and organizational signals by determining the factors that influence whether or not they establish a provider-based rural health clinic (RHC) (a joint Medicare/Medicaid program). DATA SOURCES/STUDY SETTING: Several secondary sources for 1989-1995: the AHA Annual Survey, the PPS Minimum Data Set and a list of RHCs from HCFA, the Area Resource File, and professional associations. The analysis includes all general medical/surgical rural hospitals operating in the United States during the study period. STUDY DESIGN: A longitudinal design and pooled cross-sectional data were used, with the rural hospital as the unit of analysis. Key variables were examined as sets and include measures of competitive pressures (e.g., hospital market share), physician resources, nurse practitioner/physician assistant (NP/PA) practice regulation, hospital performance pressures (e.g., operating margin), innovativeness, and institutional pressure (i.e., the cumulative force of adoption). PRINCIPAL FINDINGS: Adoption of provider-based RHCs by rural hospitals appears to be motivated less as an adaptive response to observable economic or internal organizational signals than as a reaction to bandwagon pressures. CONCLUSIONS: Rural hospitals with limited resources may resort to imitating others because of uncertainty or a limited ability to fully evaluate strategic activities. This can result in actions or behaviors that are not consistent with policy objectives and the perceived need for policy changes. Such activity in turn could have a negative effect on some providers and some rural residents. Images Figure 1 PMID:10201851

  7. Guiding Principles for Implementing School-Based Management Programs: An Online Toolkit Providing General Principles That Can Be Applied to the Implementation of School-Based Management Reforms

    Science.gov (United States)

    Patrinos, Harry Anthony; Fasih, Tazeen; Barrera, Felipe; Garcia-Moreno, Vicente A.; Bentaouet-Kattan, Raja; Baksh, Shaista; Wickramasekera, Inosha

    2007-01-01

    School-based management (SBM) has become a very popular movement over the past decade. The World Bank Education Team's SBM work program emerged out of a need to define the concept more clearly, review the evidence, support impact assessments in various countries, and provide some initial feedback to teams preparing education projects. During the…

  8. Evidence-based recommendations on care for breast cancer survivors for primary care providers: a review of evidence-based breast cancer guidelines.

    NARCIS (Netherlands)

    Spronk, I.; Korevaar, J.C.; Schellevis, F.G.; Albreht, T.; Burgers, J.S.

    2017-01-01

    Objective: To review evidence-based (EB) recommendations on survivorship care for primary care providers (PCPs) in EB breast cancer guidelines. Design and setting Guidelines were collected via experts and via literature database, guideline database and cancer agency websites searches. Method: EB

  9. Barriers to Office-Based Mental Health Care and Interest in E-Communication With Providers: A Survey Study.

    Science.gov (United States)

    Rai, Minnie; Vigod, Simone N; Hensel, Jennifer M

    2016-08-01

    With rising availability and use of Internet and mobile technology in society, the demand and need for its integration into health care is growing. Despite great potential within mental health care and growing uptake, there is still little evidence to guide how these tools should be integrated into traditional care, and for whom. To examine factors that might inform how e-communication should be implemented in our local outpatient mental health program, including barriers to traditional office-based care, patient preferences, and patient concerns. We conducted a survey in the waiting room of our outpatient mental health program located in an urban, academic ambulatory hospital. The survey assessed (1) age, mobile phone ownership, and general e-communication usage, (2) barriers to attending office-based appointments, (3) preferences for, and interest in, e-communication for mental health care, and (4) concerns about e-communication use for mental health care. We analyzed the data descriptively and examined associations between the presence of barriers, identifying as a social media user, and interest level in e-communication. Respondents (N=68) were predominantly in the age range of 25-54 years. The rate of mobile phone ownership was 91% (62/68), and 59% (40/68) of respondents identified as social media users. There was very low existing use of e-communication between providers and patients, with high levels of interest endorsed by survey respondents. Respondents expressed an interest in using e-communication with their provider to share updates and get feedback, coordinate care, and get general information. In regression analysis, both a barrier to care and identifying as a social media user were significantly associated with e-communication interest (P=.03 and P=.003, respectively). E-communication interest was highest among people who both had a barrier to office-based care and were a social media user. Despite high interest, there were also many concerns

  10. Internet-based reservation system (Internet-based control of timers for building technical services) - Final report; Internetbasiertes Reservationssystem (Internetbasierte Einstellung von Zeitsteuerungen haustechnischer Anlagen) - Schlussbericht

    Energy Technology Data Exchange (ETDEWEB)

    Huber, A.; Woodtli, M.

    2008-07-01

    A common measure to save energy in buildings is the adjustment of the operating time of the building service facilities to the busy time of the building (i.e. lowering period). For lack of better resources, the general lowering periods in irregularly occupied buildings often are reduced to a minimum or the adjustment of the operating time is completely missing. In order to adjust the operating time optimally to the actual busy time, an internet-based booking system has been developed, which allows users to register a room assignment online. This booking system is linked with the building service facilities. This ensure the optimal setting of the lowering periods and therefore allows saving energy. The technical implementation resulted from a programmable logic controller (PLC) that can be accessed via a web browser. Temperature offset boxes have been added as interface between the PLC and the existing facilities in order that the system is applicable in existing buildings too. The booking system has been installed in two test objects and has also been successfully tested with the responsible staff (caretaker, real estate management). The booking system may be contemplated online: http://www.hetag.ch. (author)

  11. 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...

  12. Creation of a Tool for Assessing Knowledge in Evidence-Based Decision-Making in Practicing Health Care Providers.

    Science.gov (United States)

    Spurr, Kathy; Dechman, Gail; Lackie, Kelly; Gilbert, Robert

    2016-01-01

    Evidence-based decision-making (EBDM) is the process health care providers (HCPs) use to identify and appraise potential evidence. It supports the integration of best research evidence with clinical expertise and patient values into the decision-making process for patient care. Competence in this process is essential to delivery of optimal care. There is no objective tool that assesses EBDM across HCP groups. This research aimed to develop a content valid tool to assess knowledge of the principles of evidence-based medicine and the EBDM process, for use with all HCPs. A Delphi process was used in the creation of the tool. Pilot testing established its content validity with the added benefit of evaluating HCPs' knowledge of EBDM. Descriptive statistics and multivariate mixed models were used to evaluate individual survey responses in total, as well as within each EBDM component. The tool consisted of 26 multiple-choice questions. A total of 12,884 HCPs in Nova Scotia were invited to participate in the web-based validation study, yielding 818 (6.3%) participants, 471 of whom completed all questions. The mean overall score was 68%. Knowledge in one component, integration of evidence with clinical expertise and patient preferences, was identified as needing development across all HCPs surveyed. A content valid tool for assessing HCP EBDM knowledge was created and can be used to support the development of continuing education programs to enhance EBDM competency.

  13. Incentive-based demand response programs designed by asset-light retail electricity providers for the day-ahead market

    DEFF Research Database (Denmark)

    Fotouhi Ghazvini, Mohammad Ali; Faria, Pedro; Ramos, Sergio

    2015-01-01

    Following the deregulation experience of retail electricity markets in most countries, the majority of the new entrants of the liberalized retail market were pure REP (retail electricity providers). These entities were subject to financial risks because of the unexpected price variations, price...... spikes, volatile loads and the potential for market power exertion by GENCO (generation companies). A REP can manage the market risks by employing the DR (demand response) programs and using its' generation and storage assets at the distribution network to serve the customers. The proposed model suggests...... to hedge the financial losses in the market. A two-stage stochastic programming problem is formulated. It aims to establish the financial incentive-based DR programs and the optimal dispatch of the DG units and ESSs. The uncertainty of the forecasted day-ahead load demand and electricity price is also...

  14. A simulation-based inventory management with genetic algorithm for uncertain demand for third-party logistics provider

    Directory of Open Access Journals (Sweden)

    Wuthichai Wongthatsanekorn

    2014-09-01

    Full Text Available This research aims to study and apply inventory management system for Third party logistics provider. Currently, the company uses economic order quantity to control inventory. The analysis of historical demand data shows that the demand is not deterministic. Hence, assumptions of using economic order quantity are violated. In this research, the simulation-based technique is applied to solve for optimal order quantity and reorder point. Since there are numerous items in the considered warehouse, ABC analysis is utilized to select important items to analyze. Then simulation and genetic algorithm are applied to find the optimal solution. Design of experiment with full factorial design is used to determine the best parameter setting of genetic algorithm. The performance measures are the average total inventory cost which composes of average ordering cost, average inventory holding cost and average lost sale cost. The results show that the average total cost for product code G2654, G2581, G0706, G2791 can be reduced by 73.43%, 49.86%, 28.50% and 13.38% respectively. For product code G2654, the average lost sale cost can be reduced by 85.30%. In summary, the solution from simulation and genetic algorithm provides better results than the one from economic order quantity method.

  15. Reservations about the conclusions of the interdivisional (APA Divisions 12 & 29) task force on evidence-based therapy relationships: what do we know, what don't we know?

    Science.gov (United States)

    Kazantzis, Nikolaos; Cronin, Timothy J; Norton, Peter J; Lai, Jerry; Hofmann, Stefan G

    2015-05-01

    We offer a critical and constructive appraisal of the conclusions provided by the Interdivisional (American Psychological Association [APA] Divisions 12 & 29) Task Force on Evidence-Based Therapy Relationships. We highlight problems in overlapping terminology and definitions, as well as problems in the conduct of its meta-analyses (i.e., duplication of studies between reviews, inappropriate study inclusion, and use of measures of specific constructs for the calculation of effects for multiple relationship elements). On this basis, we express reservation about the conclusions offered by the APA Task Force. This special issue explores whether there are other therapeutic relationship elements that warrant consideration and further study. We were particularly interested in those elements that showed promise based on empirical or theoretical grounds, and in each article, we asked for an account of how the case formulation would guide the methods of adaptation for each individual client, and how the element would contribute to clinically relevant changes. © 2015 Wiley Periodicals, Inc.

  16. Using Model-Based Systems Engineering To Provide Artifacts for NASA Project Life-Cycle and Technical Reviews

    Science.gov (United States)

    Parrott, Edith L.; Weiland, Karen J.

    2017-01-01

    The ability of systems engineers to use model-based systems engineering (MBSE) to generate self-consistent, up-to-date systems engineering products for project life-cycle and technical reviews is an important aspect for the continued and accelerated acceptance of MBSE. Currently, many review products are generated using labor-intensive, error-prone approaches based on documents, spreadsheets, and chart sets; a promised benefit of MBSE is that users will experience reductions in inconsistencies and errors. This work examines features of SysML that can be used to generate systems engineering products. Model elements, relationships, tables, and diagrams are identified for a large number of the typical systems engineering artifacts. A SysML system model can contain and generate most systems engineering products to a significant extent and this paper provides a guide on how to use MBSE to generate products for project life-cycle and technical reviews. The use of MBSE can reduce the schedule impact usually experienced for review preparation, as in many cases the review products can be auto-generated directly from the system model. These approaches are useful to systems engineers, project managers, review board members, and other key project stakeholders.

  17. Screening halogenated environmental contaminants in biota based on isotopic pattern and mass defect provided by high resolution mass spectrometry profiling

    International Nuclear Information System (INIS)

    Cariou, Ronan; Omer, Elsa; Léon, Alexis; Dervilly-Pinel, Gaud; Le Bizec, Bruno

    2016-01-01

    In the present work, we addressed the question of global seeking/screening organohalogenated compounds in a large panel of complex biological matrices, with a particular focus on unknown chemicals that may be considered as potential emerging hazards. A fishing strategy was developed based on untargeted profiling among full scan acquisition datasets provided by high resolution mass spectrometry. Since large datasets arise from such profiling, filtering useful information stands as a central question. In this way, we took advantage of the exact mass differences between Cl and Br isotopes. Indeed, our workflow involved an innovative Visual Basic for Applications script aiming at pairing features according to this mass difference, in order to point out potential organohalogenated clusters, preceded by an automated peak picking step based on the centWave function (xcms package of open access R programming environment). Then, H/Cl-scale mass defect plots were used to visualize the datasets before and after filtering. The filtering script was successfully applied to a dataset generated upon liquid chromatography coupled to ESI(−)-HRMS measurement from one eel muscle extract, allowing for realistic manual investigations of filtered clusters. Starting from 9789 initial obtained features, 1994 features were paired in 589 clusters. Hexabromocyclododecane, chlorinated paraffin series and various other compounds have been identified or tentatively identified, allowing thus broad screening of organohalogenated compounds in this extract. Although realistic, manual review of paired clusters remains time consuming and much effort should be devoted to automation. - Highlights: • We address the screening of halogenated compounds in large Full Scan HRMS datasets. • The workflow involves peak picking, pairing script and review of paired features. • The pairing script is based on exact mass differences between Cl and Br isotopes. • H/Cl scale mass defect plots are used to

  18. Screening halogenated environmental contaminants in biota based on isotopic pattern and mass defect provided by high resolution mass spectrometry profiling

    Energy Technology Data Exchange (ETDEWEB)

    Cariou, Ronan, E-mail: laberca@oniris-nantes.fr; Omer, Elsa; Léon, Alexis; Dervilly-Pinel, Gaud; Le Bizec, Bruno

    2016-09-14

    In the present work, we addressed the question of global seeking/screening organohalogenated compounds in a large panel of complex biological matrices, with a particular focus on unknown chemicals that may be considered as potential emerging hazards. A fishing strategy was developed based on untargeted profiling among full scan acquisition datasets provided by high resolution mass spectrometry. Since large datasets arise from such profiling, filtering useful information stands as a central question. In this way, we took advantage of the exact mass differences between Cl and Br isotopes. Indeed, our workflow involved an innovative Visual Basic for Applications script aiming at pairing features according to this mass difference, in order to point out potential organohalogenated clusters, preceded by an automated peak picking step based on the centWave function (xcms package of open access R programming environment). Then, H/Cl-scale mass defect plots were used to visualize the datasets before and after filtering. The filtering script was successfully applied to a dataset generated upon liquid chromatography coupled to ESI(−)-HRMS measurement from one eel muscle extract, allowing for realistic manual investigations of filtered clusters. Starting from 9789 initial obtained features, 1994 features were paired in 589 clusters. Hexabromocyclododecane, chlorinated paraffin series and various other compounds have been identified or tentatively identified, allowing thus broad screening of organohalogenated compounds in this extract. Although realistic, manual review of paired clusters remains time consuming and much effort should be devoted to automation. - Highlights: • We address the screening of halogenated compounds in large Full Scan HRMS datasets. • The workflow involves peak picking, pairing script and review of paired features. • The pairing script is based on exact mass differences between Cl and Br isotopes. • H/Cl scale mass defect plots are used to

  19. Evidence-based practice implementation: The impact of public versus private sector organization type on organizational support, provider attitudes, and adoption of evidence-based practice

    Directory of Open Access Journals (Sweden)

    Sommerfeld David H

    2009-12-01

    Full Text Available Abstract Background The goal of this study is to extend research on evidence-based practice (EBP implementation by examining the impact of organizational type (public versus private and organizational support for EBP on provider attitudes toward EBP and EBP use. Both organization theory and theory of innovation uptake and individual adoption of EBP guide the approach and analyses in this study. We anticipated that private sector organizations would provide greater levels of organizational support for EBPs leading to more positive provider attitudes towards EBPs and EBP use. We also expected attitudes toward EBPs to mediate the association of organizational support and EBP use. Methods Participants were mental health service providers from 17 communities in 16 states in the United States (n = 170. Path analyses were conducted to compare three theoretical models of the impact of organization type on organizational support for EBP and of organizational support on provider attitudes toward EBP and EBP use. Results Consistent with our predictions, private agencies provided greater support for EBP implementation, and staff working for private agencies reported more positive attitudes toward adopting EBPs. Organizational support for EBP partially mediated the association of organization type on provider attitudes toward EBP. Organizational support was significantly positively associated with attitudes toward EBP and EBP use in practice. Conclusion This study offers further support for the importance of organizational context as an influence on organizational support for EBP and provider attitudes toward adopting EBP. The study demonstrates the role organizational support in provider use of EBP in practice. This study also suggests that organizational support for innovation is a malleable factor in supporting use of EBP. Greater attention should be paid to organizational influences that can facilitate the dissemination and implementation of EBPs in

  20. Estimating Foreign Exchange Reserve Adequacy

    Directory of Open Access Journals (Sweden)

    Abdul Hakim

    2013-04-01

    Full Text Available Accumulating foreign exchange reserves, despite their cost and their impacts on other macroeconomics variables, provides some benefits. This paper models such foreign exchange reserves. To measure the adequacy of foreign exchange reserves for import, it uses total reserves-to-import ratio (TRM. The chosen independent variables are gross domestic product growth, exchange rates, opportunity cost, and a dummy variable separating the pre and post 1997 Asian financial crisis. To estimate the risky TRM value, this paper uses conditional Value-at-Risk (VaR, with the help of Glosten-Jagannathan-Runkle (GJR model to estimate the conditional volatility. The results suggest that all independent variables significantly influence TRM. They also suggest that the short and long run volatilities are evident, with the additional evidence of asymmetric effects of negative and positive past shocks. The VaR, which are calculated assuming both normal and t distributions, provide similar results, namely violations in 2005 and 2008.

  1. Measuring the Quality of Services Provided for Outpatients in Kowsar Clinic in Ardebil City Based on the SERVQUAL Model

    Directory of Open Access Journals (Sweden)

    Hasan Ghobadi

    2014-12-01

    Full Text Available Background & objectives: Today, the concept of q uality of services is particularly important in health care and customer satisfaction can be defined by comparing the expectations of the services with perception of provided services. The aim of this study was to evaluate the quality of services provided for outpatients in clinic of Ardebil city based on the SERVQUAL model.   Methods: This descriptive study was conducted on 650 patients referred to outpatient clinic since July to September 201 3 using a standardized SERVQUAL questionnaire (1988 with confirmed reliability and validity. The paired t-test and Friedman test were used for analysis of data by SPSS software.   Results: 56.1 % of respondents were male and 43.9 % of them were female . The mean age of patients was 33 ± 11.91 , 68.9 % of patients were in Ardabil and 27.3 % of them had bachelor's or higher. The results showed that there is a significant difference between perceptions and expectations of the patients about five dimensions of the service quality (tangibility, reliability, assurance, responsiveness, and empathy in the studied clinic (P< 0.001. The highest mean gap and minimum gap were related to empathy and assurance, respectively.   Conclusion: Regarding to observed differences in quality , the managers and also planners have to evaluate their performance more accurately in order to have better planning for future actions. In fact, any efforts to reduce the gap between expectation and perception of patients result in greater satisfaction, loyalty and further visits to organizations.

  2. Organization-wide adoption of computerized provider order entry systems: a study based on diffusion of innovations theory.

    Science.gov (United States)

    Rahimi, Bahlol; Timpka, Toomas; Vimarlund, Vivian; Uppugunduri, Srinivas; Svensson, Mikael

    2009-12-31

    Computerized provider order entry (CPOE) systems have been introduced to reduce medication errors, increase safety, improve work-flow efficiency, and increase medical service quality at the moment of prescription. Making the impact of CPOE systems more observable may facilitate their adoption by users. We set out to examine factors associated with the adoption of a CPOE system for inter-organizational and intra-organizational care. The diffusion of innovation theory was used to understand physicians' and nurses' attitudes and thoughts about implementation and use of the CPOE system. Two online survey questionnaires were distributed to all physicians and nurses using a CPOE system in county-wide healthcare organizations. The number of complete questionnaires analyzed was 134 from 200 nurses (67.0%) and 176 from 741 physicians (23.8%). Data were analyzed using descriptive-analytical statistical methods. More nurses (56.7%) than physicians (31.3%) stated that the CPOE system introduction had worked well in their clinical setting (P diffusion of innovation theory were not satisfied in the study setting. CPOE systems are introduced as a response to the present limitations in paper-based systems. In consequence, user expectations are often high on their relative advantages as well as on a low level of complexity. Building CPOE systems therefore requires designs that can provide rather important additional advantages, e.g. by preventing prescription errors and ultimately improving patient safety and safety of clinical work. The decision-making process leading to the implementation and use of CPOE systems in healthcare therefore has to be improved. As any change in health service settings usually faces resistance, we emphasize that CPOE system designers and healthcare decision-makers should continually collect users' feedback about the systems, while not forgetting that it also is necessary to inform the users about the potential benefits involved.

  3. Beliefs and implementation of evidence-based practice among nurses and allied healthcare providers in the Valais hospital, Switzerland.

    Science.gov (United States)

    Verloo, Henk; Desmedt, Mario; Morin, Diane

    2017-02-01

    Evidence-based practice (EBP) is upheld as a means for patients to receive the most efficient care in a given context. Despite the available evidence and positive beliefs about it, implementing EBP as standard daily practice still faces many obstacles. This study investigated the beliefs about and implementation of EBP among nurses and allied healthcare providers (AHP) in 9 acute care hospitals in the canton of Valais, Switzerland. A cross-sectional descriptive survey was conducted. The target population was composed of 1899 nurses and 126 AHPs. Beliefs about and implementation of EBP were measured using EBP-Beliefs and EBP-Implementation scales of Melnyk et al. The initial sample consisted in 491 participants (overall response rate 24.2%): 421 nurses (22.4% response rate) and 78 AHPs (61.9% response rate). The final sample, composed only of those who declared previous exposure to EBP, included 391 participants (329 nurses and 62 AHPs). Overall, participants had positive attitudes towards EBP and were willing to increase their knowledge to guide practice. However, they acknowledged poor implementation of EBP in daily practice. A significantly higher level of EBP implementation was declared by those formally trained in it (P = 0.006) and by those occupying more senior professional functions (P = 0.004). EBP-Belief scores predicted 13% of the variance in the EBP-Implementation scores (R 2  = 0.13). EBP is poorly implemented despite positive beliefs about it. Continuing education and support on EBP would help to ensure that patients receive the best available care based on high-quality evidence, patient needs, clinical expertise, and a fair distribution of healthcare resources. This study's results will be used to guide institutional strategy to increase the use of EBP in daily practice. © 2016 John Wiley & Sons, Ltd.

  4. An Integral Model to Provide Reactive and Proactive Services in an Academic CSIRT Based on Business Intelligence

    Directory of Open Access Journals (Sweden)

    Walter Fuertes

    2017-11-01

    Full Text Available Cyber-attacks have increased in severity and complexity. That requires, that the CERT/CSIRT research and develops new security tools. Therefore, our study focuses on the design of an integral model based on Business Intelligence (BI, which provides reactive and proactive services in a CSIRT, in order to alert and reduce any suspicious or malicious activity on information systems and data networks. To achieve this purpose, a solution has been assembled, that generates information stores, being compiled from a continuous network transmission of several internal and external sources of an organization. However, it contemplates a data warehouse, which is focused like a correlator of logs, being formed by the information of feeds with diverse formats. Furthermore, it analyzed attack detection and port scanning, obtained from sensors such as Snort and Passive Vulnerability Scanner, which are stored in a database, where the logs have been generated by the systems. With such inputs, we designed and implemented BI systems using the phases of the Ralph Kimball methodology, ETL and OLAP processes. In addition, a software application has been implemented using the SCRUM methodology, which allowed to link the obtained logs to the BI system for visualization in dynamic dashboards, with the purpose of generating early alerts and constructing complex queries using the user interface through objects structures. The results demonstrate, that this solution has generated early warnings based on the level of criticality and level of sensitivity of malware and vulnerabilities as well as monitoring efficiency, increasing the level of security of member institutions.

  5. A Geographical Information System Based Approach for Integrated Strategies of Tick Surveillance and Control in the Peri-Urban Natural Reserve of Monte Pellegrino (Palermo, Southern Italy).

    Science.gov (United States)

    Torina, Alessandra; Blanda, Valeria; Blanda, Marcellocalogero; Auteri, Michelangelo; La Russa, Francesco; Scimeca, Salvatore; D'Agostino, Rosalia; Disclafani, Rosaria; Villari, Sara; Currò, Vittoria; Caracappa, Santo

    2018-02-27

    Ticks (Acari: Ixodidae) are bloodsucking arthropods involved in pathogen transmission in animals and humans. Tick activity depends on various ecological factors such as vegetation, hosts, and temperature. The aim of this study was to analyse the spatial/temporal distribution of ticks in six sites within a peri-urban area of Palermo (Natural Reserve of Monte Pellegrino) and correlate it with field data using Geographical Information System (GIS) data. A total of 3092 ticks were gathered via dragging method from June 2012 to May 2014. The species collected were: Ixodes ventalloi (46.09%), Hyalomma lusitanicum (19.99%), Rhipicephalus sanguineus (17.34%), Rhipicephalus pusillus (16.11%), Haemaphisalis sulcata (0.36%), Dermacentor marginatus (0.10%), and Rhipicephalus turanicus (0.03%). GIS analysis revealed environmental characteristics of each site, and abundance of each tick species was analysed in relation to time (monthly trend) and space (site-specific abundance). A relevant presence of I. ventalloi in site 2 and H. lusitanicum in site 5 was observed, suggesting the possible exposure of animals and humans to tick-borne pathogens. Our study shows the importance of surveillance of ticks in peri-urban areas and the useful implementation of GIS analysis in vector ecology; studies on temporal and spatial distribution of ticks correlated to GIS-based ecological analysis represent an integrated strategy for decision support in public health.

  6. Diagnostic value of thallium-201 myocardial perfusion IQ-SPECT without and with computed tomography-based attenuation correction to predict clinically significant and insignificant fractional flow reserve

    Science.gov (United States)

    Tanaka, Haruki; Takahashi, Teruyuki; Ohashi, Norihiko; Tanaka, Koichi; Okada, Takenori; Kihara, Yasuki

    2017-01-01

    Abstract The aim of this study was to clarify the predictive value of fractional flow reserve (FFR) determined by myocardial perfusion imaging (MPI) using thallium (Tl)-201 IQ-SPECT without and with computed tomography-based attenuation correction (CT-AC) for patients with stable coronary artery disease (CAD). We assessed 212 angiographically identified diseased vessels using adenosine-stress Tl-201 MPI-IQ-SPECT/CT in 84 consecutive, prospectively identified patients with stable CAD. We compared the FFR in 136 of the 212 diseased vessels using visual semiquantitative interpretations of corresponding territories on MPI-IQ-SPECT images without and with CT-AC. FFR inversely correlated most accurately with regional summed difference scores (rSDS) in images without and with CT-AC (r = −0.584 and r = −0.568, respectively, both P system can predict FFR at an optimal cut-off of <0.80, and we propose a novel application of CT-AC to MPI-IQ-SPECT for predicting clinically significant and insignificant FFR even in nonobese patients. PMID:29390486

  7. Spinning Reserve From Responsive Loads

    Energy Technology Data Exchange (ETDEWEB)

    Kirby, B.J.

    2003-04-08

    Responsive load is the most underutilized reliability resource available to the power system today. It is currently not used at all to provide spinning reserve. Historically there were good reasons for this, but recent technological advances in communications and controls have provided new capabilities and eliminated many of the old obstacles. North American Electric Reliability Council (NERC), Federal Energy Regulatory Commission (FERC), Northeast Power Coordinating Council (NPCC), New York State Reliability Council (NYSRC), and New York Independent System Operator (NYISO) rules are beginning to recognize these changes and are starting to encourage responsive load provision of reliability services. The Carrier ComfortChoice responsive thermostats provide an example of these technological advances. This is a technology aimed at reducing summer peak demand through central control of residential and small commercial air-conditioning loads. It is being utilized by Long Island Power Authority (LIPA), Consolidated Edison (ConEd), Southern California Edison (SCE), and San Diego Gas and Electric (SDG&E). The technology is capable of delivering even greater response in the faster spinning reserve time frame (while still providing peak reduction). Analysis of demand reduction testing results from LIPA during the summer of 2002 provides evidence to back up this claim. It also demonstrates that loads are different from generators and that the conventional wisdom, which advocates for starting with large loads as better ancillary service providers, is flawed. The tempting approach of incrementally adapting ancillary service requirements, which were established when generators were the only available resources, will not work. While it is easier for most generators to provide replacement power and non-spinning reserve (the slower response services) than it is to supply spinning reserve (the fastest service), the opposite is true for many loads. Also, there is more financial

  8. Non-Model-Based Control of a Wheeled Vehicle Pulling Two Trailers to Provide Early Powered Mobility and Driving Experiences.

    Science.gov (United States)

    Sanders Td Vr, David A

    2018-01-01

    Non-model-based control of a wheeled vehicle pulling two trailers is proposed. It is a fun train for disabled children consisting of a locomotive and two carriages. The fun train has afforded opportunities for both disabled and able bodied young people to share an activity and has provided early driving experiences for disabled children; it has introduced them to assistive and powered mobility. The train is a nonlinear system and subject to nonholonomic kinematic constraints, so that position and state depend on the path taken to get there. The train is described, and then, a robust control algorithm using proportional-derivative filtered errors is proposed to control the locomotive. The controller was not dependent on an accurate model of the train, because the mass of the vehicle and two carriages changed depending on the number, size, and shape of children and wheelchair seats on the train. The controller was robust and stable in uncertainty. Results are presented to show the effectiveness of the approach, and the suggested control algorithm is shown to be acceptable without knowing the exact plant dynamics.

  9. Internet-based ICRP resource for healthcare providers on the risks and benefits of medical imaging that uses ionising radiation.

    Science.gov (United States)

    Demeter, S; Applegate, K E; Perez, M

    2016-06-01

    The purpose of the International Commission on Radiological Protection (ICRP) Committee 3 Working Party was to update the 2001 web-based module 'Radiation and your patient: a guide for medical practitioners' from ICRP. The key elements of this task were: to clearly identify the target audience (such as healthcare providers with an emphasis on primary care); to review other reputable sources of information; and to succinctly publish the contribution made by ICRP to the various topics. A 'question-and-answer' format addressing practical topics was adopted. These topics included benefits and risks of imaging using ionising radiation in common medical situations, as well as pertaining to specific populations such as pregnant, breast-feeding, and paediatric patients. In general, the benefits of medical imaging and related procedures far outweigh the potential risks associated with ionising radiation exposure. However, it is still important to ensure that the examinations are clinically justified, that the procedure is optimised to deliver the lowest dose commensurate with the medical purpose, and that consideration is given to diagnostic reference levels for particular classes of examinations. © The International Society for Prosthetics and Orthotics.

  10. The gene expression data of Mycobacterium tuberculosis based on Affymetrix gene chips provide insight into regulatory and hypothetical genes

    Directory of Open Access Journals (Sweden)

    Fu-Liu Casey S

    2007-05-01

    Full Text Available Abstract Background Tuberculosis remains a leading infectious disease with global public health threat. Its control and management have been complicated by multi-drug resistance and latent infection, which prompts scientists to find new and more effective drugs. With the completion of the genome sequence of the etiologic bacterium, Mycobacterium tuberculosis, it is now feasible to search for new drug targets by sieving through a large number of gene products and conduct genome-scale experiments based on microarray technology. However, the full potential of genome-wide microarray analysis in configuring interrelationships among all genes in M. tuberculosis has yet to be realized. To date, it is only possible to assign a function to 52% of proteins predicted in the genome. Results We conducted a functional-genomics study using the high-resolution Affymetrix oligonucleotide GeneChip. Approximately one-half of the genes were found to be always expressed, including more than 100 predicted conserved hypotheticals, in the genome of M. tuberculosis during the log phase of in vitro growth. The gene expression profiles were analyzed and visualized through cluster analysis to epitomize the full details of genomic behavior. Broad patterns derived from genome-wide expression experiments in this study have provided insight into the interrelationships among genes in the basic cellular processes of M. tuberculosis. Conclusion Our results have confirmed several known gene clusters in energy production, information pathways, and lipid metabolism, and also hinted at potential roles of hypothetical and regulatory proteins.

  11. Compton scattering by internal shields based on melanin-containing mushrooms provides protection of gastrointestinal tract from ionizing radiation.

    Science.gov (United States)

    Revskaya, Ekaterina; Chu, Peter; Howell, Robertha C; Schweitzer, Andrew D; Bryan, Ruth A; Harris, Matthew; Gerfen, Gary; Jiang, Zewei; Jandl, Thomas; Kim, Kami; Ting, Li-Min; Sellers, Rani S; Dadachova, Ekaterina; Casadevall, Arturo

    2012-11-01

    There is a need for radioprotectors that protect normal tissues from ionizing radiation in patients receiving high doses of radiation and during nuclear emergencies. We investigated the possibility of creating an efficient oral radioprotector based on the natural pigment melanin that would act as an internal shield and protect the tissues via Compton scattering followed by free radical scavenging. CD-1 mice were fed melanin-containing black edible mushrooms Auricularia auricila-judae before 9 Gy total body irradiation. The location of the mushrooms in the body before irradiation was determined by in vivo fluorescent imaging. Black mushrooms protected 80% of mice from the lethal dose, while control mice or those given melanin-devoid mushrooms died from gastrointestinal syndrome. The crypts of mice given black mushrooms showed less apoptosis and more cell division than those in control mice, and their white blood cell and platelet counts were restored at 45 days to preradiation levels. The role of melanin in radioprotection was proven by the fact that mice given white mushrooms supplemented with melanin survived at the same rate as mice given black mushrooms. The ability of melanin-containing mushrooms to provide remarkable protection against radiation suggests that they could be developed into oral radioprotectors.

  12. HYDROCARBONS RESERVES IN VENEZUELA

    Energy Technology Data Exchange (ETDEWEB)

    Gonzalez Cruz, D.J.

    2007-07-01

    Venezuela is an important player in the energy world, because of its hydrocarbons reserves. The process for calculating oil and associated gas reserves is described bearing in mind that 90% of the gas reserves of Venezuela are associated to oil. Likewise, an analysis is made of the oil reserves figures from 1975 to 2003. Reference is also made to inconsistencies found by international experts and the explanations offered in this respect by the Ministry of Energy and Petroleum (MENPET) and Petroleos de Venezuela (PDVSA) regarding the changes that took place in the 1980s. In turn, Hubbert's Law is explained to determine peak production of conventional oil that a reservoir or field will reach, as well as its relationship with remaining reserves. Emphasis is placed on the interest of the United Nations on this topic. The reserves of associated gas are presented along with their relationship with the different crude oils that are produced and with injected gas, as well as with respect to the possible changes that would take place in the latter if oil reserves are revised. Some recommendations are submitted so that the MENPET starts preparing the pertinent policies ruling reserves. (auth)

  13. Providing web-based feedback and social norms information to reduce student alcohol intake: a multisite investigation.

    Science.gov (United States)

    Bewick, Bridgette M; West, Robert; Gill, Jan; O'May, Fiona; Mulhern, Brendan; Barkham, Michael; Hill, Andrew J

    2010-12-19

    Unhealthy alcohol use among university students is cause for concern, yet the level of help seeking behavior for alcohol use is low within the student population. Electronic brief interventions delivered via the Internet present an alternative to traditional treatments and could enable the delivery of interventions on a population basis. Further evidence is needed of the effectiveness of Internet-delivered interventions and of their generalizability across educational institutions. Our objective was to evaluate the effectiveness across 4 UK universities of a Web-based intervention for student alcohol use. In total, 1112 participants took part. Participants were stratified by educational institution, gender, age group, year of study, and self-reported weekly consumption of alcohol and randomly assigned to either the control arm or to the immediate or delayed intervention arms. Intervention participants gained access to the intervention between weeks 1 to 7 or weeks 8 to 15, respectively. The intervention provided electronic personalized feedback and social norms information on drinking behavior accessed by logging on to a website. Participants registered interest by completing a brief screening questionnaire and were then asked to complete 4 further assessments across the 24 weeks of the study. Assessments included a retrospective weekly drinking diary, the Alcohol Use Disorders Identification Test (AUDIT), and a readiness-to-change algorithm. The outcome variable was the number of units of alcohol consumed in the last week. The effect of treatment arm and time on units consumed last week and average units consumed per drinking occasion were investigated using repeated measures multivariate analysis of covariance (MANCOVA). In addition, the data were modeled using a longitudinal regression with time points clustered within students. MANCOVA revealed a main effect of time on units of alcohol consumed over the last week. A longitudinal regression model showed an

  14. Ovarian reserve parameters

    DEFF Research Database (Denmark)

    Bentzen, J G; Forman, Julie Lyng; Pinborg, Anja

    2012-01-01

    2-5 of the menstrual cycle or during withdrawal bleeding, blood sampling and transvaginal sonography was performed. After adjusting for age, ovarian reserve parameters were lower among users than among non-users of hormonal contraception: serum AMH concentration by 29.8% (95% CI 19.9 to 38...... was observed between duration of hormonal-contraception use and ovarian reserve parameters. No dose-response relation was found between the dose of ethinyloestradiol and AMH or AFC. This study indicates that ovarian reserve markers are lower in women using sex steroids for contraception. Thus, AMH...... concentration and AFC may not retain their accuracy as predictors of ovarian reserve in women using hormonal contraception. Serum anti-Müllerian hormone (AMH) concentration is an indirect marker of the number of small follicles in the ovary and thereby the ovarian reserve. The AMH concentration is now widely...

  15. Differential treatment of hypertension by primary care providers and hypertension specialists in a barber-based intervention trial to control hypertension in Black men.

    Science.gov (United States)

    Rader, Florian; Elashoff, Robert M; Niknezhad, Sara; Victor, Ronald G

    2013-11-01

    Black men have less physician contact than other groups and thus lower rates of hypertension treatment and control. In the Barber-Assisted Reduction in Blood Pressure among Ethnic Residents trial, hypertension control in 8 active-intervention barbershops where barbers offered blood pressure (BP) checks with haircuts and motivated black male patrons with high BP to seek provider follow-up showed a small improvement over that in 7 comparison shops where patrons received hypertension pamphlets but not barber-BP checks. Undertreatment of hypertension, which is common in primary care, may have impacted the outcomes. Thus, in patrons with a baseline systolic BP of ≥140 mm Hg and 10-month follow-up including BP and medication data, we performed post hoc comparison of systolic BP reduction between comparison-arm patrons (n = 68) treated by primary care providers (PCPs) with (1) intervention-arm patrons (n = 37) treated by PCPs or (2) intervention-arm patrons (n = 33) who lacked access to PCPs and were treated by hypertension specialist physicians serving as safety net providers. The latter group had higher baseline systolic BP than the others (162 ± 3 vs 155 ± 2 and 154 ± 2 mm Hg, respectively, p hypertension specialists but was no different when they referred to PCPs (4 ± 4 mm Hg, p = 0.31). Specialist-treated patrons received more BP medication and different classes of medication than PCP-treated patrons. In conclusion, the barber-based intervention-if connected directly to specialty-level medical care-could have a large public health impact on hypertensive disease in black men. Copyright © 2013 Elsevier Inc. All rights reserved.

  16. Organization-wide adoption of computerized provider order entry systems: a study based on diffusion of innovations theory

    Directory of Open Access Journals (Sweden)

    Timpka Toomas

    2009-12-01

    Full Text Available Abstract Background Computerized provider order entry (CPOE systems have been introduced to reduce medication errors, increase safety, improve work-flow efficiency, and increase medical service quality at the moment of prescription. Making the impact of CPOE systems more observable may facilitate their adoption by users. We set out to examine factors associated with the adoption of a CPOE system for inter-organizational and intra-organizational care. Methods The diffusion of innovation theory was used to understand physicians' and nurses' attitudes and thoughts about implementation and use of the CPOE system. Two online survey questionnaires were distributed to all physicians and nurses using a CPOE system in county-wide healthcare organizations. The number of complete questionnaires analyzed was 134 from 200 nurses (67.0% and 176 from 741 physicians (23.8%. Data were analyzed using descriptive-analytical statistical methods. Results More nurses (56.7% than physicians (31.3% stated that the CPOE system introduction had worked well in their clinical setting (P P = P = 0.041. We found that in particular the received relative advantages of the CPOE system were estimated to be significantly (P P Conclusions Qualifications for CPOE adoption as defined by three attributes of diffusion of innovation theory were not satisfied in the study setting. CPOE systems are introduced as a response to the present limitations in paper-based systems. In consequence, user expectations are often high on their relative advantages as well as on a low level of complexity. Building CPOE systems therefore requires designs that can provide rather important additional advantages, e.g. by preventing prescription errors and ultimately improving patient safety and safety of clinical work. The decision-making process leading to the implementation and use of CPOE systems in healthcare therefore has to be improved. As any change in health service settings usually faces resistance

  17. Helicopter Based Magnetic Detection Of Wells At The Teapot Dome (Naval Petroleum Reserve No. 3 Oilfield: Rapid And Accurate Geophysical Algorithms For Locating Wells

    Science.gov (United States)

    Harbert, W.; Hammack, R.; Veloski, G.; Hodge, G.

    2011-12-01

    In this study Airborne magnetic data was collected by Fugro Airborne Surveys from a helicopter platform (Figure 1) using the Midas II system over the 39 km2 NPR3 (Naval Petroleum Reserve No. 3) oilfield in east-central Wyoming. The Midas II system employs two Scintrex CS-2 cesium vapor magnetometers on opposite ends of a transversely mounted, 13.4-m long horizontal boom located amidships (Fig. 1). Each magnetic sensor had an in-flight sensitivity of 0.01 nT. Real time compensation of the magnetic data for magnetic noise induced by maneuvering of the aircraft was accomplished using two fluxgate magnetometers mounted just inboard of the cesium sensors. The total area surveyed was 40.5 km2 (NPR3) near Casper, Wyoming. The purpose of the survey was to accurately locate wells that had been drilled there during more than 90 years of continuous oilfield operation. The survey was conducted at low altitude and with closely spaced flight lines to improve the detection of wells with weak magnetic response and to increase the resolution of closely spaced wells. The survey was in preparation for a planned CO2 flood to enhance oil recovery, which requires a complete well inventory with accurate locations for all existing wells. The magnetic survey was intended to locate wells that are missing from the well database and to provide accurate locations for all wells. The well location method used combined an input dataset (for example, leveled total magnetic field reduced to the pole), combined with first and second horizontal spatial derivatives of this input dataset, which were then analyzed using focal statistics and finally combined using a fuzzy combination operation. Analytic signal and the Shi and Butt (2004) ZS attribute were also analyzed using this algorithm. A parameter could be adjusted to determine sensitivity. Depending on the input dataset 88% to 100% of the wells were located, with typical values being 95% to 99% for the NPR3 field site.

  18. Geologic structure of Gofitsky deposit of titanium and zirconium and perspectives of the reserve base of titanium and zirconium in Russia

    Science.gov (United States)

    Kukhmazov, Iskander

    2016-04-01

    With the fall of the Soviet Union, all the mining deposits of titanium and zirconium appeared outside of Russian Federation. Therefore the studying of deposits of titanium and zirconium in Russia is very important nowadays. There is a paradoxical situation in the country: in spite of possible existence of national mineral resource base of Ti-Zr material, which can cover needs of the country, Russia is the one of the largest buyers of imported Ti-Zr material in the world. Many deposits are not mined, and those which are in the process of mining have poor reserves. Demand for this raw material is very great not only for Russia, but also for the world in general. Today there is a scarcity of zircon around the world and it will only increase through time. Therefore prices of products of titanium and zirconium also increase. Consequently Russian deposits of titanium and zirconium with higher content than foreign may become competitive. Russia is forced to buy raw materials (zirconium and titanium production) from former Soviet Union countries at prices higher than the world's and thus incur huge losses, including customs charges. Russia should create its own mineral resource base of Ti-Zr. Studied titanium-zirconium deposits of Stavropol region may become the basis for the south part of Russia. At first, Beshpagirsky deposit should be pointed out. It has large reserves of ore sands with high content of Ti-Zr. A combination of favorable geographical position of the area with developed industrial infrastructure makes it very beneficial as an object for high priority development. Gofitsky deposit should be pointed out as well. Its sands have a wide areal distribution and a high content of titanium and zirconium. Chokrak, Karagan-Konksk and Sarmatian sediments of the Miocene of Gofitsky deposit are productive for titanium and zirconium placers within Stavropol region of Russia. Gofitsky deposit was evaluated from financial and economic point of view and the following data

  19. Using EarthScope Construction of the Plate Boundary Observatory to Provide Locally Based Experiential Education and Outreach

    Science.gov (United States)

    Jackson, M.; Eriksson, S.; Barbour, K.; Venator, S.; Mencin, D.; Prescott, W.

    2006-12-01

    EarthScope is an NSF-funded, national science initiative to explore the structure and evolution of the North American continent and to understand the physical processes controlling earthquakes and volcanoes. This large-scale experiment provides locally based opportunities for education and outreach which engage students at various levels and the public. UNAVCO is responsible for the Plate Boundary Observatory (PBO) component of EarthScope. PBO includes the installation and operations and maintenance of large networks of Global Positioning Satellite (GPS), strainmeter, seismometer, and tiltmeter instruments and the acquisition of satellite radar imagery, all of which will be used to measure and map the smallest movements across faults, the magma movement inside active volcanoes and the very wide areas of deformation associated with plate tectonic motion. UNAVCO, through its own education and outreach activities and in collaboration with the EarthScope E&O Program, uses the PBO construction activities to increase the understanding and public appreciation of geodynamics, earth deformation processes, and their relevance to society. These include programs for public outreach via various media, events associated with local installations, a program to employ students in the construction of PBO, and development of curricular materials by use in local schools associated with the EarthScope geographic areas of focus. PBO provides information to the media to serve the needs of various groups and localities, including interpretive centers at national parks and forests, such as Mt. St. Helens. UNAVCO staff contributed to a television special with the Spanish language network Univision Aquí y Ahora program focused on the San Andreas Fault and volcanoes in Alaska. PBO participated in an Education Day at the Pathfinder Ranch Science and Outdoor Education School in Mountain Center, California. Pathfinder Ranch hosts two of the eight EarthScope borehole strainmeters in the Anza

  20. Providing affinity

    DEFF Research Database (Denmark)

    Guglielmi, Michel; Johannesen, Hl

    2004-01-01

    of belonging to people sharing deterritorialized synchronic experiences. But at the same time, the immersion experience is highly low tech and desperately analog, mainly based on fabulation, cartoons, and mushrooms growing in local forests. It ultimately appeals to the experienced sense of tangible reality....

  1. Skyline Reservation System

    Data.gov (United States)

    US Agency for International Development — Flight reservation application used for in-country flights by USAID and DoS staff in Afghanistan. The application is managed and maintained by the vendor and USAID...

  2. Cognitive Reserve Scale and ageing

    Directory of Open Access Journals (Sweden)

    Irene León

    2016-01-01

    Full Text Available The construct of cognitive reserve attempts to explain why some individuals with brain impairment, and some people during normal ageing, can solve cognitive tasks better than expected. This study aimed to estimate cognitive reserve in a healthy sample of people aged 65 years and over, with special attention to its influence on cognitive performance. For this purpose, it used the Cognitive Reserve Scale (CRS and a neuropsychological battery that included tests of attention and memory. The results revealed that women obtained higher total CRS raw scores than men. Moreover, the CRS predicted the learning curve, short-term and long-term memory, but not attentional and working memory performance. Thus, the CRS offers a new proxy of cognitive reserve based on cognitively stimulating activities performed by healthy elderly people. Following an active lifestyle throughout life was associated with better intellectual performance and positive effects on relevant aspects of quality of life.

  3. Subsurface data base for Bear Creek Valley, Chestnut Ridge, and parts of Bethel Valley on the US Department of Energy Oak Ridge Reservation

    International Nuclear Information System (INIS)

    Haase, C.S.; Gillis, G.A.; King, H.L.

    1987-04-01

    Construction data and available hydrogeological data for 582 boreholes and wells at the Y-12 Plant and in the surrounding vicinity have been assembled and tabulated in a data base. General data about boreholes and wells included in the data base are survey coordinates, elevations, and alternative names. Construction data tabulated include total depth, completion method, borehole diameter, casing and screen materials, filter pack depths, open-hole intervals, and open hole diameters. Hydrogeological data summarized includes depth to weathered and fresh bedrock, formations penetrated, and whether rock core and geophysical logs were obtained. The tabulations provide a means of determining the amount and quality of data available for a particular borehole or well. Applications of the data tabulations include evaluation of the suitability of wells for continued use in groundwater investigations and monitoring studies, site hydrogeological characterization activities, background evaluations of sites prior to initiation of new drilling activities, and geohydrologic review of selected sites prior to the initiation of remedial actions. 8 refs., 1 fig

  4. Demand as Frequency Controlled Reserve

    DEFF Research Database (Denmark)

    Xu, Zhao; Togeby, Mikael; Østergaard, Jacob

    This report summaries the research outcomes of the project ‘Demand as Frequency Controlled Reserve (DFR)’, which has received the support from Energinet.dk’s PSO program, Grant no. 2005-2-6380. The objective of this project is to investigate the technology of using electricity demands for providing...

  5. Vertical microbial community variability of carbonate-based cones may provide insight into ancient conical stromatolite formation

    Science.gov (United States)

    Bradley, James; Daille, Leslie; Trivedi, Christopher; Bojanowski, Caitlin; Nunn, Heather; Stamps, Blake; Johnson, Hope; Stevenson, Bradley; Berelson, Will; Corsetti, Frank; Spear, John

    2016-04-01

    Stromatolite morphogenesis is poorly understood, and the process by which microbial mats become mineralized is a primary question in microbialite formation. Ancient conical stromatolites are primarily carbonate-based whereas the few modern analogues in hot springs are either non-mineralized or mineralized by silica. A team from the 2015 International GeoBiology Course investigated carbonate-rich microbial cones from near Little Hot Creek (LHC), Long Valley Caldera, California, to investigate how conical stromatolites might form in a hot spring carbonate system. The cones rise up from a layered microbial mat on the east side of a 45° C pool with very low flow that is super-saturated with respect to CaCO3. Cone structures are 8-30 mm in height, are rigid and do not deform when removed from the pool. Morphological characterization through environmental scanning electronic microscopy revealed that the cone structure is maintained by a matrix of intertwining microbial filaments around carbonate grains. This matrix gives rise to cone-filaments that are arranged vertically or horizontally, and provides further stability to the cone. Preliminary 16S rRNA gene analysis indicated variability of community composition between different vertical levels of the cone. The cone tip had comparatively greater abundance of filamentous cyanobacteria including Leptolingbya, Phormidium and Isosphaera and fewer heterotrophs (e.g. Chloroflexi) compared to the cone bottom. This supports the hypothesis that cone formation may depend on the differential abundance of the microbial community and their potential functional roles. Metagenomic analyses of the cones revealed potential genes related to chemotaxis and motility. Specifically, a genomic bin identified as a member of the genus Isosphaera contained an hmp chemotaxis operon implicated in gliding motility in the cyanobacterium Nostoc punctiforme. Isosphaera is a Planctomycete shown to have phototactic capabilities, and may play a role in

  6. Parents' and service providers' perceptions of family-centred practice in a community-based, paediatric disability service in Australia.

    Science.gov (United States)

    Raghavendra, P; Murchland, S; Bentley, M; Wake-Dyster, W; Lyons, T

    2007-09-01

    For children who have physical disabilities and their families, involvement with a variety of providers of rehabilitation services is the norm rather than the exception. Despite family-centred practice (FCP) being recognized as the 'best practice' model, families experience models of service provision that range from 'expert' to 'collaborative'. After adopting FCP at Novita Children's Services in South Australia, it was imperative to determine the effectiveness of the implementation of FCP. Aim To investigate parents' and staff's perceptions of FCP at Novita as part of ongoing quality assurance activity, and to identify any gaps in the services provided. The Measures of Processes of Care (MPOC) for parents/caregivers and service providers were utilized. A total of 189 families stratified by the three age groups of clients (service providers (MPOC-SP) questionnaire. Parents generally rated the family-centred behaviours of staff as positive. Respectful and supportive care received the highest rating, while providing general information received the lowest. There were significant differences in scores for all five scales of the MPOC between metropolitan and rural families and the age of the child. Service providers also generally rated their family-centred behaviours as positive. There were significant differences among the professions in areas of showing interpersonal sensitivity and providing general information. The findings suggest that parents and service providers perceive FCP as positive at Novita, with some areas for improvement. The MPOC-20 and MPOC-SP can be used to measure FCP and to identify service delivery gaps, which warrant further exploration.

  7. The Roles of Individual and Organizational Factors in Burnout among Community-Based Mental Health Service Providers

    Science.gov (United States)

    Green, Amy E.; Albanese, Brian J.; Shapiro, Nicole M.; Aarons, Gregory A.

    2014-01-01

    Public sector mental health care providers are at high risk for burnout which negatively affects not only provider well-being but also the quality of services for clients and the functioning of organizations. This study examines the influence of demographics, work characteristic, and organizational variables on levels of burnout among child and adolescent mental health service providers operating within a public sector mental health service system. Additionally, given the dearth of research examining differences in burnout levels among mental health sub-disciplines (e.g., social work, psychology, marital and family therapy) and mental health programs (e.g., outpatient, day treatment, Wraparound, case management), analyses were conducted to compare levels of burnout among multiple mental health disciplines and program types. Surveys were completed by 285 providers across 49 mental health programs in a large urban public mental health system. Variables representing dimensions of organizational climate and transformational leadership accounted for the greatest amount of variance in provider reported burnout. Analyses demonstrated significantly lower levels of depersonalization among Wraparound providers compared to traditional case managers. Age was the only demographic variable related to burnout. Additionally, no significant effects were found for provider discipline or for agency tenure and caseload size. Results suggest the need to consider organizational development strategies aimed at creating more functional and less stressful climates and increasing levels of transformational leadership behaviors in order to reduce levels of burnout among clinicians working in public mental health settings for youth and families. PMID:24564442

  8. Reserve Retirement Equality: Treating Reserves Fairly While Saving Taxpayer Dollars

    Science.gov (United States)

    2010-06-09

    rata .121 For example, a Reserve who performs the equivalent of five years of active duty, will receive one-fourth the retired pay of his active duty...4,225 per month.124 But because reserve-retirement benefits are based on pro rata years of service, this officer’s years of service for retirement...purposes are 3,146 retirement points divided by 360.125 This results in 8.74 years pro rata years of service.126 His retirement benefits thus are

  9. 76 FR 40749 - Cost-Based and Inter-Agency Billing Rates for Medical Care or Services Provided by the Department...

    Science.gov (United States)

    2011-07-11

    ... computing Cost-Based and Inter-Agency billing rates for medical care or services provided by VA is set forth... OFFICE OF MANAGEMENT AND BUDGET DEPARTMENT OF VETERANS AFFAIRS Cost-Based and Inter-Agency Billing Rates for Medical Care or Services Provided by the Department of Veterans Affairs AGENCY: Office of...

  10. Handbook on loss reserving

    CERN Document Server

    Schmidt, Klaus; Schnaus, Anja

    2016-01-01

    This handbook presents the basic aspects of actuarial loss reserving. Besides the traditional methods, it also includes a description of more recent ones and a discussion of certain problems occurring in actuarial practice, like inflation, scarce data, large claims, slow loss development, the use of market statistics, the need for simulation techniques and the task of calculating best estimates and ranges of future losses. In property and casualty insurance the provisions for payment obligations from losses that have occurred but have not yet been settled usually constitute the largest item on the liabilities side of an insurer's balance sheet. For this reason, the determination and evaluation of these loss reserves is of considerable economic importance for every property and casualty insurer. Actuarial students, academics as well as practicing actuaries will benefit from this overview of the most important actuarial methods of loss reserving by developing an understanding of the underlying stochastic models...

  11. Lithium reserves and resources

    International Nuclear Information System (INIS)

    Evans, R.K.

    1978-01-01

    As a result of accelerating research efforts in the fields of secondary batteries and thermonuclear power generation, concern has been expressed in certain quarters regarding the availability, in sufficient quantities, of lithium. As part of a recent study by the National Research Council on behalf of the Energy Research and Development Administration, a subpanel was formed to consider the outlook for lithium. Principal areas of concern were reserves, resources and the 'surplus' available for energy applications after allowing for the growth in current lithium applications. Reserves and resources were categorized into four classes ranging from fully proved reserves to resources which are probably dependent upon the marketing of co-products to become economically attractive. Because of the proprietary nature of data on beneficiation and processing recoveries, the tonnages of available lithium are expressed in terms of plant feed. However, highly conservative assumptions have been made concerning mining recoveries and these go a considerable way to accounting for total losses. Western World reserves and resources of all classes are estimated at 10.6 million tonnes Li of which 3.5 million tonnes Li are located in the United States. Current United States capacity, virtually equivalent to Western World capacity, is 4700 tonnes Li and production in 1976 approximated to 3500 tonnes Li. Production for current applications is expected to grow to approx. 10,000 tonnes in year 2000 and 13,000 tonnes a decade later. The massive excess of reserves and resources over that necessary to support conventional requirements has limited the amount of justifiable exploration expenditures; on the last occasion, there was a a major increase in demand (by the USAEA) reserves and capacity were increased rapidly. There are no foreseeable reasons why this shouldn't happen again when the need is clear. (author)

  12. Demand as Frequency Controlled Reserve

    DEFF Research Database (Denmark)

    Xu, Zhao; Østergaard, Jacob; Togeby, Mikael

    2011-01-01

    Relying on generation side alone is deemed insufficient to fulfill the system balancing needs for future Danish power system, where a 50% wind penetration is outlined by the government for year 2025. This paper investigates using the electricity demand as frequency controlled reserve (DFR) as a new...... balancing measure, which has a high potential and can provide many advantages. Firstly, the background of the research is reviewed, including conventional power system reserves and the electricity demand side potentials. Subsequently, the control logics and corresponding design considerations for the DFR...

  13. Session 7: Reserve

    International Nuclear Information System (INIS)

    Bailey, R.; Crockford, G.

    2001-01-01

    The reserve session was devoted to some issues that came up through the workshop, which were grouped into three main areas: The Global Accelerator Network, Problems of stress and how to get organized to minimize them, What should an operations group be responsible for? This paper summarizes the discussions that took place. (author)

  14. School Shootings Stun Reservation

    Science.gov (United States)

    Borja, Rhea R.; Cavanagh, Sean

    2005-01-01

    This article deals with the impact brought by the school shootings at Red Lake Indian Reservation in Minnesota to the school community. A deeply troubled 16-year-old student shot and killed seven other people and himself at a high school. The nation's deadliest school attack since the 1999 slayings at Colorado's suburban Columbine High School took…

  15. SUIKERBOSRAND NATURE RESERVE

    African Journals Online (AJOL)

    reserve, the total length being 66 km with six overnight huts. There are also the BokmakiePie. Nature Troil. and the Cheetah Interpretive Troil. which can be used by day visitors. The former has two loops, one of 10 km and another of 17 km. The. Cheetah Troil. is much shorter and various points of interest are interpreted en ...

  16. Coronary Computed Tomographic Angiography-Dekived Fractional Flow Reserve Based on Machine Learning for Risk Stratification of Non-Culprit Coronary Narrowings in Patients with Acute Coronary Syndrome

    NARCIS (Netherlands)

    Duguay, Taylor M.; Tesche, Christian; Vliegenthart, Rozemarijn; De Cecco, Carlo N.; Lin, Han; Albrecht, Moritz H.; Varga-Szemes, Akos; De Santis, Domenico; Ebersberger, Ullrich; Bayer, Richard R.; Litwin, Sheldon E.; Hoffmann, Ellen; Steinberg, Daniel H.; Schoepf, U. Joseph

    2017-01-01

    This study investigated the prognostic value of coronary computed tomography angiography (cCTA)-derived fractional flow reserve (CT-FFR) in patients with acute coronary syndrome (ACS) and multivessel disease to gauge significance and guide management of non-culprit lesions. We retrospectively

  17. Nutrition and Physical Activity Environments of Home-Based Child Care: What Hispanic Providers Have to Say

    Science.gov (United States)

    Mena, Noereem Z.; Risica, Patricia; Gorham, Gemma; Gans, Kim M.

    2015-01-01

    Abstract Background: It is important to understand the perceptions and beliefs of family child care providers (FCCPs) regarding which factors influence children's physical activity (PA), screen-time (ST), and dietary behaviors in order to develop and implement appropriate obesity prevention interventions. The aim of this qualitative study was to explore the aforementioned perceptions and beliefs of FCCPs in Rhode Island. Methods: Four focus groups (n = 30) were held with FCCPs. Providers were female, Hispanic, and Spanish speaking. Providers were asked about different aspects of feeding, PA, and ST behaviors. Themes were coded using NVivo10 (QSR International Pty Ltd, Doncaster, Victoria, Australia). Content analysis was used to analyze final themes. Results: Providers understood the importance of providing opportunities for healthy eating and PA for the children they cared for, but there was room for improvement, especially with regard to certain feeding and ST practices. Several barriers were evident, including the lack of physical infrastructure for PA, cultural beliefs and practices related to child feeding, and difficulties working with parents to provide consistent messages across environments. Conclusions: Given that FCCPs are aware of the importance of healthy eating and PA, there is a need to address the specific barriers they face, and operationalize some of their knowledge into practical everyday actions. This formative work will inform the development of a culturally relevant, multicomponent intervention for ethnically diverse FCCPs to improve the food and PA environments of their homes, which should, in turn, improve the dietary, PA, and ST behaviors of the 2- to 5-year-old children they care for. PMID:26332455

  18. Nutrition and Physical Activity Environments of Home-Based Child Care: What Hispanic Providers Have to Say.

    Science.gov (United States)

    Tovar, Alison; Mena, Noereem Z; Risica, Patricia; Gorham, Gemma; Gans, Kim M

    2015-10-01

    It is important to understand the perceptions and beliefs of family child care providers (FCCPs) regarding which factors influence children's physical activity (PA), screen-time (ST), and dietary behaviors in order to develop and implement appropriate obesity prevention interventions. The aim of this qualitative study was to explore the aforementioned perceptions and beliefs of FCCPs in Rhode Island. Four focus groups (n = 30) were held with FCCPs. Providers were female, Hispanic, and Spanish speaking. Providers were asked about different aspects of feeding, PA, and ST behaviors. Themes were coded using NVivo10 (QSR International Pty Ltd, Doncaster, Victoria, Australia). Content analysis was used to analyze final themes. Providers understood the importance of providing opportunities for healthy eating and PA for the children they cared for, but there was room for improvement, especially with regard to certain feeding and ST practices. Several barriers were evident, including the lack of physical infrastructure for PA, cultural beliefs and practices related to child feeding, and difficulties working with parents to provide consistent messages across environments. Given that FCCPs are aware of the importance of healthy eating and PA, there is a need to address the specific barriers they face, and operationalize some of their knowledge into practical everyday actions. This formative work will inform the development of a culturally relevant, multicomponent intervention for ethnically diverse FCCPs to improve the food and PA environments of their homes, which should, in turn, improve the dietary, PA, and ST behaviors of the 2- to 5-year-old children they care for.

  19. Continuity in the provider of home-based physical therapy services and its implications for outcomes of patients.

    Science.gov (United States)

    Russell, David; Rosati, Robert J; Andreopoulos, Evie

    2012-02-01

    A growing body of research suggests that greater continuity of health care is positively associated with improved outcomes of patients. However, few studies have examined this issue in the context of physical therapy. The purpose of this study was to evaluate whether the level of continuity in the provider (provider continuity) of physical therapy services was related to outcomes in a population of patients receiving home health care. This was a retrospective observational study. Clinical and administrative records were retrieved for a population of adult patients receiving physical therapy services from a large, urban, not-for-profit certified home health care agency in 2009. Descriptive and multivariable analyses were used to examine how the level of provider continuity, calculated by use of a formula that models dispersion in contact between the patient and the providers of physical therapy services, varied across characteristics and outcomes of patients. Logistic regression analyses indicated that patients with lower levels of provider continuity had significantly higher odds of hospitalization (odds ratio [OR]=2.06, 95% confidence interval [CI]=1.90-2.23) and lower odds of improvements in the number of activity limitations (OR=0.85, 95% CI=0.80-0.92) and in the severity of activity limitations (OR=0.85, 95% CI=0.78-0.93) between the beginning and the end of the home health care episode. Baseline clinical characteristics associated with continuity of care suggest some level of indication bias. Outcome measures for activities of daily living were limited to patients who were not hospitalized during their home health stay. These findings build upon research suggesting that continuity in the patient-provider relationship is an important determinant of outcomes of patients.

  20. Eliciting Provider and Patient Perspectives on New Obesity Management Services in a Team-Based Primary Care Organization.

    Science.gov (United States)

    Royall, Dawna; Brauer, Paula; Atta-Konadu, Edwoba; Dwyer, John J M; Edwards, A Michelle; Hussey, Tracy; Kates, Nick

    2017-09-01

    Both providers and patients may have important insights to inform the development of obesity prevention and management services in Canadian primary care settings. In this formative study, insights for new obesity management services were sought from both providers and patients in 1 progressive citywide organization (150 physicians, team services, separate offices). Seven focus groups with interprofessional health providers (n = 56) and 4 focus groups with patients (n = 34) were conducted. Two clinical vignettes (adult, child) were used to focus discussion. Four analysts coded for descriptive content and interpretative themes on possible tools and care processes using NVivo. Participants identified numerous strategies for care processes, most of which could be categorized into 1 or more of 11 themes: 6 directed at clinical care of patients (raising awareness, screening, clinical care, skill building, ongoing support, and social/peer support) and 5 directed at the organization (coordination/collaboration, creating awareness among health professionals, adding new expertise to the team, marketing, and lobbying/advocacy). The approach was successful in generating an extensive list of diverse activities to be considered for implementation studies. Both patients and providers identified that multiple strategies and systems approaches will be needed to address obesity management in primary care.

  1. Using Case-Based Reasoning to Improve the Quality of Feedback Provided by Automated Assessment Systems for Programming Exercises

    Science.gov (United States)

    Kyrilov, Angelo

    2017-01-01

    Information technology is now ubiquitous in higher education institutions worldwide. More than 85% of American universities use e-learning systems to supplement traditional classroom activities. An obvious benefit of these online tools is their ability to automatically grade exercises submitted by students and provide immediate feedback. Most of…

  2. Role of Private Sector in Providing Tuberculosis Care: Evidence from a Population-based Survey in India.

    Science.gov (United States)

    Hazarika, Indrajit

    2011-01-01

    In India, a large segment of the population seeks health care services from individual or institutional private health-care providers for health care. We analyzed a nationally representative data to identify the role of private providers in delivering health care for patients with tuberculosis. The primary data source for the present analysis was the 60(th) round of the National Sample Survey. Distribution frequencies were used to analyze the distribution of key sociodemographic variables and multiple logistic regression was used to analyze the association between these variables and healthcare seeking behavior. A sample of 2203 respondents who had received ambulatory care for tuberculosis, and 4568 respondents who had received inpatient treatment were analyzed. About half of the respondents had attended private facilities for TB care. Sociodemographic variables such as paediatric age group, females, higher level of education, and economic groups were associated with attendance at private sector. Dissatisfaction with services in government facilities was cited as the main reason for preferring private facilities. Private providers play an important role in providing health care services to a large proportion of patients with tuberculosis. There is a need for innovative measures to increase participation of the private sector in the national TB control program and to improve the quality of services in government facilities.

  3. Role of private sector in providing tuberculosis care: Evidence from a population-based survey in India

    Directory of Open Access Journals (Sweden)

    Indrajit Hazarika

    2011-01-01

    Full Text Available Background: In India, a large segment of the population seeks health care services from individual or institutional private health-care providers for health care. We analyzed a nationally representative data to identify the role of private providers in delivering health care for patients with tuberculosis. Materials and Methods: The primary data source for the present analysis was the 60 th round of the National Sample Survey. Distribution frequencies were used to analyze the distribution of key sociodemographic variables and multiple logistic regression was used to analyze the association between these variables and healthcare seeking behavior. Results: A sample of 2203 respondents who had received ambulatory care for tuberculosis, and 4568 respondents who had received inpatient treatment were analyzed. About half of the respondents had attended private facilities for TB care. Sociodemographic variables such as paediatric age group, females, higher level of education, and economic groups were associated with attendance at private sector. Dissatisfaction with services in government facilities was cited as the main reason for preferring private facilities. Conclusions: Private providers play an important role in providing health care services to a large proportion of patients with tuberculosis. There is a need for innovative measures to increase participation of the private sector in the national TB control program and to improve the quality of services in government facilities.

  4. Factors that drive insulin-dosing decisions of diabetes care providers: a vignette-based study in the Netherlands

    NARCIS (Netherlands)

    Simon, A. C. R.; Schopman, J. E.; Hoekstra, J. B. L.; Abu-Hanna, A.; Gerdes, V. E. A.; Peek, N.; Holleman, F.

    2015-01-01

    To test how certain patient factors would influence the decision of Dutch care providers regarding insulin dose adjustments. We hypothesize that some of these decisions would diverge from recent evidence and consensus statements. We developed narrative vignettes describing clinical scenarios of

  5. Providing Spark and Stability: The Role of Intermediary Organizations in Establishing School-Based Youth-Adult Partnerships

    Science.gov (United States)

    Mitra, Dana L.; Sanders, Felicia C.; Perkins, Daniel F.

    2010-01-01

    The term "youth-adult partnership" increasingly is being used to define a relationship in which both youth and adults have the potential to contribute to decision making processes, to learn from one another, and to promote change. Establishing a relationship with an "intermediary organization" can provide much needed stability and sustainability…

  6. Addiction treatment provider attitudes on staff capacity and evidence-based clinical training: results from a national study.

    Science.gov (United States)

    Lundgren, Lena; Amodeo, Maryann; Krull, Ivy; Chassler, Deborah; Weidenfeld, Rachel; de Saxe Zerden, Lisa; Gowler, Rebekah; Lederer, Jaime; Cohen, Alexander; Beltrame, Clelia

    2011-01-01

    This national study of addiction-treatment organizations' implementation of evidence-based practices examines: (1) organizational/leadership factors associated with director (n = 212) attitudes regarding staff resistance to organizational change, and (2) organizational/staff factors associated with staff (n = 312) attitudes regarding evidence-based clinical training. Linear regression analyses, controlling for type of treatment unit, leadership/staff characteristics and organizational readiness to change, identified that directors who perceived their organization needed more guidance and had less staff cohesion and autonomy rated staff resistance to organizational change significantly higher. Staff with higher levels of education and greater agreement that their organization supported change had greater preference for evidence-based trainings. Federal addiction treatment policy should both promote education and training of treatment staff and organizational development of treatment CBOs.  © American Academy of Addiction Psychiatry.

  7. 2015 ACC Health Policy Statement on Cardiovascular Team-Based Care and the Role of Advanced Practice Providers.

    Science.gov (United States)

    Brush, John E; Handberg, Eileen M; Biga, Cathleen; Birtcher, Kim K; Bove, Alfred A; Casale, Paul N; Clark, Michael G; Garson, Arthur; Hines, Jerome L; Linderbaum, Jane A; Rodgers, George P; Shor, Robert A; Thourani, Vinod H; Wyman, Janet F

    2015-05-19

    The mission of the American College of Cardiology is "to transform cardiovascular care and improve heart health." Cardiovascular team-based care is a paradigm for practice that can transform care, improve heart health, and help meet the demands of the future. One strategic goal of the College is to help members successfully transition their clinical practices to the future, with all its complexity, challenges, and opportunities. The ACC's strategic plan is aligned with the triple aim of improved care, improved population health, and lower costs per capita. The traditional understanding of quality, access, and cost is that you cannot improve one component without diminishing the others. With cardiovascular team-based care, it is possible to achieve the triple aim of improving quality, access, and cost simultaneously to also improve cardiovascular health. Striving to serve the best interests of patients is the true north of our guiding principles. Cardiovascular team-based care is a model that can improve care coordination and communication and allow each team member to focus more on the quality of care. In addition, the cardiovascular team-based care model increases access to cardiovascular care and allows expansion of services to populations and geographic areas that are currently underserved. This document will increase awareness of the important components of cardiovascular team-based care and create an opportunity for more discussion about the most creative and effective means of implementing it. We hope that this document will stimulate further discussions and activities within the ACC and beyond about team-based care. We have identified areas that need improvement, specifically in APP education and state regulation. The document encourages the exploration of collaborative care models that should enable team members to optimize their education, training, experience, and talent. Improved team leadership, coordination, collaboration, engagement, and efficiency

  8. Providing High-Quality Support Services to Home-Based Child Care: A Conceptual Model and Literature Review

    Science.gov (United States)

    Bromer, Juliet; Korfmacher, Jon

    2017-01-01

    Research Findings: Home-based child care accounts for a significant proportion of nonparental child care arrangements for young children in the United States. Yet the early care and education field lacks clear models or pathways for how to improve quality in these settings. The conceptual model presented here articulates the components of…

  9. Training Addiction Counselors to Implement an Evidence-Based Intervention: Strategies for Increasing Organizational and Provider Acceptance

    Science.gov (United States)

    Woo, Stephanie M.; Hepner, Kimberly A.; Gilbert, Elizabeth A.; Osilla, Karen Chan; Hunter, Sarah B.; Munoz, Ricardo F.; Watkins, Katherine E.

    2013-01-01

    One barrier to widespread public access to empirically supported treatments (ESTs) is the limited availability and high cost of professionals trained to deliver them. Our earlier work from 2 clinical trials demonstrated that front-line addiction counselors could be trained to deliver a manualized, group-based cognitive behavioral therapy (GCBT)…

  10. A Review of the Use of Script-Based Tracking in CALL Research for Data Sharing: Applications Providing Meaning Aids

    Science.gov (United States)

    Hwu, Fenfang

    2013-01-01

    Using script-based tracking to gain insights into the way students learn or process language information can be traced as far back as to the 1980s. Nevertheless, researchers continue to face challenges in collecting and studying this type of data. The objective of this study is to propose data sharing through data repositories as a way to (a) ease…

  11. Combination Treatment of People with Multiple Sclerosis based on Collaboration between Conventional Healthcare Providers and Alternative Practitioners

    DEFF Research Database (Denmark)

    Skovgaard, Lasse; Launsø, Laila; Pedersen, Inge Kryger

    2011-01-01

    The use of alternative and complementary medicine (CAM) is prevalent among People with Multiple Sclerosis (PwMS) in Denmark as well as in other Western countries. Many PwMS combine conventional treatments and CAM; however there is little research-based knowledge about the outcomes that PwMS achieve...

  12. Providing education on evidence-based practice improved knowledge but did not change behaviour: a before and after study

    Directory of Open Access Journals (Sweden)

    Lovarini Meryl

    2005-12-01

    Full Text Available Abstract Background Many health professionals lack the skills to find and appraise published research. This lack of skills and associated knowledge needs to be addressed, and practice habits need to change, for evidence-based practice to occur. The aim of this before and after study was to evaluate the effect of a multifaceted intervention on the knowledge, skills, attitudes and behaviour of allied health professionals. Methods 114 self-selected occupational therapists were recruited. The intervention included a 2-day workshop combined with outreach support for eight months. Support involved email and telephone contact and a workplace visit. Measures were collected at baseline, post-workshop, and eight months later. The primary outcome was knowledge, measured using the Adapted Fresno Test of Evidence-Based Practice (total score 0 to 156. Secondary outcomes were attitude to evidence-based practice (% reporting improved skills and confidence; % reporting barriers, and behaviour measured using an activity diary (% engaging/not engaging in search and appraisal activities, and assignment completion. Results Post-workshop, there were significant gains in knowledge which were maintained at follow-up. The mean difference in the Adapted Fresno Test total score was 20.6 points (95% CI, 15.6 to 25.5. The change from post-workshop to follow-up was small and non-significant (mean difference 1.2 points, 95% CI, -6.0 to 8.5. Fewer participants reported lack of searching and appraisal skills as barriers to evidence-based practice over time (searching = 61%, 53%, 24%; appraisal 60%, 65%, 41%. These differences were statistically significant (p = 0.0001 and 0.010 respectively. Behaviour changed little. Pre-workshop, 6% engaged in critical appraisal increasing to 18% post-workshop and 18% at follow-up. Nearly two thirds (60% were not reading any research literature at follow-up. Twenty-three participants (20.2% completed their assignment. Conclusion Evidence-based

  13. Improving paediatric outreach services for urban Aboriginal children through partnerships: views of community-based service providers.

    Science.gov (United States)

    Thomas, S L; Williams, K; Ritchie, J; Zwi, K

    2015-11-01

    In Australia, Aboriginal children experience significantly poorer health outcomes compared with non-Aboriginal children. Health policies aimed at improving Aboriginal health outcomes include interventions in the early childhood period. There is a need for government health services to work in partnership with Aboriginal people and other services to achieve the highest level of health possible for Aboriginal children, who often require a range of services to meet complex needs. This paper describes the views of service providers on how paediatric outreach services work in partnership with other services, Aboriginal families and the community and how those partnerships could be improved to maximize health outcomes for children. In-depth, semi-structured interviews and focus groups were conducted with managers and service providers over a 6-week period in 2010. The views and suggestions of participants were documented and a thematic analysis was undertaken. Analysis of two focus groups with seven service providers and five individual interviews with service managers resulted in the identification of four themes: (i) using informal and formal ways of working; (ii) cultivating effective relationships; (iii) demonstrating cultural sensitivity; and (iv) forging strong leadership. Use of formal and informal approaches facilitated effective relationships between service providers and Aboriginal families and communities. Partnerships with the community were founded on a culturally appropriate model of care that recognized a holistic approach to health and wellness. Leadership emerged as an essential component of effective partnerships, cultivating the ethos of the workplace and creating an environment where collaboration is supported. Culturally appropriate child health services, which utilize effective relationships and employ a range of informal and formal collaboration with other services and community members, are well positioned to implement health policy and improve

  14. The limits of market-based reforms in the NHS: the case of alternative providers in primary care

    Science.gov (United States)

    2013-01-01

    Background Historically, primary medical care in the UK has been delivered by general practitioners who are independent contractors, operating under a contract, which until 2004 was subject to little performance management. In keeping with the wider political impetus to introduce markets and competition into the NHS, reforms were introduced to allow new providers to bid for contracts to provide primary care services in England. These contracts known as ‘Alternative Provider Medical Services’, were encouraged by two centrally-driven rounds of procurement (2007/8 and 2008/9). This research investigated the commissioning and operation of such Alternative Providers of Primary Care (APPCs). Methods Two qualitative case studies were undertaken in purposively sampled English Primary Care Trusts (PCTs) and their associated APPCs over 14 months (2009-10). We observed 65 hours of meetings, conducted 23 interviews with PCT and practice staff, and gathered relevant associated documentation. Results and conclusions We found that the procurement and contracting process was costly and time-consuming. Extensive local consultation was undertaken, and there was considerable opposition in some areas. Many APPCs struggled to build up their patient list sizes, whilst over-performing on walk-in contracts. Contracting for APPCs was ‘transactional’, in marked contrast to the ‘relational’ contracting usually found in the NHS, with APPCs subject to tight performance management. These complicated and costly processes contrast to those experienced by traditionally owned GP partnerships. However, managers reported that the perception of competition had led existing practices to improve their services. The Coalition Government elected in 2010 is committed to ‘Any Qualified Provider’ of secondary care, and some commentators argue that this should also be applied to primary care. Our research suggests that, if this is to happen, a debate is needed about the operation of a market

  15. The Strategic Petroleum Reserve

    Energy Technology Data Exchange (ETDEWEB)

    1991-01-01

    The Strategic Petroleum Reserve program was set into motion by the 1975 Energy Policy and Conservation Act (EPCA). By 1990, 590 million barrels of oil had been placed in storage. Salt domes along the Gulf Coast offered ideal storage. Both sweet'' and sour'' crude oil have been acquired using various purchase options. Drawdown, sale, and distribution of the oil would proceed according to guidelines set by EPCA in the event of a severe energy supply disruption. (SM)

  16. [Hypertrophy and coronary reserve].

    Science.gov (United States)

    Motz, W; Scheler, S

    2008-12-01

    Left ventricular hypertrophy represents the structural mechanism of adaptation of the left ventricle as the answer of a chronic pressure overload in arterial hypertension. Initially an increment in left ventricular wall thickness occurs. In this stadium of "concentric hypertrophy" LV systolic wall stress, LV ejection fraction and myocardial oxygen consumption per weight unit myocardium remain unchanged. In the further time course of disease LV dilatation will be present. In this phase of "excentric hypertrophy" LV systolic wall stress and myocardial oxygen consumption per weight unit myocardium rise and LV ejection fraction decreases. Patients with arterial hypertension frequently complain of angina pectoris. Angina pectoris and the positive exercise tolerance test or the positive myocardial scintigraphy are the consequence of the impaired coronary flow reserve. The coronary flow reserve is diminished due to structural and functional changes of the coronary circulation. ACE-inhibitors and AT1-receptor blockers cause a significant improvement of coronary flow reserve and regression of both left ventricular hypertrophy and myocardial fibrosis.

  17. Are deterministic methods suitable for short term reserve planning?

    International Nuclear Information System (INIS)

    Voorspools, Kris R.; D'haeseleer, William D.

    2005-01-01

    Although deterministic methods for establishing minutes reserve (such as the N-1 reserve or the percentage reserve) ignore the stochastic nature of reliability issues, they are commonly used in energy modelling as well as in practical applications. In order to check the validity of such methods, two test procedures are developed. The first checks if the N-1 reserve is a logical fixed value for minutes reserve. The second test procedure investigates whether deterministic methods can realise a stable reliability that is independent of demand. In both evaluations, the loss-of-load expectation is used as the objective stochastic criterion. The first test shows no particular reason to choose the largest unit as minutes reserve. The expected jump in reliability, resulting in low reliability for reserve margins lower than the largest unit and high reliability above, is not observed. The second test shows that both the N-1 reserve and the percentage reserve methods do not provide a stable reliability level that is independent of power demand. For the N-1 reserve, the reliability increases with decreasing maximum demand. For the percentage reserve, the reliability decreases with decreasing demand. The answer to the question raised in the title, therefore, has to be that the probability based methods are to be preferred over the deterministic methods

  18. RNA-Seq-based transcriptome profiling of early nitrogen deficiency response in cucumber seedlings provides new insight into the putative nitrogen regulatory network.

    Science.gov (United States)

    Zhao, Wenchao; Yang, Xueyong; Yu, Hongjun; Jiang, Weijie; Sun, Na; Liu, Xiaoran; Liu, Xiaolin; Zhang, Xiaomeng; Wang, Yan; Gu, Xingfang

    2015-03-01

    Nitrogen (N) is both an important macronutrient and a signal for plant growth and development. However, the early regulatory mechanism of plants in response to N starvation is not well understood, especially in cucumber, an economically important crop that normally consumes excessive N during production. In this study, the early time-course transcriptome response of cucumber leaves under N deficiency was monitored using RNA sequencing (RNA-Seq). More than 23,000 transcripts were examined in cucumber leaves, of which 364 genes were differentially expressed in response to N deficiency. Based on the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway database, gene ontology (GO) and protein-protein interaction analysis, 64 signaling-related N-deficiency-responsive genes were identified. Furthermore, the potential regulatory mechanisms of anthocyanin accumulation, Chl decline and cell wall remodeling were assessed at the transcription level. Increased ascorbic acid synthesis was identified in cucumber seedlings and fruit under N-deficient conditions, and a new corresponding regulatory hypothesis has been proposed. A data cross-comparison between model plants and cucumber was made, and some common and specific N-deficient response mechanisms were found in the present study. Our study provides novel insights into the responses of cucumber to nitrogen starvation at the global transcriptome level, which are expected to be highly useful for dissecting the N response pathways in this major vegetable and for improving N fertilization practices. © The Author 2014. Published by Oxford University Press on behalf of Japanese Society of Plant Physiologists. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  19. A tetravalent alphavirus-vector based dengue vaccine provides effective immunity in an early life mouse model.

    Science.gov (United States)

    Khalil, Syed Muaz; Tonkin, Daniel R; Mattocks, Melissa D; Snead, Andrew T; Johnston, Robert E; White, Laura J

    2014-07-07

    Dengue viruses (DENV1-4) cause 390 million clinical infections every year, several hundred thousand of which progress to severe hemorrhagic and shock syndromes. Preexisting immunity resulting from a previous DENV infection is the major risk factor for severe dengue during secondary heterologous infections. During primary infections in infants, maternal antibodies pose an analogous risk. At the same time, maternal antibodies are likely to prevent induction of endogenous anti-DENV antibodies in response to current live, attenuated virus (LAV) vaccine candidates. Any effective early life dengue vaccine has to overcome maternal antibody interference (leading to ineffective vaccination) and poor induction of antibody responses (increasing the risk of severe dengue disease upon primary infection). In a previous study, we demonstrated that a non-propagating Venezuelan equine encephalitis virus replicon expression vector (VRP), expressing the ectodomain of DENV E protein (E85), overcomes maternal interference in a BALB/c mouse model. We report here that a single immunization with a tetravalent VRP vaccine induced NAb and T-cell responses to each serotype at a level equivalent to the monovalent vaccine components, suggesting that this vaccine modality can overcome serotype interference. Furthermore, neonatal immunization was durable and could be boosted later in life to further increase NAb and T-cell responses. Although the neonatal immune response was lower in magnitude than responses in adult BALB/c mice, we demonstrate that VRP vaccines generated protective immunity from a lethal challenge after a single neonatal immunization. In summary, VRP vaccines expressing DENV antigens were immunogenic and protective in neonates, and hence are promising candidates for safe and effective vaccination in early life. Copyright © 2014 Elsevier Ltd. All rights reserved.

  20. Fourier-transform infrared spectroscopy as a novel approach to providing effect-based endpoints in duckweed toxicity testing.

    Science.gov (United States)

    Hu, Li-Xin; Ying, Guang-Guo; Chen, Xiao-Wen; Huang, Guo-Yong; Liu, You-Sheng; Jiang, Yu-Xia; Pan, Chang-Gui; Tian, Fei; Martin, Francis L

    2017-02-01

    Traditional duckweed toxicity tests only measure plant growth inhibition as an endpoint, with limited effects-based data. The present study aimed to investigate whether Fourier-transform infrared (FTIR) spectroscopy could enhance the duckweed (Lemna minor L.) toxicity test. Four chemicals (Cu, Cd, atrazine, and acetochlor) and 4 metal-containing industrial wastewater samples were tested. After exposure of duckweed to the chemicals, standard toxicity endpoints (frond number and chlorophyll content) were determined; the fronds were also interrogated using FTIR spectroscopy under optimized test conditions. Biochemical alterations associated with each treatment were assessed and further analyzed by multivariate analysis. The results showed that comparable x% of effective concentration (ECx) values could be achieved based on FTIR spectroscopy in comparison with those based on traditional toxicity endpoints. Biochemical alterations associated with different doses of toxicant were mainly attributed to lipid, protein, nucleic acid, and carbohydrate structural changes, which helped to explain toxic mechanisms. With the help of multivariate analysis, separation of clusters related to different exposure doses could be achieved. The present study is the first to show successful application of FTIR spectroscopy in standard duckweed toxicity tests with biochemical alterations as new endpoints. Environ Toxicol Chem 2017;36:346-353. © 2016 SETAC. © 2016 SETAC.

  1. Translating research into practice: the role of provider-based research networks in the diffusion of an evidence-based colon cancer treatment innovation.

    Science.gov (United States)

    Carpenter, William R; Meyer, Anne-Marie; Wu, Yang; Qaqish, Bahjat; Sanoff, Hanna K; Goldberg, Richard M; Weiner, Bryan J

    2012-08-01

    Provider-based research networks (PBRNs)--collaborative research partnerships between academic centers and community-based practitioners--are a promising model for accelerating the translation of research into practice; however, empirical evidence of accelerated translation is limited. Oxaliplatin in adjuvant combination chemotherapy is an innovation with clinical trial-proven survival benefit compared with prior therapies. The goal of this study is to examine the diffusion of oxaliplatin into community practice, and whether affiliation with the National Cancer Institute's (NCI's) Community Clinical Oncology Program (CCOP)--a nationwide cancer-focused PBRN--is associated with accelerated innovation adoption. This retrospective observational study used linked Surveillance, Epidemiology, and End Results-Medicare and NCI CCOP data to examine Medicare participants with stage III colon cancer initiating treatment in 2003 through 2006, the years surrounding oxaliplatin's Food and Drug Administration approval. A fixed-effects analysis examined chemotherapy use among patients treated outside academic centers at CCOP-affiliated practices compared with non-CCOP practices. Two-group modeling controlled for multiple levels of clustering, year of chemotherapy initiation, tumor characteristics, patient age, race, comorbidity, Medicaid dual-eligibility status, and education. Of 4055 community patients, 35% received 5-fluoruracil, 20% received oxaliplatin, 7% received another chemotherapy, and 38% received no chemotherapy. Twenty-five percent of CCOP patients received oxaliplatin, compared with 19% of non-CCOP patients. In multivariable analysis, CCOP exposure was associated with higher odds of receiving guideline-concordant treatment in general, and oxaliplatin specifically. These findings contribute to a growing set of evidence linking PBRNs with a greater probability of receiving treatment innovations and high-quality cancer care, with implications for clinical and research

  2. Helping people cope with bereavement: an opportunity for health care providers to link Web-based resources across Minnesota.

    Science.gov (United States)

    Jatoi, Aminah; Jacobs, Jane A; Zimmermann, Elizabeth; Johnson, Mary E; Nguyen, Phuong L; Hartmann, Lynn C

    2006-10-01

    The death of a loved one has a profound effect on the surviving spouse or partner, family members, and friends. But the bereaved may not always get the help and support they need. This article reviews the toll that grief takes on individuals and society and highlights the importance of connecting grieving loved ones with resources that can help them. It also suggests a need for health care institutions across the state to share information about their particular resources via the Internet with health care providers and patients.

  3. Demand Response Spinning Reserve Demonstration

    Energy Technology Data Exchange (ETDEWEB)

    Eto, Joseph H.; Nelson-Hoffman, Janine; Torres, Carlos; Hirth,Scott; Yinger, Bob; Kueck, John; Kirby, Brendan; Bernier, Clark; Wright,Roger; Barat, A.; Watson, David S.

    2007-05-01

    The Demand Response Spinning Reserve project is a pioneeringdemonstration of how existing utility load-management assets can providean important electricity system reliability resource known as spinningreserve. Using aggregated demand-side resources to provide spinningreserve will give grid operators at the California Independent SystemOperator (CAISO) and Southern California Edison (SCE) a powerful, newtool to improve system reliability, prevent rolling blackouts, and lowersystem operating costs.

  4. Forming and sustaining partnerships to provide integrated services for young people: an overview based on the headspace Geelong experience.

    Science.gov (United States)

    Callaly, Tom; von Treuer, Kathryn; van Hamond, Toni; Windle, Kelly

    2011-02-01

    To discuss critical considerations in the formation and maintenance of agency partnerships designed to provide integrated care for young people. Two years after its establishment, an evaluation of the headspace Barwon collaboration and a review of the health-care and management literature on agency collaboration were conducted. The principal findings together with the authors' experience working at establishing and maintaining the partnership are used to discuss critical issues in forming and maintaining inter-agency partnerships. Structural and process considerations are necessary but not sufficient for the successful formation and maintenance of inter-agency partnerships and integrated care provision. Specifically, organizational culture change and staff engagement is a significant challenge and planning for this is essential and often neglected. Although agreeing on common goals and objectives is an essential first step in forming partnerships designed to provide integrated care, goodwill is not enough, and the literature consistently shows that most collaborations fail to meet their objectives. Principles and lessons of organizational behaviour and management practices in the business sector can contribute a great deal to partnership planning. © 2011 Blackwell Publishing Asia Pty Ltd.

  5. Right hemisphere role in cognitive reserve.

    Science.gov (United States)

    Robertson, Ian H

    2014-06-01

    High levels of education, occupational complexity, and/or premorbid intelligence are associated with lower levels of cognitive impairment than would be expected from a given brain pathology. This has been observed across a range of conditions including Alzheimer's disease (Roe et al., 2010), stroke (Ojala-Oksala et al., 2012), traumatic brain injury (Kesler et al., 2003), and penetrating brain injury (Grafman, 1986). This cluster of factors, which seemingly protect the brain from expressing symptoms of damage, has been termed "cognitive reserve" (Stern, 2012). The current review considers one possible neural network, which may contribute to cognitive reserve. Based on the evidence that the neurotransmitter, noradrenaline mediates cognitive reserve's protective effects (Robertson, 2013) this review identifies the neurocognitive correlates of noradrenergic (NA) activity. These involve a set of inter-related cognitive processes (arousal, sustained attention, response to novelty, and awareness) with a strongly right hemisphere, fronto-parietal localization, along with working memory, which is also strongly modulated by NA. It is proposed that this set of processes is one plausible candidate for partially mediating the protective effects of cognitive reserve. In addition to its biological effects on brain structure and function, NA function may also facilitate networks for arousal, novelty, attention, awareness, and working memory, which collectively provide for a set of additional, cognitive, mechanisms that help the brain adapt to age-related changes and disease. It is hypothesized that to the extent that the lateral surface of the right prefrontal lobe and/or the right inferior parietal lobe maintain structural (white and gray matter) and functional integrity and connectivity, cognitive reserve should benefit and behavioral expression of pathologic damage should thus be mitigated. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. Least squares QR-based decomposition provides an efficient way of computing optimal regularization parameter in photoacoustic tomography.

    Science.gov (United States)

    Shaw, Calvin B; Prakash, Jaya; Pramanik, Manojit; Yalavarthy, Phaneendra K

    2013-08-01

    A computationally efficient approach that computes the optimal regularization parameter for the Tikhonov-minimization scheme is developed for photoacoustic imaging. This approach is based on the least squares-QR decomposition which is a well-known dimensionality reduction technique for a large system of equations. It is shown that the proposed framework is effective in terms of quantitative and qualitative reconstructions of initial pressure distribution enabled via finding an optimal regularization parameter. The computational efficiency and performance of the proposed method are shown using a test case of numerical blood vessel phantom, where the initial pressure is exactly known for quantitative comparison.

  7. 24 CFR 891.745 - Replacement reserve.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Replacement reserve. 891.745... and Individuals-Section 162 Assistance § 891.745 Replacement reserve. The general requirements for the replacement reserve are provided in § 891.605. For projects funded under §§ 891.655 through 891.790, the...

  8. Fractional Reserve Banking

    OpenAIRE

    Andreasen, Niels; Bjerregaard, Mads; Lund, Jonas; Olsen, Ove Bitsch; Rasmussen, Andreas Dalgas

    2012-01-01

    Projektet er bygget op omkring kritisk realisme, som er det gennemgående videnskabelige fundament til undersøgelsen af hvilke strukturelle grunde der er til finansiel ustabilitet i Danmark. Projektet går i dybden med Fractional Reserve Banking og incitamentsstrukturen i banksystemet. Vi bevæger os både på det makro- og mikroøkonomiske niveau i analysen. På makro niveau bruger vi den østrigske skole om konjunktur teori (The Positive Theory of the Cycle). På mikro niveau arbejder vi med princip...

  9. Satellite image based quantification of invasion and patch dynamics of mesquite ( Prosopis juliflora) in Great Rann of Kachchh, Kachchh Biosphere Reserve, Gujarat, India

    Science.gov (United States)

    Pasha, S. Vazeed; Satish, K. V.; Reddy, C. Sudhakar; Prasada Rao, P. V. V.; Jha, C. S.

    2014-10-01

    The invasion of alien species is a significant threat to global biodiversity and the top driver of climate change. The present study was conducted in the Great Rann of Kachchh, part of Kachchh Biosphere Reserve, Gujarat, India, which has been severely affected by invasion of Prosopis juliflora. The invasive weed infestation has been identified using multi-temporal remote sensing datasets of 1977, 1990, 1999, 2005 and 2011. Spatial analyses of the transition matrix, extent of invasive colonies, patchiness, coalescence and rate of spread were carried out. During the study period of three and half decades, almost 295 km2 of the natural land cover was converted into Prosopis cover. This study has shown an increment of 42.9% of area under Prosopis cover in the Great Rann of Kachchh, part of the Kachchh Biosphere Reserve during 1977 to 2011. Spatial analysis indicates high occupancy of Prosopis cover with most of the invasion (95.9%) occurring in the grasslands and only 4.1% in other land cover types. The process of Prosopis invasion shows high patch initiation, followed by coalescence, indicating aggressive colonization of species. The number of patches within an area of < 1 km2 increased from 1977 to 2011, indicating the formation of new Prosopis habitats by replacing the grasslands. The largest patch of Prosopis cover increased from 144 km2 in 1977 to 430 km2 in 2011. The estimated mean patch size was 7.8 km2 in 1977. The mean patch size was largest during 2011, i.e., 9 km2. The annual spread rate for Prosopis has been estimated as 2.1% during 2005-2011. The present work has investigated the long term changes in Prosopis cover in the Great Rann of Kachchh, part of Kachchh Biosphere Reserve. The spatial database generated will be useful in preparing strategies for the management of Prosopis juliflora.

  10. Providing Limited Local Electric Service During a Major Grid Outage: A First Assessment Based on Customer Willingness to Pay.

    Science.gov (United States)

    Baik, Sunhee; Morgan, M Granger; Davis, Alexander L

    2018-02-01

    While they are rare, widespread blackouts of the bulk power system can result in large costs to individuals and society. If local distribution circuits remain intact, it is possible to use new technologies including smart meters, intelligent switches that can change the topology of distribution circuits, and distributed generation owned by customers and the power company, to provide limited local electric power service. Many utilities are already making investments that would make this possible. We use customers' measured willingness to pay to explore when the incremental investments needed to implement these capabilities would be justified. Under many circumstances, upgrades in advanced distribution systems could be justified for a customer charge of less than a dollar a month (plus the cost of electricity used during outages), and would be less expensive and safer than the proliferation of small portable backup generators. We also discuss issues of social equity, extreme events, and various sources of underlying uncertainty. © 2017 Society for Risk Analysis.

  11. Pilot study of patient perception of pharmacists as care providers based on health screening encounters with student pharmacists.

    Science.gov (United States)

    Palombi, Laura C; Nelson, Leah; Fierke, Kerry K; Bastianelli, Karen

    2015-01-01

    To assess how patient perceptions of the clinical role of pharmacists may be affected by use of the AIDET communication tool during student-led health fairs, as well as how such events can help promote pharmacy practice. 12 community health fair screenings throughout northeastern Minnesota and northwestern Wisconsin, from February to November 2012. University of Minnesota-College of Pharmacy students trained in the use of AIDET employed the tool's techniques in their communication with health fair patient attendees. Project participants were those patients aged 18 years and older who successfully completed a health fair survey. The AIDET communication tool is designed to provide consistency in patient encounters through the use of key words at key times. AIDET is a mnemonic acronym that stands for acknowledge, introduce, duration, explanation, and thank you. University of Minnesota-College of Pharmacy students are taught how to use the AIDET framework in classroom and laboratory settings prior to their interactions with patients at area health fairs. Health fair attendees were asked to complete a survey to determine their satisfaction level with student pharmacist-delivered pharmacy services. 87 patients were surveyed, with a response rate of 22.5% and a completion rate of 91.6%. The average age of the patient population for the study cohort was 52 years, with greater than 50% being 65 years or older. Patient ages ranged from 24 to 89 years. When AIDET techniques were employed in a health fair setting, patients reported high levels of satisfaction with pharmacy services and said they felt "happy, comfortable, and trusting." The AIDET framework provides a consistent process for patient-centered care delivery because it places emphasis on patient needs and expectations. Use of the technique is capable of enhancing student and pharmacist engagement with patients.

  12. Methodical approaches to providing sustainable development of the transport industry management system based on self-organization

    Science.gov (United States)

    Belyantseva, Oksana; Panenkov, Andrey; Safonova, Nataliya

    2017-10-01

    Current conditions of the cognitive economy formation demand to take into account the leading role of information, knowledge and human capital in the development of the transport industry management system. The article substantiates the conceptual approach to the self-organization of a management system on the basis of innovative changes. Human capital is the key aspect of self-organization, so the directions of improving the workforce quality are justified. Basing on the information-innovative genesis of the process of self-organization, the authors justified the necessity of preventing asymmetric information. For this pupose the actions against the resistance to innovations were proposed. The implementation of certain measures contributes to the effective development of the transport management system.

  13. Ultrasound Indoor Positioning System Based on a Low-Power Wireless Sensor Network Providing Sub-Centimeter Accuracy

    Science.gov (United States)

    Medina, Carlos; Segura, José Carlos; De la Torre, Ángel

    2013-01-01

    This paper describes the TELIAMADE system, a new indoor positioning system based on time-of-flight (TOF) of ultrasonic signal to estimate the distance between a receiver node and a transmitter node. TELIAMADE system consists of a set of wireless nodes equipped with a radio module for communication and a module for the transmission and reception of ultrasound. The access to the ultrasonic channel is managed by applying a synchronization algorithm based on a time-division multiplexing (TDMA) scheme. The ultrasonic signal is transmitted using a carrier frequency of 40 kHz and the TOF measurement is estimated by applying a quadrature detector to the signal obtained at the A/D converter output. Low sampling frequencies of 17.78 kHz or even 12.31 kHz are possible using quadrature sampling in order to optimize memory requirements and to reduce the computational cost in signal processing. The distance is calculated from the TOF taking into account the speed of sound. An excellent accuracy in the estimation of the TOF is achieved using parabolic interpolation to detect of maximum of the signal envelope at the matched filter output. The signal phase information is also used for enhancing the TOF measurement accuracy. Experimental results show a root mean square error (rmse) less than 2 mm and a standard deviation less than 0.3 mm for pseudorange measurements in the range of distances between 2 and 6 m. The system location accuracy is also evaluated by applying multilateration. A sub-centimeter location accuracy is achieved with an average rmse of 9.6 mm. PMID:23486218

  14. iTRAQ-based protein profiling provides insights into the central metabolism changes driving grape berry development and ripening.

    Science.gov (United States)

    Martínez-Esteso, María José; Vilella-Antón, María Teresa; Pedreño, María Ángeles; Valero, María Luz; Bru-Martínez, Roque

    2013-10-24

    Grapevine (Vitis vinifera L.) is an economically important fruit crop. Quality-determining grape components such as sugars, acids, flavors, anthocyanins, tannins, etc., accumulate in the different grape berry development stages. Thus, correlating the proteomic profiles with the biochemical and physiological changes occurring in grape is of paramount importance to advance in our understanding of berry development and ripening processes. We report the developmental analysis of Vitis vinifera cv. Muscat Hamburg berries at the protein level from fruit set to full ripening. An iTRAQ-based bottom-up proteomic approach followed by tandem mass spectrometry led to the identification and quantitation of 411 and 630 proteins in the green and ripening phases, respectively. Two key points in development relating to changes in protein level were detected: end of the first growth period (7 mm-to-15 mm) and onset of ripening (15 mm-to-V100, V100-to-110). A functional analysis was performed using the Blast2GO software based on the enrichment of GO terms during berry growth. The study of the proteome contributes to decipher the biological processes and metabolic pathways involved in the development and quality traits of fruit and its derived products. These findings lie mainly in metabolism and storage of sugars and malate, energy-related pathways such as respiration, photosynthesis and fermentation, and the synthesis of polyphenolics as major secondary metabolites in grape berry. In addition, some key steps in carbohydrate and malate metabolism have been identified in this study, i.e., PFP-PFK or SuSy-INV switches among others, which may influence the final sugar and acid balance in ripe fruit. In conclusion, some proteins not reported to date have been detected to be deregulated in specific tissues and developmental stages, leading to formulate new hypotheses on the metabolic processes underlying grape berry development. These results open up new lines to decipher the

  15. Ultrasound Indoor Positioning System Based on a Low-Power Wireless Sensor Network Providing Sub-Centimeter Accuracy

    Directory of Open Access Journals (Sweden)

    Ángel De la Torre

    2013-03-01

    Full Text Available This paper describes the TELIAMADE system, a new indoor positioning system based on time-of-flight (TOF of ultrasonic signal to estimate the distance between a receiver node and a transmitter node. TELIAMADE system consists of a set of wireless nodes equipped with a radio module for communication and a module for the transmission and reception of ultrasound. The access to the ultrasonic channel is managed by applying a synchronization algorithm based on a time-division multiplexing (TDMA scheme. The ultrasonic signal is transmitted using a carrier frequency of 40 kHz and the TOF measurement is estimated by applying a quadrature detector to the signal obtained at the A/D converter output. Low sampling frequencies of 17.78 kHz or even 12.31 kHz are possible using quadrature sampling in order to optimize memory requirements and to reduce the computational cost in signal processing. The distance is calculated from the TOF taking into account the speed of sound. An excellent accuracy in the estimation of the TOF is achieved using parabolic interpolation to detect of maximum of the signal envelope at the matched filter output. The signal phase information is also used for enhancing the TOF measurement accuracy. Experimental results show a root mean square error (rmse less than 2 mm and a standard deviation less than 0.3 mm for pseudorange measurements in the range of distances between 2 and 6 m. The system location accuracy is also evaluated by applying multilateration. A sub-centimeter location accuracy is achieved with an average rmse of 9.6 mm.

  16. Transposon-Based Reporter Marking Provides Functional Evidence for Intercellular Bridges in the Male Germline of Rabbits.

    Directory of Open Access Journals (Sweden)

    Orsolya I Hoffmann

    Full Text Available The Sleeping Beauty transposon system was established as a robust and efficient method for germline transgenesis in different mammalian species. The generation of transgenic mice, rats, rabbits and swine carrying an identical Venus reporter construct delivered by transposon-mediated gene transfer enables comparative studies of gene expression in these lines of mammalian models. Whereas comparable expression patterns of the Venus reporter were found in somatic tissues, preliminary studies suggested that a striking difference in reporter expression may exist in mature spermatozoa of these species. Here we clearly show the differential expression of Venus reporter protein during spermatogenesis of the two compared species, the laboratory rabbit and mice. We provide evidence for the functionality of intercellular bridges in the male germline and genotype-independent transgenic phenotype of rabbit spermatids. Our data suggest that the reporter rabbit line may be a suitable tool to identify molecular mechanisms in testicular development, and may contribute to develop better animal models for male infertility in men.

  17. Providing Policy Implication Based on the R and D Portfolio Analysis in Advanced Countries in the Nuclear Technology

    International Nuclear Information System (INIS)

    Moon, K. H.; Lee, M. K.; Won, B. C.; Kim, S. S.; Lee, J. H.; Yun, S. W.; Jeong, I. K.; Lee, Y. C.; Lee, Y. J.; Kim, Y. S.

    2013-08-01

    This study is to provide the investment direction of nuclear R and D, which is the most efficient and reasonable integrating the various aspects comprehensively. This study includes four parts. In the first part, we extracted Mega-trend and driving forces of nuclear R and D field by using various reports published by National Intelligence Council of US, UN, etc. Also, in this part we established the linkage between megatrend factors focussing on nuclear and the five aspects including society, technology, ecology, economics and politics. In the second part, we analyzed the nuclear R and D investment directions of major advanced countries including US, Japan, EU and China for comparing the investment portfolio in the specific research area. In the third part, domestic investment of nuclear R and D was reviewed by analyzing the investment trend of nuclear R and D in the past, with their connection to nuclear policy, and to the levels and capacities of national technologies of nuclear. In the final part, the desirable directions of nuclear R and D investment were suggested comprehensively taking into consideration various aspects including the Mega-trend associated with nuclear, nuclear R and D directions of major advanced countries, and the level and capacities of the domestic nuclear technologies

  18. Toward an evidence-based patient-provider communication in rehabilitation: linking communication elements to better rehabilitation outcomes.

    Science.gov (United States)

    Jesus, Tiago Silva; Silva, Isabel Lopes

    2016-04-01

    There is a growing interest in linking aspects of patient-provider communication to rehabilitation outcomes. However, the field lacks a conceptual understanding on: (a) 'how' rehabilitation outcomes can be improved by communication; and (b) through 'which' elements in particular. This article elaborates on the conceptual developments toward informing further practice and research. Existing models of communication in healthcare were adapted to rehabilitation, and its outcomes through a comprehensive literature review. After depicting mediating mechanisms and variables (e.g. therapeutic engagement, adjustment toward disability), this article presents the '4 Rehab Communication Elements' deemed likely to underpin rehabilitation outcomes. The four elements are: (a) knowing the person and building a supportive relationship; (b) effective information exchange and education; (c) shared goal-setting and action planning; and (d) fostering a more positive, yet realistic, cognitive and self-reframing. This article describes an unprecedented, outcomes-oriented approach toward the design of rehabilitation communication, which has resulted in the development of a new intervention model: the '4 Rehab Communication Elements'. Further trials are needed to evaluate the impact of this whole intervention model on rehabilitation outcomes. © The Author(s) 2015.

  19. Landsat-based Earth Observations and Crowd-sourced Data Provide Near Real-time Monitoring of Chimpanzee Habitat

    Science.gov (United States)

    Nackoney, J.; Pintea, L.; Jantz, S.; Hansen, M.

    2015-12-01

    The endangered chimpanzee (Pan troglodytes) is threatened by habitat loss from resource extraction and land conversion, as well as hunting, disease and the illegal pet trade. It has been estimated that more than 70% of chimpanzee's tropical forest habitats in Africa are now threatened by land use change. Recent developments in remote sensing and cloud computing enable the use of satellite observations to provide a synoptic view of chimpanzee habitats at finer spatial and temporal resolutions that are locally relevant and consistent across the entire species' range. We present a practical Decision Support System to be used by the Jane Goodall Institute and partners to annually monitor and forecast chimpanzee habitat health in Africa. The system integrates Earth observations from 30-meter resolution Landsat data with a species-specific habitat model and a model forecasting future land use change, enhanced by crowd-sourced field data collected by local communities and rangers using the Open Data Kit app and Android mobile smartphones and tablets. While coarser-scale and static chimpanzee habitat models have been previously developed, this project is the first to develop a dynamic monitoring system updated annually via Earth observations data that will systematically monitor threats and changes in habitat over time. Since the chimpanzee is an important keystone, flagship and umbrella species, an annual chimpanzee habitat health index would support conservation goals of other species within its large 2.5 million sq. km range and could be an important indicator of overall ecosystem health of tropical forests in Africa.

  20. Becoming successful entrepreneurs. Bangladesh. ADB supports pioneering family-based approach to provide micro-credit and skills training.

    Science.gov (United States)

    Molitor, C

    1996-01-01

    The Thana Resource Development and Employment Project (TRDEP), built upon the successful experience of the Grameen Bank and other nongovernmental organizations, is a comprehensive poverty alleviation scheme implemented by the government of Bangladesh and targeted to the poorest segment of Bangladeshi society. The project provides soft loans to landless poor for income-generating activities involving non-crop livelihoods and trades. The loans are granted at an 18% interest rate including a 2% charge which goes into a risk fund. The poorest of poor are eligible to receive loans as long as each borrowing unit is a self-help group comprised of five members of one family and each member of the group assumes the responsibility of paying each other member's loan. Each member of a borrowing group may receive loans in the amount of Taka 3000-5000 (US$75-125). The loans are then repayable in 50 equal installments over the course of 1 year. One member's default disqualifies all other group members from receiving future credit until the default is cleared. TRDEP borrowers have started small, successful entrepreneurial activities with their loans as capital.

  1. Individualized FSH dosing based on ovarian reserve testing in women starting IVF/ICSI : A multicentre trial and cost-effectiveness analysis

    NARCIS (Netherlands)

    van Tilborg, Theodora C.; Oudshoorn, Simone C.; Eijkemans, Marinus J. C.; Mochtar, Monique H.; van Golde, Ron J. T.; Hoek, Annemieke; Kuchenbecker, Walter K. H.; Fleischer, Kathrin; de Bruin, Jan Peter; Groen, Henk; van Wely, Madelon; Lambalk, Cornelis B.; Laven, Joop S. E.; Mol, Ben Willem J.; Broekmans, Frank J. M.; Torrance, Helen L.

    2017-01-01

    STUDY QUESTION: Is there a difference in live birth rate and/or cost-effectiveness between antral follicle count (AFC)-based individualized FSH dosing or standard FSH dosing in women starting IVF or ICSI treatment? SUMMARY ANSWER: In women initiating IVF/ICSI, AFC-based individualized FSH dosing

  2. Individualized FSH dosing based on ovarian reserve testing in women starting IVF/ICSI: a multicentre trial and cost-effectiveness analysis

    NARCIS (Netherlands)

    van Tilborg, Theodora C.; Oudshoorn, Simone C.; Eijkemans, Marinus J. C.; Mochtar, Monique H.; van Golde, Ron J. T.; Hoek, Annemieke; Kuchenbecker, Walter K. H.; Fleischer, Kathrin; de Bruin, Jan Peter; Groen, Henk; van Wely, Madelon; Lambalk, Cornelis B.; Laven, Joop S. E.; Mol, Ben Willem J.; Broekmans, Frank J. M.; Torrance, Helen L.

    2017-01-01

    STUDY QUESTION: Is there a difference in live birth rate and/or cost-effectiveness between antral follicle count (AFC)-based individualized FSH dosing or standard FSH dosing in women starting IVF or ICSI treatment? SUMMARY ANSWER: In women initiating IVF/ICSI, AFC-based individualized FSH dosing

  3. iTRAQ-based protein profiling provides insights into the central metabolism changes driving grape berry development and ripening

    Science.gov (United States)

    2013-01-01

    Background Grapevine (Vitis vinifera L.) is an economically important fruit crop. Quality-determining grape components such as sugars, acids, flavors, anthocyanins, tannins, etc., accumulate in the different grape berry development stages. Thus, correlating the proteomic profiles with the biochemical and physiological changes occurring in grape is of paramount importance to advance in our understanding of berry development and ripening processes. Results We report the developmental analysis of Vitis vinifera cv. Muscat Hamburg berries at the protein level from fruit set to full ripening. An iTRAQ-based bottom-up proteomic approach followed by tandem mass spectrometry led to the identification and quantitation of 411 and 630 proteins in the green and ripening phases, respectively. Two key points in development relating to changes in protein level were detected: end of the first growth period (7 mm-to-15 mm) and onset of ripening (15 mm-to-V100, V100-to-110). A functional analysis was performed using the Blast2GO software based on the enrichment of GO terms during berry growth. Conclusions The study of the proteome contributes to decipher the biological processes and metabolic pathways involved in the development and quality traits of fruit and its derived products. These findings lie mainly in metabolism and storage of sugars and malate, energy-related pathways such as respiration, photosynthesis and fermentation, and the synthesis of polyphenolics as major secondary metabolites in grape berry. In addition, some key steps in carbohydrate and malate metabolism have been identified in this study, i.e., PFP-PFK or SuSy-INV switches among others, which may influence the final sugar and acid balance in ripe fruit. In conclusion, some proteins not reported to date have been detected to be deregulated in specific tissues and developmental stages, leading to formulate new hypotheses on the metabolic processes underlying grape berry development. These results open up

  4. The Reserve Component Automation System (RCAS) -- A Case Study in the Evolution of an Information Management System

    National Research Council Canada - National Science Library

    Brady, George

    1998-01-01

    The Reserve Component Automation System (RCAS) is a Wide Area/Local Area Network system designed to provide automation support for the Reserve Components' mobilization management and sustaining-base operations...

  5. Parameterizing road construction in route-based road weather models: can ground-penetrating radar provide any answers?

    Science.gov (United States)

    Hammond, D. S.; Chapman, L.; Thornes, J. E.

    2011-05-01

    A ground-penetrating radar (GPR) survey of a 32 km mixed urban and rural study route is undertaken to assess the usefulness of GPR as a tool for parameterizing road construction in a route-based road weather forecast model. It is shown that GPR can easily identify even the smallest of bridges along the route, which previous thermal mapping surveys have identified as thermal singularities with implications for winter road maintenance. Using individual GPR traces measured at each forecast point along the route, an inflexion point detection algorithm attempts to identify the depth of the uppermost subsurface layers at each forecast point for use in a road weather model instead of existing ordinal road-type classifications. This approach has the potential to allow high resolution modelling of road construction and bridge decks on a scale previously not possible within a road weather model, but initial results reveal that significant future research will be required to unlock the full potential that this technology can bring to the road weather industry.

  6. Parameterizing road construction in route-based road weather models: can ground-penetrating radar provide any answers?

    International Nuclear Information System (INIS)

    Hammond, D S; Chapman, L; Thornes, J E

    2011-01-01

    A ground-penetrating radar (GPR) survey of a 32 km mixed urban and rural study route is undertaken to assess the usefulness of GPR as a tool for parameterizing road construction in a route-based road weather forecast model. It is shown that GPR can easily identify even the smallest of bridges along the route, which previous thermal mapping surveys have identified as thermal singularities with implications for winter road maintenance. Using individual GPR traces measured at each forecast point along the route, an inflexion point detection algorithm attempts to identify the depth of the uppermost subsurface layers at each forecast point for use in a road weather model instead of existing ordinal road-type classifications. This approach has the potential to allow high resolution modelling of road construction and bridge decks on a scale previously not possible within a road weather model, but initial results reveal that significant future research will be required to unlock the full potential that this technology can bring to the road weather industry. (technical design note)

  7. Assessing reserve-building pursuits and person characteristics: psychometric validation of the Reserve-Building Measure.

    Science.gov (United States)

    Schwartz, Carolyn E; Michael, Wesley; Zhang, Jie; Rapkin, Bruce D; Sprangers, Mirjam A G

    2018-02-01

    A growing body of research suggests that regularly engaging in stimulating activities across multiple domains-physical, cultural, intellectual, communal, and spiritual-builds resilience. This project investigated the psychometric characteristics of the DeltaQuest Reserve-Building Measure for use in prospective research. The study included Rare Patient Voice panel participants. The web-based survey included the Reserve-Building Measure with one-week re-test, measures of quality of life (QOL) and well-being (PROMIS General Health; NeuroQOL Cognitive Function and Positive Affect & Well-Being short-forms; Ryff Environmental Mastery subscale); and the Big Five Inventory-10 personality measure. Classical test theory and item response theory (IRT) analyses investigated psychometric characteristics of the Reserve-Building Measure. This North American sample (n = 592) included both patients and caregivers [mean age = 44, SD 19)]. Psychometric analyses revealed distinct subscales measuring current reserve-building activities (Active in the World, Games, Outdoors, Creative, Religious/Spiritual, Exercise, Inner Life, Shopping/Cooking, Passive Media Consumption,), past reserve-building activities (Childhood Activities, Achievement), and reserve-related person-factors (Perseverance, Current and Past Social Support, and Work Value). Test-retest stability (n = 101) was moderately high for 11 of 15 subscales (ICC range 0.78-0.99); four were below 0.59 indicating a need for further refinement. IRT analyses supported the item functioning of all subscales. Correlational analyses suggest the measure's subscales tap distinct constructs (range r = 0.11-0.46) which are not redundant with QOL, well-being, or personality (range r = 0.11-0.48). The Reserve-Building Measure provides a measure of activities and person-factors related to reserve that may potentially be useful in prospective research.

  8. A clip-based protocol for breast boost radiotherapy provides clear target visualisation and demonstrates significant volume reduction over time

    International Nuclear Information System (INIS)

    Lewis, Lorraine; Cox, Jennifer; Morgia, Marita; Atyeo, John; Lamoury, Gillian

    2015-01-01

    The clinical target volume (CTV) for early stage breast cancer is difficult to clearly identify on planning computed tomography (CT) scans. Surgical clips inserted around the tumour bed should help to identify the CTV, particularly if the seroma has been reabsorbed, and enable tracking of CTV changes over time. A surgical clip-based CTV delineation protocol was introduced. CTV visibility and its post-operative shrinkage pattern were assessed. The subjects were 27 early stage breast cancer patients receiving post-operative radiotherapy alone and 15 receiving post-operative chemotherapy followed by radiotherapy. The radiotherapy alone (RT/alone) group received a CT scan at median 25 days post-operatively (CT1rt) and another at 40 Gy, median 68 days (CT2rt). The chemotherapy/RT group (chemo/RT) received a CT scan at median 18 days post-operatively (CT1ch), a planning CT scan at median 126 days (CT2ch), and another at 40 Gy (CT3ch). There was no significant difference (P = 0.08) between the initial mean CTV for each cohort. The RT/alone cohort showed significant CTV volume reduction of 38.4% (P = 0.01) at 40 Gy. The Chemo/RT cohort had significantly reduced volumes between CT1ch: median 54 cm 3 (4–118) and CT2ch: median 16 cm 3 , (2–99), (P = 0.01), but no significant volume reduction thereafter. Surgical clips enable localisation of the post-surgical seroma for radiotherapy targeting. Most seroma shrinkage occurs early, enabling CT treatment planning to take place at 7 weeks, which is within the 9 weeks recommended to limit disease recurrence

  9. A clip-based protocol for breast boost radiotherapy provides clear target visualisation and demonstrates significant volume reduction over time

    Energy Technology Data Exchange (ETDEWEB)

    Lewis, Lorraine [Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales (Australia); Cox, Jennifer [Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales (Australia); Faculty of Health Sciences, University of Sydney, Sydney, New South Wales (Australia); Morgia, Marita [Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales (Australia); Atyeo, John [Faculty of Health Sciences, University of Sydney, Sydney, New South Wales (Australia); Lamoury, Gillian [Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales (Australia)

    2015-09-15

    The clinical target volume (CTV) for early stage breast cancer is difficult to clearly identify on planning computed tomography (CT) scans. Surgical clips inserted around the tumour bed should help to identify the CTV, particularly if the seroma has been reabsorbed, and enable tracking of CTV changes over time. A surgical clip-based CTV delineation protocol was introduced. CTV visibility and its post-operative shrinkage pattern were assessed. The subjects were 27 early stage breast cancer patients receiving post-operative radiotherapy alone and 15 receiving post-operative chemotherapy followed by radiotherapy. The radiotherapy alone (RT/alone) group received a CT scan at median 25 days post-operatively (CT1rt) and another at 40 Gy, median 68 days (CT2rt). The chemotherapy/RT group (chemo/RT) received a CT scan at median 18 days post-operatively (CT1ch), a planning CT scan at median 126 days (CT2ch), and another at 40 Gy (CT3ch). There was no significant difference (P = 0.08) between the initial mean CTV for each cohort. The RT/alone cohort showed significant CTV volume reduction of 38.4% (P = 0.01) at 40 Gy. The Chemo/RT cohort had significantly reduced volumes between CT1ch: median 54 cm{sup 3} (4–118) and CT2ch: median 16 cm{sup 3}, (2–99), (P = 0.01), but no significant volume reduction thereafter. Surgical clips enable localisation of the post-surgical seroma for radiotherapy targeting. Most seroma shrinkage occurs early, enabling CT treatment planning to take place at 7 weeks, which is within the 9 weeks recommended to limit disease recurrence.

  10. IGT calculates world reserves of fossil fuels

    International Nuclear Information System (INIS)

    Anon.

    1986-01-01

    The Institute of Gas Technology has published the IGT World Reserves Survey, giving their latest tabulation of world reserves of fossil fuels and uranium. The report contains 120 Tables and 41 Figures. Estimates are provided for proved reserves, resources, current production, and life indexes of the non-renewable energy sources of the US and of the world as a whole. World regional data are also provided in many cases. The data are summarized here. 2 figures, 5 tables

  11. Vertical Microbial Community Variability of Carbonate-based Cones may Provide Insight into Formation in the Rock Record

    Science.gov (United States)

    Trivedi, C.; Bojanowski, C.; Daille, L. K.; Bradley, J.; Johnson, H.; Stamps, B. W.; Stevenson, B. S.; Berelson, W.; Corsetti, F. A.; Spear, J. R.

    2015-12-01

    Stromatolite morphogenesis is poorly understood, and the process by which microbial mats become mineralized is a primary question in microbialite formation. Ancient conical stromatolites are primarily carbonate-based whereas the few modern analogues in hot springs are either non-mineralized or mineralized by silica. A team from the 2015 International GeoBiology Course investigated carbonate-rich microbial cones from near Little Hot Creek (LHC), Long Valley Caldera, California, to investigate how conical stromatolites might form in a hot spring carbonate system. The cones are up to 3 cm tall and are found in a calm, ~45° C pool near LHC that is 4 times super-saturated with respect to CaCO3. The cones rise from a flat, layered microbial mat at the edge of the pool. Scanning electron microscopy revealed filamentous bacteria associated with calcite crystals within the cone tips. Preliminary 16S rRNA gene analysis indicated variability of community composition between different vertical levels of the cone. The cone tip had comparatively greater abundance of filamentous cyanobacteria (Leptolyngbya and Phormidium) and fewer heterotrophs (e.g. Chloroflexi) compared to the cone bottom. This supports the hypothesis that cone formation may depend on the differential abundance of the microbial community and their potential functional roles. Metagenomic analyses of the cones revealed potential genes related to chemotaxis and motility. Specifically, a genomic bin identified as a member of the genus Isosphaera contained an hmp chemotaxis operon implicated in gliding motility in the cyanobacterium Nostoc punctiforme [1]. Isosphaera is a Planctomycete shown to have phototactic capabilities [2], and may play a role in conjunction with cyanobacteria in the vertical formation of the cones. This analysis of actively growing cones indicates a complex interplay of geochemistry and microbiology that form structures which can serve as models for processes that occurred in the past and are

  12. Bandwidth Reservations in Home Networks

    DEFF Research Database (Denmark)

    Nelis, Jelle; Verslype, Dieter; Develder, Chris

    2010-01-01

    In order for service providers to provide their users high quality services in the home network, Quality of Service (QoS) provisioning is needed to protect premium services. In this paper, we describe how a Universal Plug-and-Play (UPnP) based home network architecture solves this problem...... in a heterogeneous home network. We outline how it both relieves the end user from troublesome configuration and still offers control to the service provider. We particularly present performance assessment results for UPnP-QoS v3, based on a fully operational experimental implementation. The quantitative measurement...

  13. Are uranium reserves adequate?

    International Nuclear Information System (INIS)

    Anon.

    2006-01-01

    Against a backdrop of growing concerns about global warming and geopolitical pressures on fossil energies, especially natural gas and oil, interest in nuclear power has revived considerably. Conscious of its addiction to oil and reeling from a series of gigantic blackouts, the United States, in the words of its president, must 'aggressively move forward with the construction of nuclear power plants'. Some European countries have approved new power plant construction (Finland and France), while the more reserved ones (Belgium, Germany and Sweden) have begun to show a change in attitude. Asia, meanwhile, is host to the planet's largest number of potential nuclear construction projects in this first half of the 21. century. All these signs point to a sharp rise in uranium consumption, the basic fuel for these plants. But are there enough resources to support a nuclear revival on a planetary scale? The publication of the Red Book on uranium in late May 2006 was an opportunity for Thierry Dujardin, Deputy Director of Science and Development at the OECD's Nuclear Energy Agency, to take stock of resources. He gives his opinion in this paper

  14. Cognitive Functions and Cognitive Reserve in Relation to Blood Pressure Components in a Population-Based Cohort Aged 53 to 94 Years

    Directory of Open Access Journals (Sweden)

    Nunzia Giordano

    2012-01-01

    Full Text Available In 288 men and women from general population in a cross-sectional survey, all neuropsychological tests were negatively associated with age; memory and executive function were also positively related with education. The hypertensives (HT were less efficient than the normotensives (NT in the test of memory with interference at 10 sec (MI-10 (−33%, P=0.03, clock drawing test (CLOX (−28%, P<0.01, and mini-mental state examination (MMSE (−6%, P=0.02. Lower MMSE, MI-10, and CLOX were predicted by higher systolic (odds ratio, OR, 0.97, P=0.02; OR 0.98, P<0.005; OR 0.95, P<0.001 and higher pulse blood pressure (BP (OR 0.97, P=0.02; OR 0.97, P<0.01; and 0.95, P<0.0001. The cognitive reserve index (CRI was 6% lower in the HT (P=0.03 and was predicted by higher pulse BP (OR 0.82, P<0.001. The BP vectors of lower MMSE, MI-10, and CLOX were directed towards higher values of systolic and diastolic BP, that of low CRI towards higher systolic and lower diastolic. The label of hypertension and higher values of systolic or pulse BP are associated to worse memory and executive functions. Higher diastolic BP, although insufficient to impair cognition, strengthens this association. CRI is predicted by higher systolic BP associated to lower diastolic BP.

  15. Should we provide oral health training for staff caring for people with intellectual disabilities in community based residential care? A cost-effectiveness analysis.

    Science.gov (United States)

    Mac Giolla Phadraig, Caoimhin; Nunn, June; Guerin, Suzanne; Normand, Charles

    2016-04-01

    Oral health training is often introduced into community-based residential settings to improve the oral health of people with intellectual disabilities (ID). There is a lack of appropriate evaluation of such programs, leading to difficulty in deciding how best to allocate scarce resources to achieve maximum effect. This article reports an economic analysis of one such oral health program, undertaken as part of a cluster randomized controlled trial. Firstly, we report a cost-effectiveness analysis of training care-staff compared to no training, using incremental cost-effectiveness ratios (ICERs). Effectiveness was measured as change in knowledge, reported behaviors, attitude and self-efficacy, using validated scales (K&BAS). Secondly, we costed training as it was scaled up to include all staff within the service provider in question. Data were collected in Dublin, Ireland in 2009. It cost between €7000 and €10,000 more to achieve modest improvement in K&BAS scores among a subsample of 162 care-staff, in comparison to doing nothing. Considering scaled up first round training, it cost between €58,000 and €64,000 to train the whole population of staff, from a combined dental and disability service perspective. Less than €15,000-€20,000 of this was additional to the cost of doing nothing (incremental cost). From a dental perspective, a further, second training cycle including all staff would cost between €561 and €3484 (capital costs) and €5815 (operating costs) on a two yearly basis. This study indicates that the program was a cost-effective means of improving self-reported measures and possibly oral health, relative to doing nothing. This was mainly due to low cost, rather than the large effect. In this instance, the use of cost effectiveness analysis has produced evidence, which may be more useful to decision makers than that arising from traditional methods of evaluation. There is a need for CEAs of effective interventions to allow comparison

  16. Empirical analysis of optimal strategic petroleum reserve in China

    International Nuclear Information System (INIS)

    Wei, Yi-Ming; Wu, Gang; Liu, Lan-Cui; Fan, Ying

    2008-01-01

    The Chinese government began to prepare for the establishment of strategic petroleum reserve in March 2004. Therefore, answering the question of what level of strategic petroleum reserve would be suitable for China's future economic development becomes essential. Using a decision tree model based on a cost function, this paper quantifies China's optimal strategic petroleum reserve for the period 2005-2020. This approach provides a methodology reference for further quantified discussion on China's SPR. Our results show that: for economic development and security of the energy supply, the strategic petroleum reserve should be the equivalent of 30-60 days of net oil import for an optimal solution, when the oil price is $ 50/bbl; with a reserve of an equivalent of 60-90 days of net oil import to have an optimal solution when oil price is $20-35/bbl. (author)

  17. Design of a Randomized Controlled Trial of a Web-Based Intervention to Reduce Cardiovascular Disease Risk Factors among Remote Reservation-Dwelling American Indian Adults with Type 2 Diabetes

    Science.gov (United States)

    Henderson, Jeffrey A.; Chubak, Jessica; O'Connell, Joan; Ramos, Maria C.; Jensen, Julie; Jobe, Jared B.

    2012-01-01

    We describe a randomized controlled trial, the Lakota Oyate Wicozani Pi Kte (LOWPK) trial, which was designed to determine whether a Web-based diabetes and nutritional intervention can improve risk factors related to cardiovascular disease (CVD) among a group of remote reservation-dwelling adult American Indian men and women with type 2 diabetes…

  18. Cognitive Reserve: Implications for Assessment and Intervention

    Science.gov (United States)

    Stern, Yaakov

    2014-01-01

    The concept of reserve is used to explain the observation that some individuals function better than others in the presence of brain pathology. This paper reviews the concept of reserve from its theoretical basis to the implication of reserve for clinical practice. A distinction between brain reserve, referring to individual differences in the anatomic substrate, and cognitive reserve, referring to differences in the flexibility or adaptivity of cognitive networks, is useful. Epidemiologic evidence indicates that a set of life exposures including higher educational and occupational attainment, and engaging in leisure activities is associated with a lower risk of incident dementia, suggesting that these life exposures may enhance cognitive reserve. This provides a basis for controlled clinical studies can test specific exposures that may enhance reserve. The concept of cognitive reserve also has important implications for clinical practice in terms of diagnosis and prognosis. PMID:23941972

  19. Differences and Agreement in Perception of Child Picky Eating Among Center- and Home-Based Childcare Providers and Parents and Its Impact on Utilized Mealtime Strategies

    Directory of Open Access Journals (Sweden)

    Virginia Luchini

    2017-02-01

    Full Text Available Picky eating is a problematic eating behavior caregivers may encounter with children under their care. A picky eater (PE is typically characterized as consuming a narrow range of food, as well as rejecting several food items. Much of the literature regarding PEs involves parents, although use of nonparental childcare arrangements in the United States has increased in the past several decades. Although data on parental mealtime strategies exist, little is known about how parent and childcare provider pickiness perceptions differ between types of childcare, such as center-based childcare (CBCC and home-based childcare (HBCC, or how these perceptions influence the mealtime strategies utilized. The objectives of this study were to (1 compare perceptions of child pickiness between parents and childcare providers, (2 compare percent agreement in pickiness perception between the dyads of CBCC parents and providers and HBCC parents and providers, and (3 identify mealtime strategy utilization based on pickiness perception. A total of 52 child, parent, and childcare provider triads participated in the study and completed the Mealtime Assessment Survey and the Parent/Teacher Mealtime Strategy Survey regarding the same child. Results showed that parents are 1.4 times more likely than childcare providers to perceive a child as being picky, HBCC parents and providers are 1.4 times more likely to perceive a child as being picky than CBCC parents and providers, CBCC parents and providers disagree more in their perception of child pickiness than HBCC parents and providers (41% vs 26%, and finally, perception of child pickiness has a greater influence on mealtime strategies utilized by parents. These results can be used to focus intervention efforts aimed at improving child eating habits across the home and childcare location.

  20. Comparison of effectiveness of class lecture versus workshop-based teaching of basic life support on acquiring practice skills among the health care providers.

    Science.gov (United States)

    Karim, Habib Md Reazaul; Yunus, Md; Bhattacharyya, Prithwis; Ahmed, Ghazal

    2016-01-01

    Basic life support (BLS) is an integral part of emergency medical care. Studies have shown poor knowledge of it among health care providers who are usually taught BLS by lecture-based teachings in classes. This study is designed to assess the effectiveness of class lecture versus workshop-based teaching of BLS on acquiring the practice skills on mannequin. After ethical approval and informed consent from the participants, the present study was conducted among the health care providers. Participants were grouped in lecture-based class teaching and workshop-based teaching. They were then asked to practice BLS on mannequin (Resusci Anne with QCPR) and evaluated as per performance parameters based on American Heart Association BLS. Statistical analyses are done by Fisher's exact t-test using GraphPad INSTAT software and P 0.05). Though more than 83% of lecture-based teaching group has started chest compression as compared 96% of workshop group; only 49% of the participants of lecture-based group performed quality chest compression as compared to 82% of other group (P = 0.0005). The workshop group also performed better bag mask ventilation and defibrillation (P < 0.0001). Workshop-based BLS teaching is more effective and lecture-based class teaching better is replaced in medical education curriculum.

  1. A provider based accounting architecture

    NARCIS (Netherlands)

    Parhonyi, R.; Quartel, Dick; Pras, Aiko

    2002-01-01

    This paper presents a novel content accounting architecture. Content accounting is becoming increasingly important since it is anticipated that in the near future more billable content on the Internet will be published. The architecture presented in this paper has a distributed functionality and an

  2. What's the 411? Assessing the feasibility of providing African American adolescents with HIV/AIDS prevention education in a faith-based setting.

    Science.gov (United States)

    Francis, Shelley A; Lam, Wendy K; Cance, Jessica D; Hogan, Vijaya K

    2009-06-01

    This study examines African American faith based leaders' attitudes and beliefs about providing HIV prevention education and services to adolescents. Using a convenience sample, we identified priority adolescent health issues, attitudes about abstinence messages, and willingness to provide and participate in HIV prevention. Leaders identified drugs, gangs, alcohol, sex, and pregnancy as priority health issues affecting youth in their institutions. Leaders' strongly preferred to emphasize abstinence messages. Although leaders were willing to provide youth with health education, they were not willing to discuss specific behaviors associated with HIV transmission. African American churches provide a venue to reach African American youth; however, there are limitations to relying on faith-based HIV prevention services. HIV prevention education should continue to be supplemented via parents, schools, and public health agencies.

  3. Cognitive-behavioral therapy: How medical providers can increase patient and family openness and access to evidence-based multimodal therapy for pediatric migraine

    Science.gov (United States)

    Ernst, Michelle M.; O’Brien, Hope; Powers, Scott W.

    2015-01-01

    While evidence supports the recommendation for cognitive behavioral therapy (CBT) for pediatric migraine, few children actually receive this evidence-based intervention. In this article we briefly review the most recent empirical evidence supporting CBT. We then identify both provider/system-related barriers as well as patient-related barriers. Finally, we provide practical solutions to addressing these barriers in the service of facilitating children receiving optimal comprehensive management of their headaches. PMID:26198185

  4. Reservation system with graphical user interface

    KAUST Repository

    Mohamed, Mahmoud A. Abdelhamid

    2012-01-05

    Techniques for providing a reservation system are provided. The techniques include displaying a scalable visualization object, wherein the scalable visualization object comprises an expanded view element of the reservation system depicting information in connection with a selected interval of time and a compressed view element of the reservation system depicting information in connection with one or more additional intervals of time, maintaining a visual context between the expanded view and the compressed view within the visualization object, and enabling a user to switch between the expanded view and the compressed view to facilitate use of the reservation system.

  5. Implementation of provider-based electronic medical records and improvement of the quality of data in a large HIV program in Sub-Saharan Africa.

    Directory of Open Access Journals (Sweden)

    Barbara Castelnuovo

    Full Text Available INTRODUCTION: Starting in June 2010 the Infectious Diseases Institute (IDI clinic (a large urban HIV out-patient facility switched to provider-based Electronic Medical Records (EMR from paper EMR entered in the database by data-entry clerks. Standardized clinics forms were eliminated but providers still fill free text clinical notes in physical patients' files. The objective of this study was to compare the rate of errors in the database before and after the introduction of the provider-based EMR. METHODS AND FINDINGS: Data in the database pre and post provider-based EMR was compared with the information in the patients' files and classified as correct, incorrect, and missing. We calculated the proportion of incorrect, missing and total error for key variables (toxicities, opportunistic infections, reasons for treatment change and interruption. Proportions of total errors were compared using chi-square test. A survey of the users of the EMR was also conducted. We compared data from 2,382 visits (from 100 individuals of a retrospective validation conducted in 2007 with 34,957 visits (from 10,920 individuals of a prospective validation conducted in April-August 2011. The total proportion of errors decreased from 66.5% in 2007 to 2.1% in 2011 for opportunistic infections, from 51.9% to 3.5% for ART toxicity, from 82.8% to 12.5% for reasons for ART interruption and from 94.1% to 0.9% for reasons for ART switch (all P<0.0001. The survey showed that 83% of the providers agreed that provider-based EMR led to improvement of clinical care, 80% reported improved access to patients' records, and 80% appreciated the automation of providers' tasks. CONCLUSIONS: The introduction of provider-based EMR improved the quality of data collected with a significant reduction in missing and incorrect information. The majority of providers and clients expressed satisfaction with the new system. We recommend the use of provider-based EMR in large HIV programs in Sub

  6. Concurrent use of data base and graphics computer workstations to provide graphic access to large, complex data bases for robotics control of nuclear surveillance and maintenance

    International Nuclear Information System (INIS)

    Dalton, G.R.; Tulenko, J.S.; Zhou, X.

    1990-01-01

    The University of Florida is part of a multiuniversity research effort, sponsored by the US Department of Energy which is under way to develop and deploy an advanced semi-autonomous robotic system for use in nuclear power stations. This paper reports on the development of the computer tools necessary to gain convenient graphic access to the intelligence implicit in a large complex data base such as that in a nuclear reactor plant. This program is integrated as a man/machine interface within the larger context of the total computerized robotic planning and control system. The portion of the project described here addresses the connection between the three-dimensional displays on an interactive graphic workstation and a data-base computer running a large data-base server program. Programming the two computers to work together to accept graphic queries and return answers on the graphic workstation is a key part of the interactive capability developed

  7. Communication between office-based primary care providers and nurses working within patients' homes: an analysis of process data from CAPABLE.

    Science.gov (United States)

    Smith, Patrick D; Boyd, Cynthia; Bellantoni, Julia; Roth, Jill; Becker, Kathleen L; Savage, Jessica; Nkimbeng, Manka; Szanton, Sarah L

    2016-02-01

    To examine themes of communication between office-based primary care providers and nurses working in private residences; to assess which methods of communication elicit fruitful responses to nurses' concerns. Lack of effective communication between home health care nurses and primary care providers contributes to clinical errors, inefficient care delivery and decreased patient safety. Few studies have described best practices related to frequency, methods and reasons for communication between community-based nurses and primary care providers. Secondary analysis of process data from 'Community Aging in Place: Advancing Better Living for Elders (CAPABLE)'. Independent reviewers analysed nurse documentation of communication (phone calls, letters and client coaching) initiated for 70 patients and analysed 45 letters to primary care providers to identify common concerns and recommendations raised by CAPABLE nurses. Primary care providers responded to 86% of phone calls, 56% of letters and 50% of client coaching efforts. Primary care providers addressed 86% of concerns communicated by phone, 34% of concerns communicated by letter and 41% of client-raised concerns. Nurses' letters addressed five key concerns: medication safety, pain, change in activities of daily living, fall safety and mental health. In letters, CAPABLE nurses recommended 58 interventions: medication change; referral to a specialist; patient education; and further diagnostic evaluation. Effective communication between home-based nurses and primary care providers enhances care coordination and improves outcomes for home-dwelling elders. Various methods of contact show promise for addressing specific communication needs. Nurses practicing within patients' homes can improve care coordination by using phone calls to address minor matters and written letters for detailed communication. Future research should explore implementation of Situation, Background, Assessment and Recommendation in home care to promote

  8. ListeningTime; participatory development of a web-based preparatory communication tool for elderly cancer patients and their healthcare providers.

    NARCIS (Netherlands)

    Noordman, J.; Driesenaar, J.A.; Bruinessen, I.R. van; Dulmen, S. van

    2017-01-01

    Objective: This paper outlines the participatory development process of a web-based preparatory communication tool for elderly cancer patients and their oncological healthcare providers (HCPs). This tool aims to support them to (better) prepare their encounters. An overarching aim of the project is

  9. The Impact of Home-Based Child Care Provider Unionization on the Cost, Type, and Availability of Subsidized Child Care in Illinois

    Science.gov (United States)

    Grindal, Todd; West, Martin R.; Willett, John B.; Yoshikawa, Hirokazu

    2015-01-01

    In February 2005, Illinois became the first U.S. state to grant home-based child care providers (HBCPs) the right to form a labor union in order to bargain collectively with the state government. This policy inspired similar efforts across the country and represents a potentially important direction for child care policy. To date, the implications…

  10. Home-Based Child Care Provider Education and Specialized Training: Associations with Caregiving Quality and Toddler Social-Emotional and Cognitive Outcomes

    Science.gov (United States)

    Schaack, Diana D.; Le, Vi Nhuan; Messan Setodji, Claude

    2017-01-01

    Research Findings: Although there has been considerable research on the associations between the qualifications of teachers in center-based settings and preschool-age children's developmental outcomes, very little is known about the relationships between home provider qualifications and the developmental outcomes of toddlers who attend licensed…

  11. Parents' perceptions of the services provided to children with cerebral palsy in the transition from preschool rehabilitation to school-based services

    NARCIS (Netherlands)

    Alsem, M. W.; Verhoef, M.; Gorter, J. W.; Langezaal, L. C. M.; Visser-Meily, J. M. A.; Ketelaar, M.

    2016-01-01

    To describe the course of parents' perceptions of the family centredness of rehabilitation services provided to their children with cerebral palsy (CP) before and after the transition from preschool to school-based services. Parents of 59 children with CP aged 2.5 to 4.5 years filled in the 56-item

  12. Parents' perceptions of the services provided to children with cerebral palsy in the transition from preschool rehabilitation to school-based services

    NARCIS (Netherlands)

    Alsem, M. W.; Verhoef, M.; Gorter, J. W.; Langezaal, L. C M; Visser-Meily, J. M A; Ketelaar, M.

    2016-01-01

    Aim: To describe the course of parents' perceptions of the family centredness of rehabilitation services provided to their children with cerebral palsy (CP) before and after the transition from preschool to school-based services. Background: Parents of 59 children with CP aged 2.5 to 4.5 years

  13. Favorable ratings of providers' communication behaviors among U.S. women with depression: a population-based study applying the behavioral model of health services use.

    Science.gov (United States)

    Keller, Abiola O; Gangnon, Ronald; Witt, Whitney P

    2013-01-01

    Little is known about the relationships between sociodemographic characteristics and ratings of provider communication behavior among women with depression in the United States. This study uses the Andersen Behavioral Model to examine the relationships among predisposing, enabling, and need factors and ratings of perceived patient-provider communication in women with depression. The sample consisted of women with depression who visited any provider in the previous 12 months in the 2002-2008 Medical Expenditure Panel Survey (n = 3,179; weighted n = 4,707,255). Multivariate logistic regression was used to examine the independent contribution of predisposing, enabling, and need factors on providers' communication behavior measures. Black (non-Hispanic) women were more likely to report that providers always listened carefully (odds ratio [OR], 1.40; 95% confidence interval [CI], 1.01-1.94), explained so they understood (OR, 1.53; 95% CI, 1.10-2.11), and showed respect for what they had to say (OR, 1.39; 95% CI, 1.01-1.92). Women participating in the paid workforce and those without a usual source of care were at increased risk for less favorable experiences. Participation in the paid workforce and lack of a usual source of care were associated with an increased likelihood of less optimal communication experiences. Ensuring that women with depression have reliable access to a continuous source of care and expanding the availability of nonemergent, after-hours care may be instrumental for improving patient-provider communication in this population. Copyright © 2013 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  14. Integrating an EMR-based Transition Planning Tool for CYSHCN at a Children's Hospital: A Quality Improvement Project to Increase Provider Use and Satisfaction.

    Science.gov (United States)

    Wiemann, Constance M; Hergenroeder, Albert C; Bartley, Krystle A; Sanchez-Fournier, Blanca; Hilliard, Marisa E; Warren, Laura J; Graham, Sarah C

    2015-01-01

    An electronic medical record (EMR)-based transition planning tool (TPT) designed to facilitate transition from pediatric to adult-based health care for youth (16-25 years) with special health care needs was introduced at a large children's hospital. Activities to increase provider use were implemented in five plan-do-study-act cycles. Overall, 22 of 25 (88%) consenting providers in four pediatric subspecialty services used the TPT during 303 patient encounters, with nurses and case-managers the top users and physicians the least likely users. Use was highest with intensive technical assistance and following the introduction of an upgraded tool. Provider satisfaction with the TPT and self-reported transition planning activities notably increased across the PDSA cycles. Copyright © 2015. Published by Elsevier Inc.

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

    DEFF Research Database (Denmark)

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

    2011-01-01

    Aim of the study: This study assesses the changes in self-reported quality of life (QoL) from hospitalisation to 18 months later among people with multiple sclerosis (MS) who have participated in treatments based on collaboration between conventional healthcare providers and CAM practitioners...... interventions by a team of five healthcare providers and five CAM practitioners. The outcome measure was a change in QoL (measured as the difference in total score and sub-scores on the Functional Assessment of Multiple Sclerosis (FAMS) QoL scale). Results: From hospitalisation and through an 18-month period......, people with MS who had participated in treatments based on collaboration between healthcare providers and CAM practitioners experienced a statistically significant different change in QoL compared to people with MS who had been treated within the current ‘best practice’ model. The difference in Qo...

  16. Response rates for providing a blood specimen for HIV testing in a population-based survey of young adults in Zimbabwe

    Directory of Open Access Journals (Sweden)

    Dube Hazel M

    2007-07-01

    Full Text Available Abstract Background To determine differences among persons who provided blood specimens for HIV testing compared with those who did not among those interviewed for the population-based Zimbabwe Young Adult Survey (YAS. Methods Chi-square analysis of weighted data to compare demographic and behavioral data of persons interviewed who provided specimens for anonymous testing with those who did not. Prevalence estimation to determine the impact if persons not providing specimens had higher prevalence rates than those who did. Results Comparing those who provided specimens with those who did not, there was no significant difference by age, residence, education, marital status, perceived risk, sexual experience or number of sex partners for women. A significant difference by sexual experience was found for men. Prevalence estimates did not change substantially when prevalence was assumed to be two times higher for persons not providing specimens. Conclusion When comparing persons who provided specimens for HIV testing with those who did not, few significant differences were found. If those who did not provide specimens had prevalence rates twice that of those who did, overall prevalence would not be substantially affected. Refusal to provide blood specimens does not appear to have contributed to an underestimation of HIV prevalence.

  17. Brain reserve and cognitive reserve protect against cognitive decline over 4.5 years in MS.

    Science.gov (United States)

    Sumowski, James F; Rocca, Maria A; Leavitt, Victoria M; Dackovic, Jelena; Mesaros, Sarlota; Drulovic, Jelena; DeLuca, John; Filippi, Massimo

    2014-05-20

    Based on the theories of brain reserve and cognitive reserve, we investigated whether larger maximal lifetime brain growth (MLBG) and/or greater lifetime intellectual enrichment protect against cognitive decline over time. Forty patients with multiple sclerosis (MS) underwent baseline and 4.5-year follow-up evaluations of cognitive efficiency (Symbol Digit Modalities Test, Paced Auditory Serial Addition Task) and memory (Selective Reminding Test, Spatial Recall Test). Baseline and follow-up MRIs quantified disease progression: percentage brain volume change (cerebral atrophy), percentage change in T2 lesion volume. MLBG (brain reserve) was estimated with intracranial volume; intellectual enrichment (cognitive reserve) was estimated with vocabulary. We performed repeated-measures analyses of covariance to investigate whether larger MLBG and/or greater intellectual enrichment moderate/attenuate cognitive decline over time, controlling for disease progression. Patients with MS declined in cognitive efficiency and memory (p cognitive efficiency (p = 0.031, ηp (2) = 0.122), with larger MLBG protecting against decline. MLBG did not moderate memory decline (p = 0.234, ηp (2) = 0.039). Intellectual enrichment moderated decline in cognitive efficiency (p = 0.031, ηp (2) = 0.126) and memory (p = 0.037, ηp (2) = 0.115), with greater intellectual enrichment protecting against decline. MS disease progression was more negatively associated with change in cognitive efficiency and memory among patients with lower vs higher MLBG and intellectual enrichment. We provide longitudinal support for theories of brain reserve and cognitive reserve in MS. Larger MLBG protects against decline in cognitive efficiency, and greater intellectual enrichment protects against decline in cognitive efficiency and memory. Consideration of these protective factors should improve prediction of future cognitive decline in patients with MS. © 2014 American Academy of Neurology.

  18. Provider Health and Wellness.

    Science.gov (United States)

    Nanda, Anil; Wasan, Anita; Sussman, James

    Provider health and wellness is a significant issue and can impact patient care, including patient satisfaction, quality of care, medical errors, malpractice risk, as well as provider and office staff turnover and early retirement. Health and wellness encompasses various areas including burnout, depression, divorce, and suicide and affects providers of all specialties and at all levels of training. Providers deal with many everyday stresses, including electronic health records, office politics, insurance and billing issues, dissatisfied patients, and their own personal and family issues. Approximately half of all physicians suffer from burnout, and the rate of burnout among physicians of all specialties is increasing. An important first step in dealing with burnout is recognition and then seeking assistance. Strategies to prevent and treat burnout include increasing provider resiliency as well as implementing practical changes in the everyday practice of medicine. There is currently very little data regarding health and wellness specifically in the field of allergy and immunology, and studies are necessary to determine the prevalence of burnout and related issues in this field. Many medical specialties as well as state and national medical associations have health and wellness committees and other resources, which are essential for providers. Health and wellness programs should be introduced early in a provider's training and continued throughout a provider's career. Copyright © 2017 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  19. Reserve reporting in the United States coal industry

    International Nuclear Information System (INIS)

    Grubert, Emily

    2012-01-01

    United States energy policymaking can be better supported with accurate and consistent data on coal reserves, both in the public and private sectors. In particular, reserve data for coal and other energy resources should be directly comparable so that decision-makers can easily understand the relationship among available resources. Long-term policy and investment choices regarding energy security, the environment, and resource allocation depend on accurate information, but existing and easily available data on the magnitude of geologically, environmentally, economically, socially, and legally accessible coal reserves are of insufficient quality to guide such decisions. Even still, these data are often presented for use in policy and energy analysis. Currently, coal reserves are overstated relative to competitor energy resource reserves, in part because coal reporting standards have historically been more liberal and vague than standards for resources like natural gas. Overstating the marketable coal resource could lead to inefficient allocation of limited capital investment that can be difficult to reverse. US government bodies like the Energy Information Administration, United States Geological Survey, Securities and Exchange Commission, and Bureau of Land Management can help correct deficiencies by clarifying standards and collecting data that are relevant for decision-makers, such as energy-based reserve information. - Highlights: ► US Coal reserves are important to public and private policy and investment decisions. ► Poor quality data and coal reserve overreporting misrepresent reality. ► Choices made based on bad information can lead to long-term capital misallocation. ► Numerous government agencies are tasked with providing public data on coal reserves. ► Clearer, more restrictive reserves reporting standards can aid decision-makers.

  20. 77 FR 60107 - National Estuarine Research Reserve System

    Science.gov (United States)

    2012-10-02

    .... The Rookery Bay Reserve takes an integrated approach to management, linking research, education... catastrophic change events. The Reserve's Environmental Learning Center provides excellent visitor education... Kachemak Bay Reserve takes an integrated approach to management by linking research, education, and...

  1. Understanding how different recruitment strategies impact parent engagement with an iPad-based intervention to provide personalized information about adolescent vaccines.

    Science.gov (United States)

    Dempsey, Amanda F; Maertens, Julie; Beaty, Brenda L; O'Leary, Sean T

    2015-05-01

    Inadequate provider time for addressing parents' questions and concerns about adolescent vaccines is a barrier to vaccine utilization. We sought to determine how different recruitment strategies impact the degree of engagement with an intervention that provided this information via an iPad placed in a clinical setting. We provided to three pediatric practices in the Denver area the "Teen VaxScene" web site that generates individually customized information for parents about adolescent vaccines. Three recruitment strategies were assessed for their impact on parental use of the intervention as follows: passive recruitment using posters to advertise a "kiosk" version of the intervention; posters plus a $10 incentive for using the kiosk; and posters plus a $10 incentive plus decoupling the iPad from the kiosks to enable "roving." We assessed the engagement with the intervention at multiple levels including log in, consent, and completion of a baseline survey and viewing individually tailored web pages. Surveys were used to assess barriers to using the intervention. During the 14-month study period, 693 people had contact with the iPad, 199 consented, and 48 completed the survey to enable creation of tailored content; and 42 used the tailored site. Five times as many parents (n = 40) consented to participation during the 2 months when the intervention was "roving" than during the 10-month "passive" recruitment period. Engagement with the tailored material was low, with most users viewing only the "table of contents" pages. Utilizers and nonutilizers of the intervention had similar demographic characteristics. Enabling the iPad to "rove" in the clinic greatly increased the proportion of parents consenting to use the intervention. However, meaningful engagement with the material was low. Further research is needed to understand the most effective and time efficient ways to provide vaccine-related educational information to parents of adolescents. Copyright © 2015 Society

  2. The internal migration between public and faith-based health providers: a cross-sectional, retrospective and multicentre study from southern Tanzania.

    Science.gov (United States)

    Tabatabai, Patrik; Prytherch, Helen; Baumgarten, Inge; Kisanga, Oberlin M E; Schmidt-Ehry, Bergis; Marx, Michael

    2013-07-01

    To assess the magnitude, direction and underlying dynamics of internal health worker migration between public and faith-based health providers from a hospital perspective. Two complementary tools were implemented in 10 public and six faith-based hospitals in southern Tanzania. A hospital questionnaire assessed magnitude and direction of staff migration between January 2006 and June 2009. Interviews with 42 public and 20 faith-based maternity nurses evaluated differences in staff perspectives and motives for the observed migration patterns. The predominant direction of staff movement was from the faith-based to the public sector: 69.1% (n = 105/152) of hospital staff exits and 60.6% (n = 60/99) of hospital staff gains. Nurses were the largest group among the migrating health workforce. Faith-based hospitals lost 59.3% (n = 86/145) of nurses and 90.6% (n = 77/85) of registered nurses to the public sector, whereby public hospitals reported 13.5% (n = 59/436) of nurses and 24.4% (n = 41/168) of registered nurses being former faith-based employees. Interviews revealed significantly inferior staff perspectives among faith-based respondents than their public colleagues. Main differences were identified regarding career development and training, management support, employee engagement and workload. This study revealed considerable internal health worker migration from the faith-based to the public sector. Staff retention and motivation within faith-based hospitals are not restricted to financial considerations, and salary gaps can no longer uniquely explain this movement pattern. The consequences for the catchment area of faith-based hospitals are potentially severe and erode cooperation potential between the public and private health sector.

  3. Adaptation and validation of the Evidence-Based Practice Belief and Implementation scales for French-speaking Swiss nurses and allied healthcare providers.

    Science.gov (United States)

    Verloo, Henk; Desmedt, Mario; Morin, Diane

    2017-09-01

    To evaluate two psychometric properties of the French versions of the Evidence-Based Practice Beliefs and Evidence-Based Practice Implementation scales, namely their internal consistency and construct validity. The Evidence-Based Practice Beliefs and Evidence-Based Practice Implementation scales developed by Melnyk et al. are recognised as valid, reliable instruments in English. However, no psychometric validation for their French versions existed. Secondary analysis of a cross sectional survey. Source data came from a cross-sectional descriptive study sample of 382 nurses and other allied healthcare providers. Cronbach's alpha was used to evaluate internal consistency, and principal axis factor analysis and varimax rotation were computed to determine construct validity. The French Evidence-Based Practice Beliefs and Evidence-Based Practice Implementation scales showed excellent reliability, with Cronbach's alphas close to the scores established by Melnyk et al.'s original versions. Principal axis factor analysis showed medium-to-high factor loading scores without obtaining collinearity. Principal axis factor analysis with varimax rotation of the 16-item Evidence-Based Practice Beliefs scale resulted in a four-factor loading structure. Principal axis factor analysis with varimax rotation of the 17-item Evidence-Based Practice Implementation scale revealed a two-factor loading structure. Further research should attempt to understand why the French Evidence-Based Practice Implementation scale showed a two-factor loading structure but Melnyk et al.'s original has only one. The French versions of the Evidence-Based Practice Beliefs and Evidence-Based Practice Implementation scales can both be considered valid and reliable instruments for measuring Evidence-Based Practice beliefs and implementation. The results suggest that the French Evidence-Based Practice Beliefs and Evidence-Based Practice Implementation scales are valid and reliable and can therefore be used to

  4. National integration of mental health providers in VA home-based primary care: an innovative model for mental health care delivery with older adults.

    Science.gov (United States)

    Karlin, Bradley E; Karel, Michele J

    2014-10-01

    To promote mental health (MH) service access and quality for veterans with complex and chronic medical, social, and behavioral conditions, the U.S. Department of Veterans Affairs (VA) has integrated a full-time MH provider into each VA home-based primary care (HBPC) team. The goal of the current evaluation is to examine the nature and extent to which MH care processes and practices have been integrated into HBPC nationally. Separate surveys assessing the integration of a wide range of MH care practices and HBPC team processes were sent to MH providers and program directors in each HBPC program in 2010. A total of 132 MH providers representing 119 HBPC programs, and 112 program directors completed the surveys. The most common clinical issues addressed by MH providers were depression, coping with illness and disability, anxiety, caregiver/family stress, and cognitive evaluation. Other team members typically conducted initial MH screenings, with MH providers' time focusing on cases with identified needs. Approximately 40% of MH providers' time was devoted to direct clinical care. Significant time was also spent on team activities, driving, and charting. Integration of MH services into HBPC is feasible and facilitates service access for a vulnerable population. Mental health care delivery in HPBC generally involves a high degree of interdisciplinary practice. Mental health integration into HBPC may serve as a model for other systems interested in promoting MH care delivery among homebound and other older individuals. Published by Oxford University Press on behalf of The Gerontological Society of America 2013.

  5. Army Reserve Capabilities-Based Prioritization Study

    Science.gov (United States)

    2008-08-15

    journal databases such as JSTOR , ABI Inform, Proquest, and Emerald; syllabi for courses in strategic management and planning at Harvard, MIT, Wharton, and...methodology for prioritization. • Secure, database repository of appropriate bins, criteria or metrics for prioritization. • Reproducible...Prioritization PPBC/SRG Initial POM Database turned over to Army Budget TGM Issued ARB Final POM/BES Decisions Price/Rate Changes Other Fact-of-Life Changes

  6. The effectiveness and feasibility of videoconferencing technology to provide evidence-based treatment to rural domestic violence and sexual assault populations.

    Science.gov (United States)

    Hassija, Christina; Gray, Matt J

    2011-05-01

    Although evidence-based treatments for post-traumatic stress disorder (PTSD) have been available for some time, many treatment-seeking trauma survivors are unable to access such services. This is especially the case in remote and rural areas where access to specialists is an exception rather than a rule. Advances in videoconferencing-based technologies are improving rural residents' access to specialized psychological services. However, at present, little is known about the viability and efficacy of providing psychological interventions via distal technologies to individuals who present at rural domestic violence and rape crisis centers. The present study attempts to partially address this void by evaluating, in the context of an uncontrolled trial, the effectiveness and feasibility of providing evidence-based, trauma-focused treatment via videoconferencing to rural survivors of domestic violence and sexual assault. Participants in the present study were clients referred to the Wyoming Trauma Telehealth Treatment Clinic (WTTTC) for psychological services via videoconferencing from distal domestic violence and rape crisis centers located in the state of Wyoming. Fifteen female victims of assaultive violence who received at least four sessions of trauma-focused treatment via videoconferencing-based technology at distal rape and domestic violence crisis centers were included in the present study. Participants completed measures of PTSD and depression symptom severity and client satisfaction. Participants evidenced large reductions on measures of PTSD (d = 1.17) and depression (d = 1.24) symptom severity following treatment via videoconferencing. Additionally, participants reported a high degree of satisfaction with videoconferencing-administered services. Results provide evidence in support of videoconferencing as an effective means to provide psychological services to rural domestic violence and sexual assault populations. Clinical implications and avenues

  7. The Formation of the Image of Top-Ranked Hotels through Real Online Customer Reviews: A Corpus-Based Study of Evaluative Adjectives as Image-Formers/Providers

    OpenAIRE

    Edo Marzá, Nuria

    2013-01-01

    This study is grounded on a corpus-based analysis of evaluative adjectives as hotel image-formers/providers conducted from a multifaceted yet complementary perspective which departs from the notion of destination image formation (Gartner, 1993; Baloglu & McCleary, 1999, Gylling, 2004 among others) focused on a specific aspect, that of the hotel of destination, and to a specific genre, the online (hotel) customer review. The corpus of study, which contains more than 250 000 wor...

  8. The attitudes of primary healthcare providers towards web-based training on public health services in rural China: a cross-sectional study.

    Science.gov (United States)

    Zhan, X X; Zhang, Z X; Sun, F; Peng, W J; Zhang, H; Yan, W R

    2016-12-01

    To explore the attitudes of primary healthcare workers, including township public health workers (TPHWs) and village doctors (ViDs), towards web-based training on basic public health services (BPHS) and to examine the factors influencing their attitudes. Cross-sectional study. Questionnaires addressing training status, needs, and attitudes towards web-based public health training were administered to 2768 primary healthcare workers from May to September 2013. Multivariate logistic regression models were used to identify the factors that were significantly associated with a positive attitude towards web-based public health training. Among the 2768 participants, 90.6% of the TPHWs and 86.9% of the ViDs expressed a positive attitude towards web-based BPHS training. TPHWs who had a positive attitude towards previous public health training (odds ratio [OR] = 2.75, 95% confidence interval [CI] = 1.28-5.93) and better computer skills (OR = 2.59, 95% CI = 1.03-6.48) were more likely to adopt web-based training on BPHS, as were ViDs who had better computer skills (OR = 2.54, 95% CI = 1.58-4.11) and better Internet speeds (neutral: OR = 2.81, 95% CI = 1.58-5.01; satisfied: OR = 2.53, 95% CI = 1.28-5.01). TPHWs who tended to read papers (OR = 0.24, 95% CI = 0.11-0.50) and were aged 50 years or older (OR = 0.34, 95% CI = 0.14-0.87), as were ViDs who tended to read papers (OR = 0.48, 95% CI = 0.29-0.77), expressed a more negative attitude towards web-based BPHS training. The findings indicated that most primary healthcare workers have a positive attitude towards web-based BPHS training. More priority measures, such as conducting computer training, improving Internet quality and integrating mobile technology, are recommended and will further improve the implementation of web-based public health training programs. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  9. A General Business Model for Marine Reserves

    Science.gov (United States)

    Sala, Enric; Costello, Christopher; Dougherty, Dawn; Heal, Geoffrey; Kelleher, Kieran; Murray, Jason H.; Rosenberg, Andrew A.; Sumaila, Rashid

    2013-01-01

    Marine reserves are an effective tool for protecting biodiversity locally, with potential economic benefits including enhancement of local fisheries, increased tourism, and maintenance of ecosystem services. However, fishing communities often fear short-term income losses associated with closures, and thus may oppose marine reserves. Here we review empirical data and develop bioeconomic models to show that the value of marine reserves (enhanced adjacent fishing + tourism) may often exceed the pre-reserve value, and that economic benefits can offset the costs in as little as five years. These results suggest the need for a new business model for creating and managing reserves, which could pay for themselves and turn a profit for stakeholder groups. Our model could be expanded to include ecosystem services and other benefits, and it provides a general framework to estimate costs and benefits of reserves and to develop such business models. PMID:23573192

  10. Brain reserve and cognitive reserve in multiple sclerosis

    Science.gov (United States)

    Rocca, Maria A.; Leavitt, Victoria M.; Riccitelli, Gianna; Comi, Giancarlo; DeLuca, John; Filippi, Massimo

    2013-01-01

    Objective: We first tested the brain reserve (BR) hypothesis in multiple sclerosis (MS) by examining whether larger maximal lifetime brain volume (MLBV; determined by genetics) protects against disease-related cognitive impairment, and then investigated whether cognitive reserve (CR) gained through life experience (intellectually enriching leisure activities) protects against cognitive decline independently of MLBV (BR). Methods: Sixty-two patients with MS (41 relapsing-remitting MS, 21 secondary progressive MS) received MRIs to estimate BR (MLBV, estimated with intracranial volume [ICV]) and disease burden (T2 lesion load; atrophy of gray matter, white matter, thalamus, and hippocampus). Early-life cognitive leisure was measured as a source of CR. We assessed cognitive status with tasks of cognitive efficiency and memory. Hierarchical regressions were used to investigate whether higher BR (ICV) protects against cognitive impairment, and whether higher CR (leisure) independently protects against cognitive impairment over and above BR. Results: Cognitive status was positively associated with ICV (R2 = 0.066, p = 0.017). An ICV × disease burden interaction (R2 = 0.050, p = 0.030) revealed that larger ICV attenuated the impact of disease burden on cognition. Controlling for BR, higher education (R2 = 0.047, p = 0.030) and leisure (R2 = 0.090, p = 0.001) predicted better cognition. A leisure × disease burden interaction (R2 = 0.037, p = 0.030) showed that leisure independently attenuated the impact of disease burden on cognition. Follow-up analyses revealed that BR protected against cognitive inefficiency, not memory deficits, whereas CR was more protective against memory deficits than cognitive inefficiency. Conclusion: We provide evidence of BR in MS, and show that CR independently protects against disease-related cognitive decline over and above BR. Lifestyle choices protect against cognitive impairment independently of genetic factors outside of one's control

  11. Strategic Petroleum Reserve annual/quarterly report

    Energy Technology Data Exchange (ETDEWEB)

    1993-02-16

    During 1992 the Department continued planning activities for the expansion of the Strategic Petroleum Reserve to one billion barrels. A draft Environmental Impact Statement for the five candidate sites was completed in October 1992, and a series of public hearings was held during December 1992. Conceptual design engineering activities, life cycle cost estimates and geotechnical studies to support the technical requirements for an Strategic Petroleum Reserve Plan Amendment were essentially completed in December 1992. At the end of 1992, the Strategic Petroleum Reserve crude oil inventory was 574.7 million barrels and an additional 1.7 million barrels was in transit to the Reserve. During 1992 approximately 6.2 million barrels of crude oil were acquired for the Reserve. A Department of Energy Tiger Team Environmental, Safety and Health (ES&H) Assessment was conducted at the Strategic Petroleum Reserve from March 9 through April 10, 1992. In general, the Tiger Team found that Strategic Petroleum Reserve activities do not pose undue environmental, safety or health risks. The Strategic Petroleum Reserve`s Final Corrective Action Plan, prepared in response to the Tiger Team assessment, was submitted for Department approval in December 1992. On November 18, 1992, the Assistant Secretary for Fossil Energy selected DynMcDennott Petroleum Operations Company to provide management and operating services for the Strategic Petroleum Reserve for a period of 5 years commencing April 1, 1993. DynMcDermott will succeed Boeing Petroleum Services, Inc.

  12. Reserve valuation in electric power systems

    Science.gov (United States)

    Ruiz, Pablo Ariel

    Operational reliability is provided in part by scheduling capacity in excess of the load forecast. This reserve capacity balances the uncertain power demand with the supply in real time and provides for equipment outages. Traditionally, reserve scheduling has been ensured by enforcing reserve requirements in the operations planning. An alternate approach is to employ a stochastic formulation, which allows the explicit modeling of the sources of uncertainty. This thesis compares stochastic and reserve methods and evaluates the benefits of a combined approach for the efficient management of uncertainty in the unit commitment problem. Numerical studies show that the unit commitment solutions obtained for the combined approach are robust and superior with respect to the traditional approach. These robust solutions are especially valuable in areas with a high proportion of wind power, as their built-in flexibility allows the dispatch of practically all the available wind power while minimizing the costs of operation. The scheduled reserve has an economic value since it reduces the outage costs. In several electricity markets, reserve demand functions have been implemented to take into account the value of reserve in the market clearing process. These often take the form of a step-down function at the reserve requirement level, and as such they may not appropriately represent the reserve value. The value of reserve is impacted by the reliability, dynamic and stochastic characteristics of system components, the system operation policies, and the economic aspects such as the risk preferences of the demand. In this thesis, these aspects are taken into account to approximate the reserve value and construct reserve demand functions. Illustrative examples show that the demand functions constructed have similarities with those implemented in some markets.

  13. Expansion of Treatment for Hepatitis C Virus Infection by Task Shifting to Community-Based Nonspecialist Providers: A Nonrandomized Clinical Trial.

    Science.gov (United States)

    Kattakuzhy, Sarah; Gross, Chloe; Emmanuel, Benjamin; Teferi, Gebeyehu; Jenkins, Veronica; Silk, Rachel; Akoth, Elizabeth; Thomas, Aurielle; Ahmed, Charisse; Espinosa, Michelle; Price, Angie; Rosenthal, Elana; Tang, Lydia; Wilson, Eleanor; Bentzen, Soren; Masur, Henry; Kottilil, Shyam

    2017-09-05

    Direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) infection has resulted in high rates of disease cure; however, not enough specialists currently are available to provide care. To determine the efficacy of HCV treatment independently provided by nurse practitioners (NPs), primary care physicians (PCPs), or specialist physicians using DAA therapy. Nonrandomized, open-label clinical trial initiated in 2015. (ClinicalTrials.gov: NCT02339038). 13 urban, federally qualified health centers (FQHCs) in the District of Columbia. A referred sample of 600 patients, of whom 96% were black, 69% were male, 82% were treatment naive, and 20% had cirrhosis. Seventy-two percent of the patients had HCV genotype 1a infection. The baseline characteristics of patients seen by each provider type were similar. Patients were assigned in a nonrandomized but specified manner to receive treatment from 1 of 5 NPs, 5 PCPs, or 6 specialists. All providers underwent an identical 3-hour training session based on guidelines. Patients received treatment with ledipasvir-sofosbuvir, which was provided on site, according to U.S. Food and Drug Administration labeling requirements. Sustained virologic response (SVR). 516 patients achieved SVR, a response rate of 86% (95% CI, 83.0% to 88.7%), with no major safety signals. Response rates were consistent across the 3 provider types: NPs, 89.3% (CI, 83.3% to 93.8%); PCPs, 86.9% (CI, 80.6% to 91.7%); and specialists, 83.8% (CI, 79.0% to 87.8%). Patient loss to follow-up was the major cause of non-SVR. Nonrandomized patient distribution; possible referral bias. In a real-world cohort of patients at urban FQHCs, HCV treatment administered by nonspecialist providers was as safe and effective as that provided by specialists. Nurse practitioners and PCPs with compact didactic training could substantially expand the availability of community-based providers to escalate HCV therapy, bridging existing gaps in the continuum of care for patients with

  14. Evaluation of a Web-based intervention providing tailored advice for self-management of minor respiratory symptoms: exploratory randomized controlled trial.

    Science.gov (United States)

    Yardley, Lucy; Joseph, Judith; Michie, Susan; Weal, Mark; Wills, Gary; Little, Paul

    2010-12-15

    There has been relatively little research on the role of web-based support for self-care in the management of minor, acute symptoms, in contrast to the wealth of recent research into Internet interventions to support self-management of long-term conditions. This study was designed as an evaluation of the usage and effects of the "Internet Doctor" website providing tailored advice on self-management of minor respiratory symptoms (eg, cough, sore throat, fever, runny nose), in preparation for a definitive trial of clinical effectiveness. The first aim was to evaluate the effects of using the Internet Doctor webpages on patient enablement and use of health services, to test whether the tailored, theory-based advice provided by the Internet Doctor was superior to providing a static webpage providing the best existing patient information (the control condition). The second aim was to gain an understanding of the processes that might mediate any change in intentions to consult the doctor, by comparing changes in relevant beliefs and illness perceptions in the intervention and control groups, and by analyzing usage of the Internet Doctor webpages and predictors of intention change. Participants (N = 714) completed baseline measures of beliefs about their symptoms and self-care online, and were then automatically randomized to the Internet Doctor or control group. These measures were completed again by 332 participants after 48 hours. Four weeks later, 214 participants completed measures of enablement and health service use. The Internet Doctor resulted in higher levels of satisfaction than the control information (mean 6.58 and 5.86, respectively; P = .002) and resulted in higher levels of enablement a month later (median 3 and 2, respectively; P = .03). Understanding of illness improved in the 48 hours following use of the Internet Doctor webpages, whereas it did not improve in the control group (mean change from baseline 0.21 and -0.06, respectively, P = .05). Decline

  15. Accessibility, Availability, and Potential Benefits of Psycho-Oncology Services: The Perspective of Community-Based Physicians Providing Cancer Survivorship Care.

    Science.gov (United States)

    Zimmermann-Schlegel, Verena; Hartmann, Mechthild; Sklenarova, Halina; Herzog, Wolfgang; Haun, Markus W

    2017-06-01

    As persons of trust, community-based physicians providing survivorship care (e.g., general practitioners [GPs]) often serve as the primary contacts for cancer survivors disclosing distress. From the perspective of physicians providing survivorship care for cancer patients, this study explores (a) the accessibility, availability, and potential benefits of psycho-oncology services; (b) whether physicians themselves provide psychosocial support; and (c) predictors for impeded referrals of survivors to services. In a cross-sectional survey, all GPs and community-based specialists in a defined region were interviewed. In addition to descriptive analyses, categorical data were investigated by applying chi-square tests. Predictors for impeded referrals were explored through logistic regression. Of 683 responding physicians, the vast majority stated that survivors benefit from psycho-oncology services (96.8%), but the physicians also articulated that insufficient coverage of psycho-oncology services (90.9%) was often accompanied by impeded referrals (77.7%). A substantial proportion (14.9%) of physicians did not offer any psychosocial support. The odds of physicians in rural areas reporting impeded referrals were 1.91 times greater than the odds of physicians in large urban areas making a similar report (95% confidence interval [1.07, 3.40]). Most community-based physicians providing survivorship care regard psycho-oncology services as highly beneficial. However, a large number of physicians report tremendous difficulty referring patients. Focusing on those physicians not providing any psychosocial support, health policy approaches should specifically (a) raise awareness of the role of physicians as persons of trust for survivors, (b) highlight the effectiveness of psycho-oncology services, and (c) encourage a proactive attitude toward the assessment of unmet needs and the initiation of comprehensive care. Community-based physicians providing survivorship care for cancer

  16. Classification of uranium reserves/resources

    International Nuclear Information System (INIS)

    1998-08-01

    Projections of future availability of uranium to meet present and future nuclear power requirements depend on the reliability of uranium resource estimates. Lack of harmony of the definition of the different classes of uranium reserves and resources between countries makes the compilation and analysis of such information difficult. The problem was accentuated in the early 1990s with the entry of uranium producing countries from the former Soviet Union, eastern Europe and China into the world uranium supply market. The need for an internationally acceptable reserve/resource classification system and terminology using market based criteria is therefore obvious. This publication was compiled from participant's contributions and findings of the Consultants Meetings on Harmonization of Uranium Resource Assessment Concepts held in Vienna from 22 to 25 June 1992, and two Consultants Meetings on the Development of a More Meaningful Classification of Uranium Resources held in Kiev, Ukraine on 24-26 April 1995 and 20-23 August 1996. This document includes 11 contributions, summary, list of participants of the Consultants Meetings. Each contribution has been indexed and provided with an abstract

  17. Using a Time-Driven Activity-Based Costing Model To Determine the Actual Cost of Services Provided by a Transgenic Core.

    Science.gov (United States)

    Gerwin, Philip M; Norinsky, Rada M; Tolwani, Ravi J

    2018-03-01

    Laboratory animal programs and core laboratories often set service rates based on cost estimates. However, actual costs may be unknown, and service rates may not reflect the actual cost of services. Accurately evaluating the actual costs of services can be challenging and time-consuming. We used a time-driven activity-based costing (ABC) model to determine the cost of services provided by a resource laboratory at our institution. The time-driven approach is a more efficient approach to calculating costs than using a traditional ABC model. We calculated only 2 parameters: the time required to perform an activity and the unit cost of the activity based on employee cost. This method allowed us to rapidly and accurately calculate the actual cost of services provided, including microinjection of a DNA construct, microinjection of embryonic stem cells, embryo transfer, and in vitro fertilization. We successfully implemented a time-driven ABC model to evaluate the cost of these services and the capacity of labor used to deliver them. We determined how actual costs compared with current service rates. In addition, we determined that the labor supplied to conduct all services (10,645 min/wk) exceeded the practical labor capacity (8400 min/wk), indicating that the laboratory team was highly efficient and that additional labor capacity was needed to prevent overloading of the current team. Importantly, this time-driven ABC approach allowed us to establish a baseline model that can easily be updated to reflect operational changes or changes in labor costs. We demonstrated that a time-driven ABC model is a powerful management tool that can be applied to other core facilities as well as to entire animal programs, providing valuable information that can be used to set rates based on the actual cost of services and to improve operating efficiency.

  18. Diagnostic value of thallium-201 myocardial perfusion IQ-SPECT without and with computed tomography-based attenuation correction to predict clinically significant and insignificant fractional flow reserve: A single-center prospective study.

    Science.gov (United States)

    Tanaka, Haruki; Takahashi, Teruyuki; Ohashi, Norihiko; Tanaka, Koichi; Okada, Takenori; Kihara, Yasuki

    2017-12-01

    The aim of this study was to clarify the predictive value of fractional flow reserve (FFR) determined by myocardial perfusion imaging (MPI) using thallium (Tl)-201 IQ-SPECT without and with computed tomography-based attenuation correction (CT-AC) for patients with stable coronary artery disease (CAD).We assessed 212 angiographically identified diseased vessels using adenosine-stress Tl-201 MPI-IQ-SPECT/CT in 84 consecutive, prospectively identified patients with stable CAD. We compared the FFR in 136 of the 212 diseased vessels using visual semiquantitative interpretations of corresponding territories on MPI-IQ-SPECT images without and with CT-AC.FFR inversely correlated most accurately with regional summed difference scores (rSDS) in images without and with CT-AC (r = -0.584 and r = -0.568, respectively, both P system can predict FFR at an optimal cut-off of reserved.

  19. Part II, Provider perspectives: should patients be activated to request evidence-based medicine? a qualitative study of the VA project to implement diuretics (VAPID

    Directory of Open Access Journals (Sweden)

    Christensen Alan J

    2010-03-01

    initiating thiazide treatment included a hesitancy to switch medications if the patient was at or near goal blood pressure on a different anti-hypertensive. Conclusions Patient activation was acceptable to providers as a guideline implementation strategy, with considerable value placed on the activation process itself. By 'aligning' patients' objectives with those of their providers, this process also facilitated part of the effectiveness of the intervention. Patient activation shows promise for wider use as an implementation strategy, and should be tested in other areas of evidence-based medicine. Trial registration National Clinical Trial Registry number NCT00265538

  20. Assessing U.S. coal resources and reserves

    Science.gov (United States)

    Shaffer, Brian N.

    2017-09-27

    The U.S. Coal Resources and Reserves Assessment Project, as part of the U.S. Geological Survey (USGS) Energy Resources Program, conducts systematic, geology-based, regional assessments of significant coal beds in major coal basins in the United States. These assessments detail the quantity, quality, location, and economic potential of the Nation’s remaining coal resources and reserves and provide objective scientific information that assists in the formulation of energy strategies, environmental policies, land-use management practices, and economic projections.

  1. A CONTEXT AWARE BASED PRE-HANDOFF SUPPORT APPROACH TO PROVIDE OPTIMAL QOS FOR STREAMING APPLICATIONS OVER VEHICULAR AD HOC NETWORKS – HOSA

    Directory of Open Access Journals (Sweden)

    K. RAMESH BABU

    2015-06-01

    Full Text Available Large variations in network Quality of Service (QoS such as bandwidth, latency, jitter, and reliability may occur during media transfer over vehicular ad hoc networks (VANET. Usage of VANET over mobile and wireless computing applications experience “bursty” QoS behavior during the execution over distributed network scenarios. Applications such as streaming media services need to adapt their functionalities to any change in network status. Moreover, an enhanced software platform is necessary to provide adaptive network management services to upper software components. HOSA, a handoff service broker based architecture for QoS adaptation over VANET supports in providing awareness. HOSA is structured as a middleware platform both to provide QoS awareness to streaming applications as well to manage dynamic ad hoc network resources with support over handoff in an adaptive fashion. HOSA is well analyzed over routing schemes such as TIBSCRPH, SIP and ABSRP where performance of HOSA was measured using throughput, traffic intensity and end to end delay. HOSA has been analyzed using JXTA development toolkit over C++ implemented classes to demonstrate its performance over varying node mobility established using vehicular mobility based conference application.

  2. Reserve growth in oil fields of the North Sea

    Science.gov (United States)

    Klett, T.R.; Gautier, D.L.

    2005-01-01

    -growth patterns among oil fields that produce from primarily clastic and primarily chalk reservoirs, in addition to a greater number of fields in each of the two categories, allow separate reserve-growth models to be constructed based on reservoir-rock type. Reserve-growth models referenced to the date of discovery and to the date of first production may be constructed from North Sea field data. Years since discovery or years since first production are used as surrogates for, or measures of, field-development effort that is applied to promote reserve growth. Better estimates of recoverable oil are made as fields are developed. Because much of the field development occurs some time later than the field discovery date, reserve-growth models referenced to the date of first production may provide a more appropriate measure of development than does date of discovery. ?? 2005 EAGE/Geological Society of London.

  3. ANALISA PERBANDINGAN KETELITIAN PENENTUAN POSISI DENGAN GPS RTK-NTRIP DENGAN BASE GPS CORS BIG DARI BERBAGAI MACAM MOBILE PROVIDER DIDASARKAN PADA PERGESERAN LINEAR (STUDI KASUS: SURABAYA

    Directory of Open Access Journals (Sweden)

    Atika Sari

    2015-02-01

    Full Text Available Penentuan posisi dalam pemetaan menggunakan penginderaan jauh dan foto udara memerlukan pengamatan GPS geodetik sebagai titik kontrol yang memilki ketelitian tinggi. Sistem koreksi data penentuan posisinya diperoleh dari transmisi data dari stasiun base ke receiver. Dalam perkembangan sekarang ini metode pengukuran RTK telah menggunakan metode NTRIP (Networked Transport of RTCM via Internet Protocol sebagai metode transmisi koreksi data dengan menggunakan intenet sehingga pengukuran tersebut masih bisa dilakukan dengan jarak yang lebih jauh dari base-nya. Pada metode NTRIP ini menggunakan metode pengiriman koreksi data GNSS melalui jaringan internet. Pengembangan sistem dengan fasilitas akses internet mobile melalui general packet radio service (GPRS dan global system for mobile (GSM, menyediakan metode cepat dan handal untuk mendistribusikan baris data GPS atau koreksi diferensial real-time (DGPS / RTK ke penerima GPS di daerah manapun yang berada di bawah jangkauan jaringan telepon seluler. Sehingga untuk mengetahui provider yang sesuai digunakan dalam wilayah surabaya dalam menggunakan metode RTK NTRIP maka dilakukanlah penelitian ini. Dari hasil pengamatan dari pengukuran dengan menggunakan  metode RTK-NTRIP dengan base GPS CORS BIG didapat nilai rata-rata dari masing-masing provider sekitar < 4 m.

  4. Analysis of bacterial core communities in the central Baltic by comparative RNA-DNA-based fingerprinting provides links to structure-function relationships.

    Science.gov (United States)

    Brettar, Ingrid; Christen, Richard; Höfle, Manfred G

    2012-01-01

    Understanding structure-function links of microbial communities is a central theme of microbial ecology since its beginning. To this end, we studied the spatial variability of the bacterioplankton community structure and composition across the central Baltic Sea at four stations, which were up to 450 km apart and at a depth profile representative for the central part (Gotland Deep, 235 m). Bacterial community structure was followed by 16S ribosomal RNA (rRNA)- and 16S rRNA gene-based fingerprints using single-strand conformation polymorphism (SSCP) electrophoresis. Species composition was determined by sequence analysis of SSCP bands. High similarities of the bacterioplankton communities across several hundred kilometers were observed in the surface water using RNA- and DNA-based fingerprints. In these surface communities, the RNA- and DNA-based fingerprints resulted in very different pattern, presumably indicating large difference between the active members of the community as represented by RNA-based fingerprints and the present members represented by the DNA-based fingerprints. This large discrepancy changed gradually over depth, resulting in highly similar RNA- and DNA-based fingerprints in the anoxic part of the water column below 130 m depth. A conceivable mechanism explaining this high similarity could be the reduced oxidative stress in the anoxic zone. The stable communities on the surface and in the anoxic zone indicate the strong influence of the hydrography on the bacterioplankton community structure. Comparative analysis of RNA- and DNA-based community structure provided criteria for the identification of the core community, its key members and their links to biogeochemical functions.

  5. Do frontline health care providers know enough about artemisinin-based combination therapy to rationally treat malaria? A cross-sectional survey in Gezira State, Sudan.

    Science.gov (United States)

    Mannan, Abeer A; Elmardi, Khalid A; Idris, Yassir A; Spector, Jonathan M; Ali, Nahid A; Malik, Elfatih M

    2015-03-26

    In 2004, artemisinin-based combination therapy (ACT) was introduced in Sudan for the treatment of malaria. The role of health care providers working in first-level health care facilities is central for the effective implementation of this revised malaria treatment policy. However, information about their level of ACT knowledge is inadequate. This study sought to describe frontline health care providers' knowledge about the formulations and dose regimens of nationally recommended ACT in Sudan. This cross-sectional study took place in Gezira State, Sudan. Data were gathered from five localities comprising forty primary health care facilities. A total of 119 health care providers participated in the study (72 prescribers and 47 dispensers). The primary outcome was the proportion of health care providers who were ACT knowledgeable, a composite indicator of health care providers' ability to (1) define what combination therapy is; (2) identify the recommended first- and second-line treatments; and (3) correctly state the dose regimens for each. All prescribers and 95.7% (46/47) of dispensers were aware of the new national malaria treatment policy. However, 93.1% (67/72) of prescribers compared to 87.2% (41/47) of dispensers recognized artesunate-sulphadoxine/pyrimethamine as the recommended first-line treatment in Sudan. Only a small number of prescribers and dispensers (9.4% and 13.6%, respectively) were able to correctly define the meaning of a combination therapy. Overall, only 22% (26/119, 95% CI 14.6-29.4) of health care providers were found to be ACT knowledgeable with no statistically significant difference between prescribers and dispensers. Overall, ACT knowledge among frontline health care providers is very poor. This finding suggests that efforts are needed to improve knowledge of prescribers and dispensers working in first-level health care facilities, perhaps through implementing focused, provider-oriented training programmes. Additionally, a system for

  6. An evidence based alcohol screening, brief intervention and referral to treatment (SBIRT) curriculum for emergency department (ED) providers improves skills and utilization.

    Science.gov (United States)

    Bernstein, Edward; Bernstein, Judith; Feldman, James; Fernandez, William; Hagan, Melissa; Mitchell, Patricia; Safi, Clara; Woolard, Robert; Mello, Mike; Baird, Janette; Lee, Christina; Bazargan-Hejazi, Shahrzad; Broderick, Kerry; Laperrier, Kathryn A; Kellermann, Arthur; Wald, Marlena M; Taylor, Robert E; Walton, Kim; Grant-Ervin, Michelle; Rollinson, Denise; Edwards, David; Chan, Theodore; Davis, Dan; Buchanan Marshall, Jean; Aseltine, Robert; James, Amy; Schilling, Elizabeth; Abu-Hasaballah, Khamis; Baumann, Brigitte M; Boudreaux, Edwin D; Maio, Ronald F; Cunningham, Rebecca M; Murrell, Teresa; Doezema, David; Anglin, Deirdre; Eliassen, Adriana; Martin, Marcus; Pines, Jesse; Buchanan, Leslie; Turner, James; D'Onofrio, Gail; Degutis, Linda C; Owens, Patricia

    2007-01-01

    Emergency Departments (EDs) offer an opportunity to improve the care of patients with at-risk and dependent drinking by teaching staff to screen, perform brief intervention and refer to treatment (SBIRT). We describe here the implementation at 14 Academic EDs of a structured SBIRT curriculum to determine if this learning experience improves provider beliefs and practices. ED faculty, residents, nurses, physician extenders, social workers, and Emergency Medical Technicians (EMTs) were surveyed prior to participating in either a two hour interactive workshops with case simulations, or a web-based program (www.ed.bmc.org/sbirt). A pre-post repeated measures design assessed changes in provider beliefs and practices at three and 12 months post-exposure. Among 402 ED providers, 74% reported SBIRT skills all improved significantly over baseline. Gains decreased somewhat at 12 months, but remained above baseline. Length of time in practice was positively associated with SBIRT utilization, controlling for gender, race and type of profession. Persistent barriers included time limitations and lack of referral resources. ED providers respond favorably to SBIRT. Changes in utilization were substantial at three months post-exposure to a standardized curriculum, but less apparent after 12 months. Booster sessions, trained assistants and infrastructure supports may be needed to sustain changes over the longer term.

  7. Food Products Made With Glycomacropeptide, a Low Phenylalanine Whey Protein, Provide a New Alternative to Amino Acid-Based Medical Foods for Nutrition Management of Phenylketonuria

    Science.gov (United States)

    Van Calcar, Sandra C.; Ney, Denise M.

    2012-01-01

    Phenylketonuria (PKU), an inborn error in phenylalanine (phe) metabolism, requires lifelong nutrition management with a low-phe diet, which includes a phe-free amino acid-based medical formula to provide the majority of an individual’s protein needs. Compliance with this diet is often difficult for older children, adolescents and adults with PKU. The whey protein glycomacropeptide (GMP) is ideally suited for the PKU diet since it is naturally low in phe. Nutritionally complete, acceptable medical foods and beverages can be made with GMP to increase the variety of protein sources for the PKU diet. As an intact protein, GMP improves protein utilization and increases satiety compared with amino acids. Thus, GMP provides a new, more physiologic source of low-phe dietary protein for those with PKU. PMID:22818728

  8. Ubiquitous Connected Train Based on Train-to-Ground and Intra-Wagon Communications Capable of Providing on Trip Customized Digital Services for Passengers

    Science.gov (United States)

    Salaberria, Itziar; Perallos, Asier; Azpilicueta, Leire; Falcone, Francisco; Carballedo, Roberto; Angulo, Ignacio; Elejoste, Pilar; Bahillo, Alfonso; Astrain, José Javier; Villadangos, Jesús

    2014-01-01

    During the last years, the application of different wireless technologies has been explored in order to enable Internet connectivity from vehicles. In addition, the widespread adoption of smartphones by citizens represents a great opportunity to integrate such nomadic devices inside vehicles in order to provide new and personalized on trip services for passengers. In this paper, a proposal of communication architecture to provide the ubiquitous connectivity needed to enhance the smart train concept is presented and preliminarily tested. It combines an intra-wagon communication system based on nomadic devices connected through a Bluetooth Piconet Network with a highly innovative train-to-ground communication system. In order to validate this communication solution, several tests and simulations have been performed and their results are described in this paper. PMID:24803192

  9. An imaging informatics-based ePR (electronic patient record) system for providing decision support in evaluating dose optimization in stroke rehabilitation

    Science.gov (United States)

    Liu, Brent J.; Winstein, Carolee; Wang, Ximing; Konersman, Matt; Martinez, Clarisa; Schweighofer, Nicolas

    2012-02-01

    Stroke is one of the major causes of death and disability in America. After stroke, about 65% of survivors still suffer from severe paresis, while rehabilitation treatment strategy after stroke plays an essential role in recovery. Currently, there is a clinical trial (NIH award #HD065438) to determine the optimal dose of rehabilitation for persistent recovery of arm and hand paresis. For DOSE (Dose Optimization Stroke Evaluation), laboratory-based measurements, such as the Wolf Motor Function test, behavioral questionnaires (e.g. Motor Activity Log-MAL), and MR, DTI, and Transcranial Magnetic Stimulation (TMS) imaging studies are planned. Current data collection processes are tedious and reside in various standalone systems including hardcopy forms. In order to improve the efficiency of this clinical trial and facilitate decision support, a web-based imaging informatics system has been implemented together with utilizing mobile devices (eg, iPAD, tablet PC's, laptops) for collecting input data and integrating all multi-media data into a single system. The system aims to provide clinical imaging informatics management and a platform to develop tools to predict the treatment effect based on the imaging studies and the treatment dosage with mathematical models. Since there is a large amount of information to be recorded within the DOSE project, the system provides clinical data entry through mobile device applications thus allowing users to collect data at the point of patient interaction without typing into a desktop computer, which is inconvenient. Imaging analysis tools will also be developed for structural MRI, DTI, and TMS imaging studies that will be integrated within the system and correlated with the clinical and behavioral data. This system provides a research platform for future development of mathematical models to evaluate the differences between prediction and reality and thus improve and refine the models rapidly and efficiently.

  10. Using Videoconferencing Technology to Provide Breastfeeding Support to Low-Income Women: Connecting Hospital-Based Lactation Consultants with Clients Receiving Care at a Community Health Center.

    Science.gov (United States)

    Friesen, Carol A; Hormuth, Laura J; Petersen, Devan; Babbitt, Tina

    2015-11-01

    The Tele-Lactation Pilot Project (TLPP), 1 of 13 community-based breastfeeding projects implemented in Indiana in 2013 using Centers for Disease Control and Prevention grant funds, explored the feasibility of using videoconferencing technology to provide breastfeeding education and support to low-income women by a centrally located International Board Certified Lactation Consultant (IBCLC). The IBCLC was housed at the Breastfeeding Center at the hospital where the women would deliver; the women receiving the education and support were located at an inner-city community health center (CHC) where they received their primary care. The videoconferencing sessions were juxtaposed with the women's regularly scheduled prenatal and postnatal visits at the CHC. After delivery, the lactation consultant visited the mother and infant in person at the hospital to offer additional support. Overall, 35 mothers were served by the TLPP during the 9-month project period. A total of 134 visits (30-45 minutes each) were conducted (3.8 sessions per woman). At the conclusion of the project, interviews with key participants indicated that the tele-lactation videoconferencing sessions were easy to implement, allowed the IBCLC to reach a wider client base, and allowed the women to receive expert support that they might not have otherwise received. Comments indicated that, in addition to providing education and increasing the women's confidence, the tele-lactation sessions appeared to have decreased the mothers' anxiety about the birthing process and the hospital experience. The TLPP demonstrated that incorporating videoconferencing technology into routine care can help foster collaboration among health care providers and provide mothers with continuous, easily accessible breastfeeding education and support. © The Author(s) 2015.

  11. Use of gadolinium-based magnetic resonance imaging contrast agents and awareness of brain gadolinium deposition among pediatric providers in North America

    Energy Technology Data Exchange (ETDEWEB)

    Mithal, Leena B. [Northwestern University, Feinberg School of Medicine, Ann and Robert H. Lurie Children' s Hospital of Chicago, Department of Pediatrics, Chicago, IL (United States); Patel, Payal S. [University of Arizona College of Medicine, Department of Pediatrics, Phoenix, AZ (United States); Mithal, Divakar [Northwestern University, Feinberg School of Medicine, Ann and Robert H. Lurie Children' s Hospital of Chicago, Department of Pediatric Neurology, Chicago, IL (United States); Palac, Hannah L. [Northwestern University, Biostatistics, Feinberg School of Medicine, Ann and Robert H. Lurie Children' s Hospital of Chicago, Chicago, IL (United States); Rozenfeld, Michael N. [University of Arizona College of Medicine, Department of Radiology, Phoenix, AZ (United States)

    2017-05-15

    Numerous recent articles have reported brain gadolinium deposition when using linear but not macrocyclic gadolinium-based contrast agents (GBCAs). To determine the current landscape of gadolinium use among pediatric institutions and the knowledge base of radiologists and referring providers with regard to GBCAs and brain gadolinium deposition. We e-mailed voluntary closed surveys to 5,390 physicians in various pediatric professional societies between January 2016 and March 2016. We used chi-square and Fisher exact tests to compare response distributions among specialties. We found that 80% of surveyed pediatric hospitals use macrocyclic contrast agents. In the last year, 58% switched their agent, most commonly to gadoterate meglumine, with the most common reason being brain gadolinium deposition. Furthermore, surveys indicated that 23% of hospitals are considering switching, and, of these, 83% would switch to gadoterate meglumine; the most common reasons were brain gadolinium deposition and safety. Radiologists were more aware of brain gadolinium deposition than non-radiologist physicians (87% vs. 26%; P<0.0001). Radiologists and referring providers expressed similar levels of concern (95% and 89%). Twelve percent of radiologists and 2% of referring providers reported patients asking about brain gadolinium deposition. Radiologists were significantly more comfortable addressing patient inquiries than referring pediatric physicians (48% vs. 6%; P<0.0001). The number of MRIs requested by referring pediatric physicians correlated with their knowledge of brain gadolinium deposition, contrast agent used by their hospital, and comfort discussing brain gadolinium deposition with patients (P<0.0001). Since the discovery of brain gadolinium deposition, many pediatric hospitals have switched to or plan to switch to a more stable macrocyclic MR contrast agent, most commonly gadoterate meglumine. Despite this, there is need for substantial further education of radiologists and

  12. "Awake, smoky, and hot": providing an evidence-base for managing the risks associated with occupational stressors encountered by wildland firefighters.

    Science.gov (United States)

    Aisbett, B; Wolkow, A; Sprajcer, M; Ferguson, S A

    2012-09-01

    To curtail the spread of wildfire, firefighters are often required to work long hours in hot, smoky conditions with little rest between consecutive shifts. In isolation, heat, smoke, and sleep disruption can have a detrimental impact on cognitive and physical abilities. Far less is known, however, about the combined impact that heat, smoke, and sleep disruption can have on firefighters' performance during wildfire suppression or on human performance in general. The available literature, though scant, suggests that audio and visual tracking may be degraded after sustained heat exposure following one night of sleep deprivation. Exposure to heat and carbon monoxide, in contrast, appears to have only limited impact on cognitive performance, even after physical exercise. Heat and carbon monoxide exposure does, however, increase physiological exertion to a given work or exercise bout. To the authors' knowledge, there are no published studies that have explored the impacts of heat exposure following sleep disruption on physical work performance, sleep disruption and smoke exposure on physical or cognitive work, or the combined impacts of sleep disruption, smoke and heat exposure on cognitive or physical work. While more integrative research is needed, the current review provides a summary of the available evidence and an indication of the degree of confidence agencies can have in the research. This will allow both the scientific community and agencies to make informed recommendations regarding the management of wildland firefighters' health and safety on the fireground. Copyright © 2012 Elsevier Ltd. All rights reserved.

  13. Implementation of CycleTel Family Advice: an SMS-based service to provide family planning and fertility awareness information in India.

    Science.gov (United States)

    Ashcroft, Nicki; Shelus, Victoria; Garg, Himanshu; McLarnon-Silk, Courtney; Jennings, Victoria H

    2017-01-01

    CycleTel Family Advice (CFA), an SMS-based service designed to improve knowledge of fertility and family planning (FP), was delivered to over 100,000 people in India from April to August 2015. The goal of CFA was to increase knowledge on a range of reproductive health topics, e.g., the menstrual cycle, fertility, and FP, and to increase positive perceptions and use of FP. This paper focuses on the best practices and operational challenges for providing an SMS service based on the implementation experience of CFA. The implementation process for CFA was well documented, specifically program design, commercial partnerships, formative research, design of messages, and recruitment of users. The impact of CFA on knowledge, attitudes, and behaviors was assessed through phone surveys before and after message delivery. Programmatic data and phone surveys resulted in several operational findings, particularly in the areas of user behavior, partnership management, and mHealth research. While there were improvements in knowledge, there were not significant changes in FP use and couple communication. The intervention yielded insights into designing an mHealth intervention as well as the opportunities and challenges of implementing a stand-alone SMS-based service with a broad audience. Lessons learned were that (I) SMS-based interventions, without other supporting systems, may not lead to high user engagement or behavior change; (II) partnerships with private sector technical platforms can help overcome the difficult problem of marketing and outreach, but they bring limitations to user interface and dependencies on a commercial structure; (III) collecting demographic data required to provide tailored content may be a barrier to user acquisition; and (IV) while phone surveys are useful for evaluation of mHealth interventions, reaching users is challenging and response rates are low.

  14. Biosphere reserves: Attributes for success.

    Science.gov (United States)

    Van Cuong, Chu; Dart, Peter; Hockings, Marc

    2017-03-01

    Biosphere reserves established under the UNESCO Man and the Biosphere Program aim to harmonise biodiversity conservation and sustainable development. Concerns over the extent to which the reserve network was living up to this ideal led to the development of a new strategy in 1995 (the Seville Strategy) to enhance the operation of the network of reserves. An evaluation of effectiveness of management of the biosphere reserve network was called for as part of this strategy. Expert opinion was assembled through a Delphi Process to identify successful and less successful reserves and investigate common factors influencing success or failure. Ninety biosphere reserves including sixty successful and thirty less successful reserves in 42 countries across all five Man and the Biosphere Program regions were identified. Most successful sites are the post-Seville generation while the majority of unsuccessful sites are pre-Seville that are managed as national parks and have not been amended to conform to the characteristics that are meant to define a biosphere reserve. Stakeholder participation and collaboration, governance, finance and resources, management, and awareness and communication are the most influential factors in the success or failure of the biosphere reserves. For success, the biosphere reserve concept needs to be clearly understood and applied through landscape zoning. Designated reserves then need a management system with inclusive good governance, strong participation and collaboration, adequate finance and human resource allocation and stable and responsible management and implementation. All rather obvious but it is difficult to achieve without commitment to the biosphere reserve concept by the governance authorities. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. Improving the Design of a Conservation Reserve for a Critically Endangered Species.

    Science.gov (United States)

    Taylor, Chris; Cadenhead, Natasha; Lindenmayer, David B; Wintle, Brendan A

    2017-01-01

    Setting aside protected areas is a key strategy for tackling biodiversity loss. Reserve effectiveness depends on the extent to which protected areas capture both known occurrences and areas likely to support the species. We assessed the effectiveness of the existing reserve network for Leadbeater's Possum (Gymnobelideus leadbeateri) and other forest-dependent species, and compared the existing reserve system to a set of plausible reserve expansion options based on area targets implied in a recent Population Viability Analysis (PVA). The existing Leadbeater's Reserve and surrounding reserve system captured 7.6% and 29.6% of cumulative habitat suitability, respectively, across the landscape. Expanded reserve scenarios captured 34% to 62% of cumulative habitat suitability. We found acute trade-offs between conserving Leadbeater's Possum habitat and conserving habitat of other forest-dependent species. Our analysis provides a template for systematically expanding and evaluating reserve expansion options in terms of trade-offs between priority species' needs.

  16. Improving the Design of a Conservation Reserve for a Critically Endangered Species.

    Directory of Open Access Journals (Sweden)

    Chris Taylor

    Full Text Available Setting aside protected areas is a key strategy for tackling biodiversity loss. Reserve effectiveness depends on the extent to which protected areas capture both known occurrences and areas likely to support the species. We assessed the effectiveness of the existing reserve network for Leadbeater's Possum (Gymnobelideus leadbeateri and other forest-dependent species, and compared the existing reserve system to a set of plausible reserve expansion options based on area targets implied in a recent Population Viability Analysis (PVA. The existing Leadbeater's Reserve and surrounding reserve system captured 7.6% and 29.6% of cumulative habitat suitability, respectively, across the landscape. Expanded reserve scenarios captured 34% to 62% of cumulative habitat suitability. We found acute trade-offs between conserving Leadbeater's Possum habitat and conserving habitat of other forest-dependent species. Our analysis provides a template for systematically expanding and evaluating reserve expansion options in terms of trade-offs between priority species' needs.

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

    Science.gov (United States)

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

    2011-07-01

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

  18. Reserves and cash flows under stochastic retirement

    DEFF Research Database (Denmark)

    Gad, Kamille Sofie Tågholt; Nielsen, Jeppe Woetmann

    2016-01-01

    and the guarantees provided. Stochastic retirement creates a need to rethink the construction of disability products for high ages and ways to handle this are discussed. We show how to calculate market reserves and how to use modified transition probabilities to calculate expected cash flows without significantly...... more complexity than in the traditional model. At last, we demonstrate the impact of stochastic retirement on market reserves and expected cash flow in numerical examples....

  19. Investigating the Effectiveness, Acceptability and Impact on Healthcare Usage of Providing a Cognitive-Behavioural Based Psychological Therapy Service for Patients with Primary Antibody Deficiency.

    Science.gov (United States)

    Campbell, Mari; Clarke, Alex; Symes, Andrew; Workman, Sarita; Stauss, Hans; Webster, A David

    2018-02-01

    Patients with primary antibody deficiency report poorer quality of life and higher rates of anxiety and depression than the general population. Cognitive-behavioral therapy has been shown to be a valuable treatment for patients with other long-term physical health conditions, improving well-being and enabling them to manage their symptoms more effectively. The aim of this project was to establish the feasibility and effectiveness of providing cognitive-behavioral based therapy to patients with primary antibody deficiency. Forty-four patients completed a course of psychological therapy. Participants completed a series of self-report measures examining psychological and physical health, and service usage, prior to starting treatment and following their final session. They also provided feedback on their experience of treatment. Patients showed improvements in anxiety, depression, insomnia and fatigue. There was a high level of acceptability of the service and the potential for long-term cost savings to the NHS. Psychological therapy based on the cognitive-behavioral model of treatment appears to be a valuable treatment for patients with primary antibody deficiency and comorbid mental health difficulties.

  20. The Use of eHealth and Provider-Based Health Services by Patients with Diabetes Mellitus: Protocol for a Cross-Sectional Study.

    Science.gov (United States)

    Hansen, Anne Helen; Bradway, Meghan; Broz, Jan; Claudi, Tor; Henriksen, Øystein; Wangberg, Silje C; Årsand, Eirik

    2016-10-31

    The prevalence of diabetes and the use of electronic health (eHealth) resources are increasing. People with diabetes need frequent monitoring and follow-up of health parameters, and eHealth services can be of great significance in this regard. However, little is known about the extent to which different kinds of eHealth tools are used, and how the use of eHealth is associated with the use of provider-based health care services among people with diabetes. The primary objective of this study is to investigate the use of eHealth and its association with the use of provider-based health care services. The secondary objectives include investigating which eHealth services are used (apps, search engines, video services, social media), the relationship between socioeconomic status and the use of different eHealth tools, whether the use of eHealth is discussed in the clinical encounter, and whether such tools might lead to (or prevent) doctor visits and referrals. We will conduct cross-sectional studies based on self-reported questionnaire data from the population-based seventh Tromsø Study. Participants will be diabetic patients aged 40 years and older. According to our estimates, approximately 1050 participants will be eligible for inclusion. Data will be analyzed using descriptive statistics, chi-square tests, and univariable and multivariable logistic regressions. The grant proposal for this study was approved by the Northern Norway Regional Health Authority on November 23, 2015 (HST 1306-16). Recruitment of participants for the Tromsø Study started in 2015 and will continue throughout 2016. This particular project started on July 1, 2016. This project may yield benefits for patients, health care providers, hospitals, and society as a whole. Benefits are related to improved prevention services, health, experience of care services, self-management tools and services, organizational structures, efficiency of specialist care use, allocation of resources, and

  1. Treatment Outcomes and Costs of Providing Antiretroviral Therapy at a Primary Health Clinic versus a Hospital-Based HIV Clinic in South Africa.

    Directory of Open Access Journals (Sweden)

    Lawrence C Long

    Full Text Available In 2010 South Africa revised its HIV treatment guidelines to allow the initiation and management of patients on antiretroviral therapy (ART by nurses, rather than solely doctors, under a program called NIMART (Nurse Initiated and Managed Antiretroviral Therapy. We compared the outcomes and costs of NIMART between the two major public sector HIV treatment delivery models in use in South Africa today, primary health clinics and hospital-based HIV clinics.The study was conducted at one hospital-based outpatient HIV clinic and one primary health clinic (PHC in Gauteng Province. A retrospective cohort of adult patients initiated on ART at the PHC was propensity-score matched to patients initiated at the hospital outpatient clinic. Each patient was assigned a 12-month outcome of alive and in care or died/lost to follow up. Costs were estimated from the provider perspective for the 12 months after ART initiation. The proportion of patients alive and in care at 12 months did not differ between the PHC (76.5% and the hospital-based site (74.2%. The average annual cost per patient alive and in care at 12 months after ART initiation was significantly lower at the PHC (US$238 than at the hospital outpatient clinic (US$428.Initiating and managing ART patients at PHCs under NIMART is producing equally good outcomes as hospital-based HIV clinic care at much lower cost. Evolution of hospital-based clinics into referral facilities that serve complicated patients, while investing most program expansion resources into PHCs, may be a preferred strategy for achieving treatment coverage targets.

  2. National indicators of health literacy: ability to understand health information and to engage actively with healthcare providers - a population-based survey among Danish adults.

    Science.gov (United States)

    Bo, Anne; Friis, Karina; Osborne, Richard H; Maindal, Helle Terkildsen

    2014-10-22

    Health literacy is a multidimensional concept covering a range of cognitive and social skills necessary for participation in health care. Knowledge of health literacy levels in general populations and how health literacy levels impacts on social health inequity is lacking. The primary aim of this study was to perform a population-based assessment of dimensions of health literacy related to understanding health information and to engaging with healthcare providers. Secondly, the aim was to examine associations between socio-economic characteristics with these dimensions of health literacy. A population-based survey was conducted between January and April 2013 in the Central Denmark Region. Postal invitations were sent to a random sample of 46,354 individuals >25 years of age. Two health literacy dimensions were selected from the Health Literacy Questionnaire (HLQ™): i) Understanding health information well enough to know what to do (5 items), and ii) Ability to actively engage with health care providers (5 items). Response options ranged from 1 (very difficult) to 4 (very easy). We investigated the level of perceived difficulty of each task, and the associations between the two dimensions and socio-economic characteristics. A total of 29,473 (63.6%) responded to the survey. Between 8.8%, 95% CI: 8.4-9.2 and 20.2%, 95% CI: 19.6-20.8 of the general population perceived the health literacy tasks as difficult or very difficult at the individual item level. On the scale level, the mean rating for i) understanding health information was 3.10, 95% CI: 3.09-3.10, and 3.07, 95% CI: 3.07-3.08 for ii) engagement with health care providers. Low levels of the two dimensions were associated with low income, low education level, living alone, and to non-Danish ethnicity. Associations with sex and age differed by the specific health literacy dimension. Estimates on two key dimensions of health literacy in a general population are now available. A substantial proportion of the

  3. Evidence-based obstetrics in four hospitals in China: An observational study to explore clinical practice, women's preferences and provider's views

    Directory of Open Access Journals (Sweden)

    Liang Ji

    2001-05-01

    Full Text Available Abstract Background Evidence-based obstetric care is widely promoted in developing countries, but the success of implementation is not known. Using selected childbirth care procedures in four hospitals in Shanghai, we compared practice against evidence-based information, and explored user and provider views about each procedure. Methods Observational study. Using the Cochrane Library, we identified six procedures that should be avoided as routine and two that should be encouraged. Procedure rate determined by exit interviews with women, verified using hospital notes. Views of women and providers explored with in depth interviews. The study sites were three hospitals in Shanghai and one in neighbouring province of Jiangsu. 150 women at each centre for procedure rate, and 48 in-depth interviews with women and providers. Results Vaginal births were 50% (303/599 of the total. Of the six practices where evidence suggests they should be avoided as routine, three were performed with rates above 70%: pubic shaving (3 hospitals, rectal examination (3 hospitals, and episiotomy (3 hospitals. Most women delivered lying down, pain relief was rarely given, and only in the urban district hospital did women routinely have a companion. Most women wanted support or companionship during labour and to be given pain relief; but current practice is insufficient to meet women's needs. Conclusion Obstetric practice is not following best available evidence in the hospitals studied. There is a need to adjust hospital policy to support the use of interventions proven to be of benefit to women during childbirth, and develop approaches that ensure clinical practice changes.

  4. Simultaneous subcutaneous and conjunctival administration of the influenza viral vector based Brucella abortus vaccine to pregnant heifers provides better protection against B. abortus 544 infection than the commercial B. abortus S19 vaccine.

    Science.gov (United States)

    Tabynov, Kaissar; Orynbayev, Mukhit; Renukaradhya, Gourapura J; Sansyzbay, Abylai

    2016-09-30

    In this study, we explored possibility of increasing the protective efficacy of our novel influenza viral vector based B. abortus vaccine (Flu-BA) in pregnant heifers by adapting an innovative method of vaccine delivery. We administered the vaccine concurrently via the conjunctival and subcutaneous routes to pregnant heifers, and these routes were previously tested individually. The Flu-BA vaccination of pregnant heifers (n=9) against a challenge B. abortus 544 infection provided protection from abortion, infection of heifers and fetuses/calves by 88.8%, 100% and 100%, respectively (alpha=0.004-0.0007 vs. negative control; n=7). Our candidate vaccine using this delivery method provided slightly better protection than the commercial B. abortus S19 vaccine in pregnant heifers (n=8), which provided protection from abortion, infection of heifers and fetuses/calves by 87.5%, 75% and 87.5%, respectively. This improved method of the Flu-BA vaccine administration is highly recommended for the recovery of farms which has high prevalence of brucellosis. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Computerized reserves assessment improves colliery planning. [Poland

    Energy Technology Data Exchange (ETDEWEB)

    Pozor, L.; Wrobel, R.

    1984-01-01

    The authors describe systems developed in Poland for the computerised assessment of coal reserves. The Zasoby system calculates coal reserves and evaluates selected natural properties of seams within the boundaries of an arbitrary mining property, based entirely on exploratory borehole data. The IOS-10 system is based on the Polish data bank for bituminous coal deposits. It is not suitable for use in mine design procedures, but is widely used for the statistical recording of reserves in areas currently being worked. The major part of the paper is devoted to a description of the Geo-3 system, used for the computation of reserves in prospective areas from borehole data, as well as in active mining areas or partially worked-out deposits. The computation method is explained and examples of the results obtained are given.

  6. Commercial helium reserves, continental rifting and volcanism

    Science.gov (United States)

    Ballentine, C. J.; Barry, P. H.; Hillegonds, D.; Fontijn, K.; Bluett, J.; Abraham-James, T.; Danabalan, D.; Gluyas, J.; Brennwald, M. S.; Pluess, B.; Seneshens, D.; Sherwood Lollar, B.

    2017-12-01

    Helium has many industrial applications, but notably provides the unique cooling medium for superconducting magnets in medical MRI scanners and high energy beam lines. In 2013 the global supply chainfailed to meet demand causing significant concern - the `Liquid Helium Crisis' [1]. The 2017 closure of Quatar borders, a major helium supplier, is likely to further disrupt helium supply, and accentuates the urgent need to diversify supply. Helium is found in very few natural gas reservoirs that have focused 4He produced by the dispersed decay (a-particle) of U and Th in the crust. We show here, using the example of the Rukwa section of the Tanzanian East African Rift, how continental rifting and local volcanism provides the combination of processes required to generate helium reserves. The ancient continental crust provides the source of 4He. Rifting and associated magmatism provides the tectonic and thermal mechanism to mobilise deep fluid circulation, focusing flow to the near surface along major basement faults. Helium-rich springs in the Tanzanian Great Rift Valley were first identified in the 1950's[2]. The isotopic compositions and major element chemistry of the gases from springs and seeps are consistent with their release from the crystalline basement during rifting [3]. Within the Rukwa Rift Valley, helium seeps occur in the vicinity of trapping structures that have the potential to store significant reserves of helium [3]. Soil gas surveys over 6 prospective trapping structures (1m depth, n=1486) show helium anomalies in 5 out of the 6 at levels similar to those observed over a known helium-rich gas reservoir at 1200m depth (7% He - Harley Dome, Utah). Detailed macroseep gas compositions collected over two days (n=17) at one site allows us to distinguish shallow gas contributions and shows the deep gas to contain between 8-10% helium, significantly increasing resource estimates based on uncorrected values (1.8-4.2%)[2,3]. The remainder of the deep gas is

  7. Providing traceability for neuroimaging analyses.

    Science.gov (United States)

    McClatchey, Richard; Branson, Andrew; Anjum, Ashiq; Bloodsworth, Peter; Habib, Irfan; Munir, Kamran; Shamdasani, Jetendr; Soomro, Kamran

    2013-09-01

    With the increasingly digital nature of biomedical data and as the complexity of analyses in medical research increases, the need for accurate information capture, traceability and accessibility has become crucial to medical researchers in the pursuance of their research goals. Grid- or Cloud-based technologies, often based on so-called Service Oriented Architectures (SOA), are increasingly being seen as viable solutions for managing distributed data and algorithms in the bio-medical domain. For neuroscientific analyses, especially those centred on complex image analysis, traceability of processes and datasets is essential but up to now this has not been captured in a manner that facilitates collaborative study. Few examples exist, of deployed medical systems based on Grids that provide the traceability of research data needed to facilitate complex analyses and none have been evaluated in practice. Over the past decade, we have been working with mammographers, paediatricians and neuroscientists in three generations of projects to provide the data management and provenance services now required for 21st century medical research. This paper outlines the finding of a requirements study and a resulting system architecture for the production of services to support neuroscientific studies of biomarkers for Alzheimer's disease. The paper proposes a software infrastructure and services that provide the foundation for such support. It introduces the use of the CRISTAL software to provide provenance management as one of a number of services delivered on a SOA, deployed to manage neuroimaging projects that have been studying biomarkers for Alzheimer's disease. In the neuGRID and N4U projects a Provenance Service has been delivered that captures and reconstructs the workflow information needed to facilitate researchers in conducting neuroimaging analyses. The software enables neuroscientists to track the evolution of workflows and datasets. It also tracks the outcomes of

  8. Reserve selection using nonlinear species distribution models.

    Science.gov (United States)

    Moilanen, Atte

    2005-06-01

    Reserve design is concerned with optimal selection of sites for new conservation areas. Spatial reserve design explicitly considers the spatial pattern of the proposed reserve network and the effects of that pattern on reserve cost and/or ability to maintain species there. The vast majority of reserve selection formulations have assumed a linear problem structure, which effectively means that the biological value of a potential reserve site does not depend on the pattern of selected cells. However, spatial population dynamics and autocorrelation cause the biological values of neighboring sites to be interdependent. Habitat degradation may have indirect negative effects on biodiversity in areas neighboring the degraded site as a result of, for example, negative edge effects or lower permeability for animal movement. In this study, I present a formulation and a spatial optimization algorithm for nonlinear reserve selection problems in grid-based landscapes that accounts for interdependent site values. The method is demonstrated using habitat maps and nonlinear habitat models for threatened birds in the Netherlands, and it is shown that near-optimal solutions are found for regions consisting of up to hundreds of thousands grid cells, a landscape size much larger than those commonly attempted even with linear reserve selection formulations.

  9. Youth Problems on Indian Reservations.

    Science.gov (United States)

    Underhill, Ruth M., Ed.

    Juvenile delinquency was identified as the major problem affecting youth on Indian reservations. Causes for delinquency which were discussed included culture conflict, expectation of failure, unemployment, failure of homes and parents, discrimination, inadequate education, off-reservation schools, and alcoholism. Needs identified by tribal leaders…

  10. Can Creativity Predict Cognitive Reserve?

    Science.gov (United States)

    Palmiero, Massimiliano; Di Giacomo, Dina; Passafiume, Domenico

    2016-01-01

    Cognitive reserve relies on the ability to effectively cope with aging and brain damage by using alternate processes to approach tasks when standard approaches are no longer available. In this study, the issue if creativity can predict cognitive reserve has been explored. Forty participants (mean age: 61 years) filled out: the Cognitive Reserve…

  11. A touch-screen based paired-associates learning (PAL) task for the rat may provide a translatable pharmacological model of human cognitive impairment.

    Science.gov (United States)

    Talpos, John C; Aerts, Nancy; Fellini, Laetitia; Steckler, Thomas

    2014-07-01

    The use of touch-screen equipped operant boxes is an increasingly popular approach for modeling human cognition in the rodent. However little data is currently available describing the effects of pharmacological manipulations on touch-screen based tasks. Owing to the relationship between performance on visual-spatial paired associates learning (PAL) with schizophrenia and Alzheimer's disease one task of specific interest is the touch-screen PAL task developed for rodents (J. Talpos et al., 2009). The goal of this study was to profile a range of the commonly used pharmacological models of schizophrenia and Alzheimer's disease to investigate the sensitivity of PAL to these models of disease. Male Lister hooded rats were trained on PAL until stable performance was obtained. The effects of PCP, ketamine, amphetamine, LSD, scopolamine, and biperiden (recently proposed as an alternative to scopolamine) were then tested on animals performing the PAL task. While all compounds influenced responding during PAL, only PCP and amphetamine impaired performance with minimal changes in secondary measures (response latencies, trials completed). Surprisingly ketamine did not cause a change in percent correct despite being an NMDA antagonist, indicating that not all NMDA antagonists are equal in the touch-screen platform. This finding is in agreement with existing literature showing differential effects of NMDA antagonists on a wide variety of behavioral assays include tasks of attention, memory, and cognitive flexibility (Gilmour et al., 2009; Dix et al., 2010; Smith et al., 2011). Moreover biperiden showed no benefit when compared to scopolamine, highlighting the current lack of an effective pharmacological model of cholinergic dysfunction in the touch-screen platform. These data demonstrate that performance on PAL can be disrupted by common pharmacological disease models, suggesting that PAL may have the sensitivity to serve as a translational test for the study of cognition in

  12. Personal and provider level factors influence participation to cervical cancer screening: A retrospective register-based study of 1.3 million women in Norway.

    Science.gov (United States)

    Leinonen, Maarit K; Campbell, Suzanne; Klungsøyr, Ole; Lönnberg, Stefan; Hansen, Bo T; Nygård, Mari

    2017-01-01

    High coverage is essential for an effective screening programme. Here we present screening barriers and facilitators among 1.3 million women aged 25-69years eligible for screening within the Norwegian Cervical Cancer Screening Program (NCCSP). We defined non-adherence as no screening test in 2008-2012. We divided adherent women into those screened spontaneously, and those who had a smear after receiving a reminder from the NCCSP. Explanatory variables were extracted from several nationwide registers, and modelled by modified Poisson regression. In total, 34% of women were non-adherent. 31% of native Norwegians were non-adherent, compared to 50% of immigrants. Immigrant status was a strong predictor of non-adherence, but the vast majority of non-adherent women were still native Norwegians. Higher non-adherence rates were associated with having a male general practitioner (GP), a foreign GP, a young GP, and distance to the screening site. Being unmarried, having no children, having lower socioeconomic position and region of residence predicted non-adherence and, to a smaller extent, reminded adherence to screening. In contrast, previous experience with cervical abnormalities substantially increased adherence to screening. The population-based screening programme promotes equity by recruiting women who are less likely to participate spontaneously. However, socioeconomic disparities were evident in a country with a nationwide programme and a policy of equal access to health care. Initiatives aimed at removing practical and financial barriers to equitable screening delivery and at reducing the effect of sociodemographic attributes on screening participation are needed. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  13. IQ as moderator of terminal decline in perceptual and motor speed, spatial, and verbal ability: Testing the cognitive reserve hypothesis in a population-based sample followed from age 70 until death.

    Science.gov (United States)

    Thorvaldsson, Valgeir; Skoog, Ingmar; Johansson, Boo

    2017-03-01

    Terminal decline (TD) refers to acceleration in within-person cognitive decline prior to death. The cognitive reserve hypothesis postulates that individuals with higher IQ are able to better tolerate age-related increase in brain pathologies. On average, they will exhibit a later onset of TD, but once they start to decline, their trajectory is steeper relative to those with lower IQ. We tested these predictions using data from initially nondemented individuals (n = 179) in the H70-study repeatedly measured at ages 70, 75, 79, 81, 85, 88, 90, 92, 95, 97, 99, and 100, or until death, on cognitive tests of perceptual-and-motor-speed and spatial and verbal ability. We quantified IQ using the Raven's Coloured Progressive Matrices (RCPM) test administrated at age 70. We fitted random change point TD models to the data, within a Bayesian framework, conditioned on IQ, age of death, education, and sex. In line with predictions, we found that 1 additional standard deviation on the IQ scale was associated with a delay in onset of TD by 1.87 (95% highest density interval [HDI; 0.20, 4.08]) years on speed, 1.96 (95% HDI [0.15, 3.54]) years on verbal ability, but only 0.88 (95% HDI [-0.93, 3.49]) year on spatial ability. Higher IQ was associated with steeper rate of decline within the TD phase on measures of speed and verbal ability, whereas results on spatial ability were nonconclusive. Our findings provide partial support for the cognitive reserve hypothesis and demonstrate that IQ can be a significant moderator of cognitive change trajectories in old age. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  14. Midwives' experiences of referring obese women to either a community or home-based antenatal weight management service: Implications for service providers and midwifery practice.

    Science.gov (United States)

    Atkinson, Lou; French, David P; Ménage, Diane; Olander, Ellinor K

    2017-06-01

    a variety of services to support women to undertake weight management behaviours during pregnancy have recently been implemented as a means to reduce the risks to mother and infant. In the UK, midwives lead the care of the majority of pregnant women and are seen as the ideal source of referral into antenatal services. However, midwives have reported concerns regarding raising the topic of weight with obese women and negative referral experiences have been cited as a reason not to engage with a service. This study explored midwives' experiences of referring women to one of two antenatal weight management services. qualitative, cross-sectional interview and focus group study, with data analysed thematically. midwifery teams in the West Midlands, England. midwives responsible for referring to either a home-based, one to one service (N=12), or a community-based, group service (N=11). four themes emerged from the data. Participants generally had a positive View of the service, but their Information needs were not fully met, as they wanted more detail about the service and feedback regarding the women they had referred. Approaches to referral differed, with some participants referring all women who met the eligibility criteria, and some offering women a choice to be referred or not. Occasionally the topic was not raised at all when a negative reception was anticipated. Reasons for poor uptake of the services included pragmatic barriers, and their perception of women's lack of interest in weight management. midwives' differing views on choice and gaining agreement to refer means referral practices vary, which could increase the risk that obese women have inequitable access to weight management services. However, midwives' confidence in the services on offer may be increased with more detailed information about the service and feedback on referrals, which would additionally act as prompts to refer. weight management services need to improve communication with their

  15. Adenovirus vector-based multi-epitope vaccine provides partial protection against H5, H7, and H9 avian influenza viruses

    Science.gov (United States)

    Hassan, Ahmed O.; Amen, Omar; Sayedahmed, Ekramy E.; Vemula, Sai V.; Amoah, Samuel; York, Ian; Gangappa, Shivaprakash; Sambhara, Suryaprakash; Mittal, Suresh K.

    2017-01-01

    The emergence of H5, H7, and H9 avian influenza virus subtypes in humans reveals their pandemic potential. Although human-to-human transmission has been limited, the genetic reassortment of the avian and human/porcine influenza viruses or mutations in some of the genes resulting in virus replication in the upper respiratory tract of humans could generate novel pandemic influenza viruses. Current vaccines do not provide cross protection against antigenically distinct strains of the H5, H7, and H9 influenza viruses. Therefore, newer vaccine approaches are needed to overcome these potential threats. We developed an egg-independent, adenovirus vector-based, multi-epitope (ME) vaccine approach using the relatively conserved immunogenic domains of the H5N1 influenza virus [M2 ectodomain (M2e), hemagglutinin (HA) fusion domain (HFD), T-cell epitope of nucleoprotein (TNP). and HA α-helix domain (HαD)]. Our ME vaccine induced humoral and cell-mediated immune responses and caused a significant reduction in the viral loads in the lungs of vaccinated mice that were challenged with antigenically distinct H5, H7, or H9 avian influenza viruses. These results suggest that our ME vaccine approach provided broad protection against the avian influenza viruses. Further improvement of this vaccine will lead to a pre-pandemic vaccine that may lower morbidity, hinder transmission, and prevent mortality in a pandemic situation before a strain-matched vaccine becomes available. PMID:29023601

  16. An Internet-Based GIS Platform Providing Data for Visualization and Spatial Analysis of Urbanization in Major Asian and African Cities

    Directory of Open Access Journals (Sweden)

    Hao Gong

    2017-08-01

    Full Text Available Rapid urbanization in developing countries has been observed to be relatively high in the last two decades, especially in the Asian and African regions. Although many researchers have made efforts to improve the understanding of the urbanization trends of various cities in Asia and Africa, the absence of platforms where local stakeholders can visualize and obtain processed urbanization data for their specific needs or analysis, still remains a gap. In this paper, we present an Internet-based GIS platform called MEGA-WEB. The Platform was developed in view of the urban planning and management challenges in developing countries of Asia and Africa due to the limited availability of data resources, effective tools, and proficiency in data analysis. MEGA-WEB provides online access, visualization, spatial analysis, and data sharing services following a mashup framework of the MEGA-WEB Geo Web Services (GWS, with the third-party map services using HTML5/JavaScript techniques. Through the integration of GIS, remote sensing, geo-modelling, and Internet GIS, several indicators for analyzing urbanization are provided in MEGA-WEB to give diverse perspectives on the urbanization of not only the physical land surface condition, but also the relationships of population, energy use, and the environment. The design, architecture, system functions, and uses of MEGA-WEB are discussed in the paper. The MEGA-WEB project is aimed at contributing to sustainable urban development in developing countries of Asia and Africa.

  17. Validation of 2 new measures of continuity of care based on year-to-year follow-up with known providers of health care.

    Science.gov (United States)

    Tousignant, Pierre; Diop, Mamadou; Fournier, Michel; Roy, Yves; Haggerty, Jeannie; Hogg, William; Beaulieu, Marie-Dominique

    2014-01-01

    In a primary care context favoring group practices, we assessed the validity of 2 new continuity measures (both versions of known provider continuity, KPC) that capture the concentration of care over time from multiple physicians (multiple provider continuity, KPC-MP) or from the physician seen most often (personal provider continuity, KPC-PP). Patients with diabetes or cardiovascular disease (N = 765) were approached in the waiting rooms of 28 primary care clinics in 3 regions of the province of Quebec, Canada; answered a survey questionnaire measuring relational continuity, interpersonal communication, coordination within the clinic, coordination with specialists, and overall coordination; and gave permission for their medical records to be reviewed and their medical services utilization data for the previous 2 years to be accessed to measure KPC. Using generalized linear mixed models, we assessed the association between KPC and the patients' responses. Among the 5 different patient-reported measures or their combination, KPC-MP was significantly related with overall coordination of care: for high continuity, the odds ratio (OR) = 2.02 (95% CI, 1.33-3.07), and for moderate continuity, OR = 1.61 (95% CI, 1.06-2.46). KPC-MP was also related with the combined continuity score: for high continuity, OR = 1.52 (95% CI, 1.11-2.09), and for moderate continuity, OR = 1.48 (95% CI, 1.10-2.00). KPC-PP was not significantly associated with any of the survey measures. The KPC-MP measure, based on readily available administrative data, is associated with patient-perceived overall coordination of care among multiple physicians. KPC measures are potentially a valuable and low-cost way to follow the effects of changes favoring group practice on continuity of care for entire populations. They are easy to replicate over time and across jurisdictions. © 2014 Annals of Family Medicine, Inc.

  18. A fuzzy-based approach for strategic choices in electric energy supply. The case of a Swiss power provider on the eve of electricity market opening

    International Nuclear Information System (INIS)

    Nguene, Gustave Nguene; Finger, Matthias

    2007-01-01

    Risk evaluation and strategic choice has become very complex for power providers, because of the growing number of uncertain parameters involved, such as energy market prices, water inflow, and demand. The lack of information and the absence of the decision maker's perception are just some of the many elements that must be accounted for. Therefore, with an approach based on fuzzy set theory, this paper aims to propose a methodology based on strategic choices that will enable decision makers to evaluate the performance of their strategies and portfolios through the computation of an indicator of economic performance, for different time-horizons. By subsequently considering the different imprecise parameters - such as the electricity spot price, the natural gas market price, rainfall and snow, etc. - in the assessment of different strategies and the analysis of their impacts through scenario analysis, it is concluded that the resulting profit depends not only on the perception of the market player, but also on the imprecision of the variables - the same strategy may produce two different results under a different combination of parameters - as well as on the time-horizon considered. On a simple basis, it has also been possible to compare portfolios of customers. (Author)

  19. Un Abrazo Para La Familia: an evidenced-based rehabilitation approach in providing cancer education to low-SES Hispanic co-survivors.

    Science.gov (United States)

    Marshall, Catherine A; Curran, Melissa A; Koerner, Susan Silverberg; Kroll, Thilo; Hickman, Amy C; García, Francisco

    2014-12-01

    We discuss Un Abrazo Para La Familia as an effective, rehabilitation-informed evidence-based model of education, information-sharing, and skill teaching for use with low-income Hispanic co-survivors of cancer. Over 2 years, 120 co-survivors participated in the intervention. The majority of participants (96 %) were women and all but one reported being Hispanic. Both in years 1 and 2, we followed the same pre- and post-intervention evaluation design. Based on pre- and post-intervention assessments of cancer-related knowledge and self-efficacy, the percentage of questions answered correctly about cancer significantly increased for co-survivors. Self-efficacy significantly increased as well. Using item analysis, we explored skill teaching as a mechanism for the effective delivery of Un Abrazo and recommend the use of promotoras in providing the intervention. Of the 12 cancer knowledge items resulting in statistically significant increases of cancer knowledge, 5 were taught via interactive skill teaching. Given the projected rise in the incidence of cancer in Hispanic populations, coupled with the fact that people from low-income backgrounds face unique challenges in cancer prevention and management, implications of the Un Abrazo model for future research and policy regarding cancer and families are considered.

  20. Developing a gender-based approach to chronic conditions and women's health: a qualitative investigation of community-dwelling women and service provider perspectives.

    Science.gov (United States)

    DiGiacomo, Michelle; Green, Anna; Rodrigues, Emma; Mulligan, Kathryn; Davidson, Patricia M

    2015-11-21

    Chronic conditions contribute to over 70 % of Australia's total disease burden, and this is set to increase to 80 % by 2020. Women's greater longevity means that they are more likely than men to live with disability and have unique health concerns related to their gender based roles in society. Cultural and social issues can impact on women's health and are important to consider in health services planning and research. In this study, we aimed to identify barriers and facilitators to providing a gender-based approach to chronic conditions and women's health in an eastern metropolitan region of Australia. Focus groups were used to engage both community-dwelling women who had chronic conditions and relevant professional stakeholders in the target area. Recorded proceedings underwent thematic analysis. Five focus groups were conducted with professional stakeholders and women community members in February and March 2014. Resultant themes included: women's disempowerment through interactions with health systems; social and economic constraints and caregiving roles act to exclude women from participating in self-care and society; and empowerment can be achieved through integrated models of care that facilitate voice and enable communication and engagement. This study underscores the importance of including perspectives of sex and gender in health care services planning. Tailoring services to socio-demographic and cultural groups is critical in promoting access to health care services. Unique epidemiological trends, particularly the ageing of women and new migrant groups, require particular attention.

  1. Communicating marine reserve science to diverse audiences

    Science.gov (United States)

    Grorud-Colvert, Kirsten; Lester, Sarah E.; Airamé, Satie; Neeley, Elizabeth; Gaines, Steven D.

    2010-01-01

    As human impacts cause ecosystem-wide changes in the oceans, the need to protect and restore marine resources has led to increasing calls for and establishment of marine reserves. Scientific information about marine reserves has multiplied over the last decade, providing useful knowledge about this tool for resource users, managers, policy makers, and the general public. This information must be conveyed to nonscientists in a nontechnical, credible, and neutral format, but most scientists are not trained to communicate in this style or to develop effective strategies for sharing their scientific knowledge. Here, we present a case study from California, in which communicating scientific information during the process to establish marine reserves in the Channel Islands and along the California mainland coast expanded into an international communication effort. We discuss how to develop a strategy for communicating marine reserve science to diverse audiences and highlight the influence that effective science communication can have in discussions about marine management. PMID:20427745

  2. Communicating marine reserve science to diverse audiences.

    Science.gov (United States)

    Grorud-Colvert, Kirsten; Lester, Sarah E; Airamé, Satie; Neeley, Elizabeth; Gaines, Steven D

    2010-10-26

    As human impacts cause ecosystem-wide changes in the oceans, the need to protect and restore marine resources has led to increasing calls for and establishment of marine reserves. Scientific information about marine reserves has multiplied over the last decade, providing useful knowledge about this tool for resource users, managers, policy makers, and the general public. This information must be conveyed to nonscientists in a nontechnical, credible, and neutral format, but most scientists are not trained to communicate in this style or to develop effective strategies for sharing their scientific knowledge. Here, we present a case study from California, in which communicating scientific information during the process to establish marine reserves in the Channel Islands and along the California mainland coast expanded into an international communication effort. We discuss how to develop a strategy for communicating marine reserve science to diverse audiences and highlight the influence that effective science communication can have in discussions about marine management.

  3. The Economics of NASA Mission Cost Reserves

    Science.gov (United States)

    Whitley, Sally; Shinn, Stephen

    2012-01-01

    Increases in NASA mission costs have led to analysis of the causes and magnitude of historical mission overruns as well as mitigation and prevention attempts. This paper hypothesizes that one cause is that the availability of reserves may reduce incentives to control costs. We draw a comparison to the insurance concept of moral hazard, and we use actuarial techniques to better understand the increase in mission costs due to the availability of reserves. NASA's CADRe database provided the data against which we tested our hypothesis and discovered that there is correlation between the amount of available reserves and project overruns, particularly for mission hardware cost increases. We address the question of how to prevent reserves from increasing mission spending without increasing cost risk to projects.

  4. An extension to a statistical approach for family based association studies provides insights into genetic risk factors for multiple sclerosis in the HLA-DRB1 gene

    Directory of Open Access Journals (Sweden)

    Sadovnick A Dessa

    2009-02-01

    Full Text Available Abstract Background Multiple sclerosis (MS is a complex trait in which genes in the MHC class II region exert the single strongest effect on genetic susceptibility. The principal MHC class II haplotype that increases MS risk in individuals of Northern European descent are those that bear HLA-DRB1*15. However, several other HLA-DRB1 alleles have been positively and negatively associated with MS and each of the main allelotypes is composed of many sub-allelotypes with slightly different sequence composition. Given the role of this locus in antigen presentation it has been suggested that variations in the peptide binding site of the allele may underlie allelic variation in disease risk. Methods In an investigation of 7,333 individuals from 1,352 MS families, we assessed the nucleotide sequence of HLA-DRB1 for any effects on disease susceptibility extending a recently published method of statistical analysis for family-based association studies to the particular challenges of hyper-variable genetic regions. Results We found that amino acid 60 of the HLA-DRB1 peptide sequence, which had previously been postulated based on structural features, is unlikely to play a major role. Instead, empirical evidence based on sequence information suggests that MS susceptibility arises primarily from amino acid 13. Conclusion Identifying a single amino acid as a major risk factor provides major practical implications for risk and for the exploration of mechanisms, although the mechanism of amino acid 13 in the HLA-DRB1 sequence's involvement in MS as well as the identity of additional variants on MHC haplotypes that influence risk need to be uncovered.

  5. CT Determination of Fractional Flow Reserve in Coronary Lesions

    Directory of Open Access Journals (Sweden)

    Mester András

    2016-12-01

    Full Text Available Invasively determined fractional flow reserve (FFR represents the gold-standard method for the functional evaluation of coronary lesions. Coronary computed tomography angiography (CCTA provides characterization of the coronary anatomy, with important morphological information on the atherosclerotic plaques, but does not offer a hemodynamic evaluation of coronary artery lesions. CT evaluation of FFR (FFRCT is a new noninvasive diagnostic method, which provides anatomical and functional assessment of the whole coronary tree, based on computational techniques, with no more radiation or hyperemic agent administration compared with routine CCTA. Recent studies demonstrated the safety and accuracy of FFRCT and its therapeutic use and cost benefits in real-world clinical use.

  6. Disaggregating reserve-to-production ratios: An algorithm for United States oil and gas reserve development

    Science.gov (United States)

    Williams, Charles William

    Reserve-to-production ratios for oil and gas development are utilized by oil and gas producing states to monitor oil and gas reserve and production dynamics. These ratios are used to determine production levels for the manipulation of oil and gas prices while maintaining adequate reserves for future development. These aggregate reserve-to-production ratios do not provide information concerning development cost and the best time necessary to develop newly discovered reserves. Oil and gas reserves are a semi-finished inventory because development of the reserves must take place in order to implement production. These reserves are considered semi-finished in that they are not counted unless it is economically profitable to produce them. The development of these reserves is encouraged by profit maximization economic variables which must consider the legal, political, and geological aspects of a project. This development is comprised of a myriad of incremental operational decisions, each of which influences profit maximization. The primary purpose of this study was to provide a model for characterizing a single product multi-period inventory/production optimization problem from an unconstrained quantity of raw material which was produced and stored as inventory reserve. This optimization was determined by evaluating dynamic changes in new additions to reserves and the subsequent depletion of these reserves with the maximization of production. A secondary purpose was to determine an equation for exponential depletion of proved reserves which presented a more comprehensive representation of reserve-to-production ratio values than an inadequate and frequently used aggregate historical method. The final purpose of this study was to determine the most accurate delay time for a proved reserve to achieve maximum production. This calculated time provided a measure of the discounted cost and calculation of net present value for developing new reserves. This study concluded that

  7. Fractional Reserve Banking: Some Quibbles

    OpenAIRE

    Bagus, Philipp; Howden, David

    2010-01-01

    We explore several unaddressed issues in George Selgin’s (1988) claim that the best monetary system to maintain monetary equilibrium is a fractional reserve free banking one. The claim that adverse clearing balances would limit credit expansion in a fractional reserve free banking system is more troublesome than previously reckoned. Both lengthened clearing periods and interbank agreements render credit expansion unrestrained. “The theory of free banking” confuses increases in money held with...

  8. Cognitive reserve and symptom experience in multiple sclerosis: a buffer to disability progression over time?

    Science.gov (United States)

    Schwartz, Carolyn E; Quaranto, Brian R; Healy, Brian C; Benedict, Ralph H; Vollmer, Timothy L

    2013-10-01

    To investigate the possible buffering effect of cognitive reserve on symptom experience for multiple sclerosis (MS) disease course. Secondary analysis of longitudinal data from the North American Research Committee on MS Registry. Registry study and web-based supplemental survey. People with MS (N=859). Not applicable. Two health outcome measures, the Symptom Inventory and the Performance Scales, were collected biannually over 1 and 6 years, respectively. Active and passive cognitive reserve was measured using the Stern Leisure Activities and the Sole-Padulles Childhood Enrichment tools, respectively. Linear regression, chi-square, multilevel random-effects modeling, and classification and regression tree modeling were used to compare cross-sectional means, disease course by cognitive reserve, longitudinal trajectories, and active cognitive reserve item endorsement by disability groups, respectively. Patients with high-active reserve had a lesser symptom burden than those with low-active reserve independent of passive reserve (PCognitive reserve was associated with course of disease, such that high-active patients were overrepresented among relapsing-remitting patients, and underrepresented among patients with progressive disease (χ(2)=14.7, Preserve and time in mobility, fatigue, and overall disability in the whole sample (Pcognitive reserve was associated with less deterioration (Pcognitive reserve evidenced no effect in the longitudinal analyses. Active cognitive reserve scores across disability groups had a similar range but comprised different items, indicating that patients maintain active cognitive reserve with different activities as the disease progresses. Our findings suggest that active cognitive reserve is a buffer for functional limitation across disability groupings. Cognitive reserve may provide an alternative lens for thinking about the disease course of MS, providing a longer "runway" until disability accrual through cortical remodeling. Loss of

  9. Demand as Frequency-controlled Reserve

    DEFF Research Database (Denmark)

    Bang, Christian; Rasmussen, Christian Brandt; Østergaard, Jacob

    electric loads to provide frequency controlled primary reserves. The devices collected data from domestic households and industrial loads covering i.e. circulation pumps, electrical domestic heating, bottle coolers, a wastewater treatment plant etc., that have been analysed and used for the papers...

  10. 78 FR 66715 - Federal Reserve Bank Services

    Science.gov (United States)

    2013-11-06

    ... imputed costs and earn net income of $24.6 million, compared with the target of $4.2 million. Although the... initiatives, and to increase product revenue. 4.2014 Pricing--The following summarizes the Reserve Banks... Banks will discontinue the Choice Receiver program, which provides pricing incentives to those customers...

  11. Kikiskawâwasow - prenatal healthcare provider perceptions of effective care for First Nations women: an ethnographic community-based participatory research study.

    Science.gov (United States)

    Oster, Richard T; Bruno, Grant; Montour, Margaret; Roasting, Matilda; Lightning, Rick; Rain, Patricia; Graham, Bonny; Mayan, Maria J; Toth, Ellen L; Bell, Rhonda C

    2016-08-11

    Pregnant Indigenous women suffer a disproportionate burden of risk and adverse outcomes relative to non-Indigenous women. Although there has been a call for improved prenatal care, examples are scarce. Therefore, we explored the characteristics of effective care with First Nations women from the perspective of prenatal healthcare providers (HCPs). We conducted an ethnographic community-based participatory research study in collaboration with a large Cree First Nations community in Alberta, Canada. We carried out semi-structured interviews with 12 prenatal healthcare providers (HCPs) that were recorded, transcribed, and subjected to qualitative content analysis. According to the participants, relationships and trust, cultural understanding, and context-specific care were key features of effective prenatal care and challenge the typical healthcare model. HCPs that are able to foster sincere, non-judgmental, and enjoyable interactions with patients may be more effective in treating pregnant First Nations women, and better able to express empathy and understanding. Ongoing HCP cultural understanding specific to the community served is crucial to trusting relationships, and arises from real experiences and learning from patients over and above relying only on formal cultural sensitivity training. Consequently, HCPs report being better able to adapt a more flexible, all-inclusive, and accessible approach that meets specific needs of patients. Aligned with the recommendations of the Truth and Reconciliation Commission of Canada, improving prenatal care for First Nations women needs to allow for genuine relationship building with patients, with enhanced and authentic cultural understanding by HCPs, and care approaches tailored to women's needs, culture, and context.

  12. Cognitive reserve and appraisal in multiple sclerosis.

    Science.gov (United States)

    Schwartz, Carolyn E; Snook, Erin; Quaranto, Brian; Benedict, Ralph H B; Rapkin, Bruce D; Vollmer, Timothy

    2013-01-01

    Cognitive appraisal processes underlying self-report affect the interpretation of patient-reported outcomes. These processes are relevant to resilience and adaptability, and may relate to how cognitive reserve protects against disability in multiple sclerosis (MS). To describe how passive and active indicators of cognitive reserve relate to QOL appraisal processes in MS. Cross-sectional data (n=860) were drawn from the North American Research Committee on MS (NARCOMS) Registry, from whom additional survey data were collected. Cognitive reserve was measured using the Stern and Sole-Padulles measures. Using the quality of life appraisal profile (QOLAP), we assessed how MS patients conceptualize their experiences and how that impacts how they report their quality of life. Multivariate analysis of variance was used to compare groups within sets of appraisal parameters, and t-tests or chi-square tests were used to compare mean item responses within appraisal parameters for continuous or dichotomous variables, respectively. People high in passive or active reserve report different conceptualizations of QOL, different types of goals, and considering different types of experiences and standards of comparison in responding to QOL questionnaires, as compared to low-reserve individuals. Although item response patterns were slightly different between passive and active indicators, they generally reflect a tendency in high-reserve individuals to emphasize the positive, focus on aspects of their life that are more controllable, and less based in fantasy. MS patients high in cognitive reserve differ in their cognitive appraisals from their low reserve counterparts. These appraisal metrics may predict disease course and other important clinical outcomes in MS patients. Copyright © 2012 Elsevier B.V. All rights reserved.

  13. Outcomes from a university-based low-cost in vitro fertilization program providing access to care for a low-resource socioculturally diverse urban community.

    Science.gov (United States)

    Herndon, Christopher N; Anaya, Yanett; Noel, Martha; Cakmak, Hakan; Cedars, Marcelle I

    2017-10-01

    To report on outcomes from a university-based low-cost and low-complexity IVF program using mild stimulation approaches and simplified protocols to provide basic access to ART to a socioculturally diverse low-income urban population. Retrospective cohort study. Academic infertility center. Sixty-five infertile couples were enrolled from a county hospital serving a low-resource largely immigrant population. Patients were nonrandomly allocated to one of four mild stimulation protocols: clomiphene/letrozole alone, two clomiphene/letrozole-based protocols involving sequential or flare addition of low-dose gonadotropins, and low-dose gonadotropins alone. Clinical fellows managed all aspects of cycle preparation, monitoring, oocyte retrieval, and embryo transfer under an attending preceptor. Retrieval was undertaken without administration of deep anesthesia, and laboratory interventions were minimized. All embryo transfers were performed at the cleavage stage. Sociomedical demographics, treatment response, and pregnancy outcomes were recorded. From August 2010 to June 2016, 65 patients initiated 161 stimulation IVF cycles, which resulted in 107 retrievals, 91 fresh embryo transfers, and 40 frozen embryo transfer cycles. The mean age of patients was 33.3 years, and mean reported duration of infertility was 5.3 years; 33.5% (54/161) of cycles were cancelled before oocyte retrieval, with 13% due to premature ovulation. Overall, cumulative live birth rates per retrieval including subsequent use of frozen embryos was 29.0%; 44.6% (29/65) of patients enrolled in the program achieved pregnancy. Use of mild stimulation protocols, simplified monitoring, and minimized laboratory handling procedures enabled access to care in a low-resource socioculturally diverse infertile population. Copyright © 2017. Published by Elsevier Inc.

  14. Improved Effectiveness of Reserve Forces During Reserve Duty Training.

    Science.gov (United States)

    Treadaway, Harry H.

    The problem areas of motivation, job enrichment, recruiting, and retention are addressed from the viewpoint of the behavioral scientist. Special attention is given to relating job enrichment and motivation techniques, as successfully demonstrated in industry, to the United State Army Reserve. Research method utilized was a literature review…

  15. Cerebral correlates of cognitive reserve.

    Science.gov (United States)

    Whalley, Lawrence J; Staff, Roger T; Fox, Helen C; Murray, Alison D

    2016-01-30

    Cognitive reserve is a hypothetical concept introduced to explain discrepancies between severity of clinical dementia syndromes and the extent of dementia pathology. We examined cognitive reserve in a research programme that followed up a non-clinical sample born in 1921 or 1936 and IQ-tested age 11 years in 1932 or 1947. Structural MRI exams were acquired in about 50% of the sample from whom a subsample were recruited into an additional fMRI study. Here, we summarise findings from seven inter-related studies. These support an understanding of cognitive reserve as a balance between positive life course activity-driven experiences and the negative effects of brain pathologies including cerebrovascular disease and total and regional brain volume loss. Hypothesised structural equation models illustrate the relative causal effects of these positive and negative contributions. Cognitive reserve is considered in the context of choice of interventions to prevent dementia and the opposing effects of cerebrovascular disease and Alzheimer like brain appearances. Crown Copyright © 2015. Published by Elsevier Ireland Ltd. All rights reserved.

  16. Extractive reserves in Brazilian Amazonia

    Energy Technology Data Exchange (ETDEWEB)

    Fearnside, P.M (National Institute for Research in the Amazon, Manaus-Amazonas (Brazil))

    1989-06-01

    In 1985 an opportunity arose for maintaining tracts of Amazonian forest under sustainable use. Brazil's National Council of Rubber Tappers and the Rural Worker's Union proposed the creation of a set of reserves of a new type, called extractive reserves. The first six are being established in one of the Brazilian states most threatened by deforestatation. The creation of extractive reserves grants legal protection to forest land traditionally used by rubber tappers, Brazil-nut gatherers, and other extractivists. The term extrativismo (extractivism) in Brazil refers to removing nontimber forest products, such as latex, resins, and nuts, without felling the trees. Approximately 30 products are collected for commercial sale. Many more types of forest materials are gathered, for example as food and medicines, for the extractivists' own use. The reserve proposal is attractive for several reasons related to social problems. It allows the rubber tappers to continue their livelihood rather than be expelled by deforestation. However, it is unlikely that sufficient land will be set aside as extractive reserves to employ all the tappers. Displaced rubber tappers already swell the ranks of urban slum dwellers in Brazil's Amazonian cities, and they have become refugees to continue their profession in the forests of neighboring countries, such as Bolivia.

  17. PROVIDING WOMEN, KEPT MEN

    Science.gov (United States)

    Mojola, Sanyu A

    2014-01-01

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

  18. Micellar effect on the sensitivity of spectrophotometric Mo(VI) determination based on the formation of gallic acid complex providing evidence for the polyoxoanion structure of molybdate ions

    International Nuclear Information System (INIS)

    Tascioglu, Senay; Sendil, Olcay; Beyreli, Sivekar

    2007-01-01

    In this study effects of anionic (sodium dodecyl sulfate, SDS), cationic (cetyltrimethylammonium bromide, CTAB) and nonionic (Triton X-100, TX100) micelles on the sensitivity of spectrophotometric molybdenum(VI) (Mo) determination based on the formation of a binary complex with gallic acid (GA) were investigated. Micellar CTAB was found to enhance the formation of Mo-GA complex. SDS micelles exerted an inhibitory effect while TX100 micelles had no effect on the complex formation. By the optimization of experimental conditions, the determination limit of the method suggested in the literature was lowered from 5.2 x 10 -5 to 4.6 x 10 -6 and to 5.7 x 10 -7 M, in the absence and presence of CTAB, respectively. The mechanism of the effect of CTAB was investigated by spectrophotometric titrations and it was concluded that CTAB did not form a ternary complex with Mo and GA. The stoichiometry of the complex, deduced from the results of spectrophotometric titrations, provided evidence for the formation of para-Mo 7 O 4 6- polyanions at pH 4.5, indicating to the formation of a charge transfer complex between these ions and GA in micellar medium

  19. Natural radioactivity as indicator of petroleum reserves

    International Nuclear Information System (INIS)

    Palacios, T.; Viloriab, L.; Sajo Bohusa, K.; Gomez, A.

    2001-01-01

    The possibilities of the measurement method of Radon emanation from the ground, using passive detectors, to identify oil-saturated beds in reserves or well-known deposit was evaluated in the North part of the Orinoco river and in some areas of Zulia Sate, Venezuela. The existence of Negative anomalies of radon emanation in regions of proven petroleum reserves was shown. The Space variability of emanated Radon concentration from the ground was measured and maps of three-dimensional contour curves applying different surface models were obtained, which allowed to locate the anomalies of radon emanation and to compare them with the location of reserves reported by other methods. In both regions it was obtained that the area having the lowest radon value is surrounded by an annular region of high radon values, being able to identify a locally decreased emanation over petroleum reserves as compared to the surroundings. The cause of such anomalies is not identified but they can provide useful information for locating the deeply buried oil reserves. Both regions showed a decrease in gamma activity and in upward flow of gases CH4 and C02 over the geologic structures which contain petroleum reserves Underneath. An applicable experimental routine was proposed to other regions. We conclude that the method of etched track detection can be useful in recognizing the subsurface oil-bearing structures and the technique is relatively simple and inexpensive

  20. Hydrocarbon Reserves: Abundance or Scarcity

    International Nuclear Information System (INIS)

    2005-01-01

    IFP and the OAPEC jointly organize a regular international seminar dealing with world oil-related problems appearing in the news. For the first time, this seminar has been opened to oil and gas company specialists, service companies, research centers and independents. This year's theme concerns oil and gas reserves: are they abundant or are we headed towards the shortages announced by some experts? This theme is especially topical in that: oil and gas currently meet two thirds of world energy needs and almost completely dominate the transport sector; the reserves declared by the OAPEC countries account for nearly half of world reserves; the price of a barrel of oil went through the roof in 2004; world energy demand is growing fast and alternative sources of energy are far from ready to take over from oil and gas in the next few decades. Since the reserves correspond to the volume it is technically and economically viable to produce, the seminar has, of course, dealt with the technical and economic questions that arise in connection with exploration and production, but it has also considered changes in the geopolitical context. Presentations by the leading companies of the OAPEC countries and by the IFP group were completed by presentation from the International Energy Agency (IEA), the United States Geological Survey (USGS), the IHS Energy Group, Total and Gaz de France. This document gathers the transparencies of the following presentations: Hydrocarbon reserves in OAPEC members countries: current and future (M. Al-Lababidi); Non OAPEC liquid reserves and production forecasts (Y. Mathieu); World oil and gas resources and production outlook (K. Chew); Global investments in the upstream (F. Birol); Total's policy in the oil and gas sector (C. de Margerie); Gaz de France's policy in the oil and gas sector (J. Abiteboul); NOC/IOC's opportunities in OPEC countries (I. Sandrea); Relationships between companies, countries and investors: How they may impact on the growth

  1. Hydrocarbon Reserves: Abundance or Scarcity

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2005-07-01

    IFP and the OAPEC jointly organize a regular international seminar dealing with world oil-related problems appearing in the news. For the first time, this seminar has been opened to oil and gas company specialists, service companies, research centers and independents. This year's theme concerns oil and gas reserves: are they abundant or are we headed towards the shortages announced by some experts? This theme is especially topical in that: oil and gas currently meet two thirds of world energy needs and almost completely dominate the transport sector; the reserves declared by the OAPEC countries account for nearly half of world reserves; the price of a barrel of oil went through the roof in 2004; world energy demand is growing fast and alternative sources of energy are far from ready to take over from oil and gas in the next few decades. Since the reserves correspond to the volume it is technically and economically viable to produce, the seminar has, of course, dealt with the technical and economic questions that arise in connection with exploration and production, but it has also considered changes in the geopolitical context. Presentations by the leading companies of the OAPEC countries and by the IFP group were completed by presentation from the International Energy Agency (IEA), the United States Geological Survey (USGS), the IHS Energy Group, Total and Gaz de France. This document gathers the transparencies of the following presentations: Hydrocarbon reserves in OAPEC members countries: current and future (M. Al-Lababidi); Non OAPEC liquid reserves and production forecasts (Y. Mathieu); World oil and gas resources and production outlook (K. Chew); Global investments in the upstream (F. Birol); Total's policy in the oil and gas sector (C. de Margerie); Gaz de France's policy in the oil and gas sector (J. Abiteboul); NOC/IOC's opportunities in OPEC countries (I. Sandrea); Relationships between companies, countries and investors: How they may

  2. Resources for Economic Educators from the Federal Reserve Bank of St. Louis

    Science.gov (United States)

    Suiter, Mary C.; Taylor, Keith G.

    2016-01-01

    The Federal Reserve Bank of St. Louis has a long history of providing economic and financial information to the public that continues today, although the format, delivery, and amount of information have changed over the years. Today, the St. Louis Fed provides Web-based data and information services, including FRED® and FRASER®, and publications,…

  3. Achieving Provider Engagement

    Science.gov (United States)

    Greenfield, Geva; Pappas, Yannis; Car, Josip; Majeed, Azeem; Harris, Matthew

    2014-01-01

    The literature on integrated care is limited with respect to practical learning and experience. Although some attention has been paid to organizational processes and structures, not enough is paid to people, relationships, and the importance of these in bringing about integration. Little is known, for example, about provider engagement in the organizational change process, how to obtain and maintain it, and how it is demonstrated in the delivery of integrated care. Based on qualitative data from the evaluation of a large-scale integrated care initiative in London, United Kingdom, we explored the role of provider engagement in effective integration of services. Using thematic analysis, we identified an evolving engagement narrative with three distinct phases: enthusiasm, antipathy, and ambivalence, and argue that health care managers need to be aware of the impact of professional engagement to succeed in advancing the integrated care agenda. PMID:25212855

  4. A whole blood monokine-based reporter assay