WorldWideScience

Sample records for reserve base provide

  1. 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.

  2. 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.

  3. 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.

  4. Assessment of quality of water provided for wildlife in the Central Kalahari Game Reserve, Botswana

    Science.gov (United States)

    Selebatso, Moses; Maude, Glyn; Fynn, Richard W. S.

    2018-06-01

    Arid and semi-arid environments have low and unpredictable rainfall patterns resulting in limited availability of surface water for wildlife. In the Central Kalahari Game Reserve (CKGR) wildlife populations have lost access to natural surface water through cordon fences, livestock and human encroachment along the access routes. Artificial waterholes have been developed in the reserve to compensate for this loss. However, there have not been any assessments of the quality of water provided for wildlife and how that may be contributing to populations declines in the CKGR. We assessed water quality from 12 artificial waterholes against both Botswana and international livestock standards for drinking. Overall the quality of water provided is poor and poses a health risk to both animals and humans. Eight out of twelve boreholes tested exceeded the maximum acceptable Total Dissolved Solids (TDS) limits while three and four boreholes have toxic levels of lead and arsenic, respectively. Thus, pumping ground water could have more negative than positive impacts on wildlife thus defeating the intended management purpose. Failure to provide water of acceptable quality is a major concern for wildlife management in the CKGR and it may underlie some wildlife declines in the reserve. These findings confirm that restriction of populations from natural water sources create complex management challenges, especially where safe and sustainable alternative sources are scarce. Restriction of access of the population to natural water sources by fences and provision of poor quality water could compromise the overall fitness of wildlife populations and contribute to their decline.

  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.

  8. 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

  9. 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

    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......The smart grid concept is a key issue in the future power systems, namely at the distribution level, with deep concerns in the operation and planning of these systems. Several advantages and benefits for both technical and economic operation of the power system and of the electricity markets...... 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...

  10. 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.

  11. 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

    modifications. The LDR method can effectively adapt the participation factors of reserve providers to respond to system imbalance signals. The policies considered the covariance of historic system imbalance signals to reduce the overall reserve cost. When applying this method to the cell-based power system...... for a certain horizon, the influence of different time resolutions on policy-making is also investigated, which presents guidance for its practical application. The main results illustrate that: (a) the LDR-based method shows better performance, by producing smaller reserve costs compared to the costs given...... by a reference method; and (b) the cost index decreases with increased time intervals, however, longer intervals might result in insufficient reserves, due to low time resolution. On the other hand, shorter time intervals require heavy computational time. Thus, it is important to choose a proper time interval...

  12. 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

    The provision of reserves in power systems is of great importance in what concerns keeping an adequate and acceptable level of security and reliability. This need for reserves and the way they are defined and dispatched gain increasing importance in the present and future context of smart grids...

  13. 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.

  14. Toward Coordinated Robust Allocation of Reserve Policies for a Cell-based Power System

    DEFF Research Database (Denmark)

    Hu, Junjie; Heussen, Kai; Claessens, Bert

    2016-01-01

    Conventional regulation reserves have fixed participation factors and are thus not well suited to utilize differentiated capabilities of ancillary service providers. This study applies linear decision rules-based (LDR) control policies, which effectively adapt the present participation factor...... in dependence of the imbalance signal of previous time steps. The LDR-policies are centrally computed using a robust optimization approach which takes into account both the covariances of historic imbalance signals and the operational flexibility of ancillary service providers. The concept is then extended...... to the cooperation of multiple cells. Two illustrating examples are presented to show the functioning of the proposed LDR method....

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

    Science.gov (United States)

    2014-10-08

    Force Base, Texas • Air National Guard Combat Readiness Training Center, Alpena, Michigan • 113th Air Support Operations Squadron, Terre Haute...Wing, Terre Haute, Indiana • 185th Air Refueling Wing, Sioux City, Iowa • 349 Air Mobility Wing, Travis Air Force Base, California • 434 Air

  16. 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.

  17. 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...

  18. 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.

  19. 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

  20. Defense Base Realignment and Closure Budget Data for Naval Air Stations Dallas, Texas, and Memphis, Tennessee, Realigning to Carswell Air Reserve Base, Texas

    National Research Council Canada - National Science Library

    Granetto, Paul

    1994-01-01

    .... This report provides the results of the audit of 16 projects, valued at $122 million, for the realignment of the Naval Air Stations Memphis, Tennessee, and Dallas, Texas, to Carswell Air Reserve Base, Texas...

  1. 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.

  2. Social Network Analysis of the Caste-Based Reservation System in India

    OpenAIRE

    Iyengar, S. R. S.; Parasuram, Aishwarya; Saini, Jaspal Singh

    2015-01-01

    It has been argued that the reservation system in India, which has existed since the time of Indian Independence (1947), has caused more havoc and degradation than progress. This being a popular public opinion, these notions have not been based on any rigorous scientific study or research. In this paper, we revisit the cultural divide among the Indian population from a purely social networks based approach. We study the reservation system in detail, starting from its past and observing its ef...

  3. 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.

  4. 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.

  5. 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

  6. 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.

  7. A solar reserve methodology for renewable energy integration studies based on sub-hourly variability analysis

    Energy Technology Data Exchange (ETDEWEB)

    Ibanez, Eduardo; Brinkman, Gregory; Hummon, Marissa [National Renewable Energy Lab. (NREL), Golden, CO (United States); Lew, Debra

    2012-07-01

    Increasing penetration of wind and solar energy are raising concerns among electric system operators because of the variability and uncertainty associated with the power sources. Previous work focused on the quantification of reserves for systems with wind power. This paper presents a new methodology that allows the determination of necessary reserves for high penetrations of photovoltaic power and compares it to the wind-based methodology. The solar reserve methodology was applied to Phase 2 of the Western Wind and Solar Integration Study. A summary of the results is included. (orig.)

  8. Diagnostic performance of a Lattice Boltzmann-based method for CT-based fractional flow reserve.

    Science.gov (United States)

    Giannopoulos, Andreas A; Tang, Anji; Ge, Yin; Cheezum, Michael K; Steigner, Michael L; Fujimoto, Shinichiro; Kumamaru, Kanako K; Chiappino, Dante; Della Latta, Daniele; Berti, Sergio; Chiappino, Sara; Rybicki, Frank J; Melchionna, Simone; Mitsouras, Dimitrios

    2018-02-20

    Fractional flow reserve (FFR) estimated from coronary computed tomography angiography (CT-FFR) offers non-invasive detection of lesion-specific ischaemia. We aimed to develop and validate a fast CT-FFR algorithm utilising the Lattice Boltzmann method for blood flow simulation (LBM CT-FFR). Sixty-four patients with clinically indicated CTA and invasive FFR measurement from three institutions were retrospectively analysed. CT-FFR was performed using an onsite tool interfacing with a commercial Lattice Boltzmann fluid dynamics cloud-based platform. Diagnostic accuracy of LBM CT-FFR ≤0.8 and percent diameter stenosis >50% by CTA to detect invasive FFR ≤0.8 were compared using area under the receiver operating characteristic curve (AUC). Sixty patients successfully underwent LBM CT-FFR analysis; 29 of 73 lesions in 69 vessels had invasive FFR ≤0.8. Total time to perform LBM CT-FFR was 40±10 min. Compared to invasive FFR, LBM CT-FFR had good correlation (r=0.64), small bias (0.009) and good limits of agreement (-0.223 to 0.206). The AUC of LBM CT-FFR (AUC=0.894, 95% confidence interval [CI]: 0.792-0.996) was significantly higher than CTA (AUC=0.685, 95% CI: 0.576-0.794) to detect FFR ≤0.8 (p=0.0021). Per-lesion specificity, sensitivity, and accuracy of LBM CT-FFR were 97.7%, 79.3%, and 90.4%, respectively. LBM CT-FFR has very good diagnostic accuracy to detect lesion-specific ischaemia (FFR ≤0.8) and can be performed in less than one hour.

  9. 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.

  10. 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.

  11. 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.

  12. 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.

  13. 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

  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. 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

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. A DUAL RESERVATION CDMA-BASED MAC PROTOCOL WITH POWER CONTROL FOR AD HOC NETWORKS

    Institute of Scientific and Technical Information of China (English)

    Jia Min; Chen Huimin; Yuan Yuhua

    2007-01-01

    This paper proposes a new multi-channel Medium Access Control (MAC) protocol named as Dual Reservation Code Division Multiple Access (CDMA) based MAC protocol with Power Control (DRCPC). The code channel is divided into common channel, broadcast channel and several data channels. And dynamic power control mechanism is implemented to reduce near-far interference. Compared with IEEE 802.11 Distributed Coordination Function (DCF) protocol, the results show that the proposed mechanism improves the average throughput and limits the transmission delay efficiently.

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

    Science.gov (United States)

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

    2014-01-01

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

  2. 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.

  3. Electronic health systems: challenges faced by hospital-based providers.

    Science.gov (United States)

    Agno, Christina Farala; Guo, Kristina L

    2013-01-01

    The purpose of this article is to discuss specific challenges faced by hospitals adopting the use of electronic medical records and implementing electronic health record (EHR) systems. Challenges include user and information technology support; ease of technical use and software interface capabilities; compliance; and financial, legal, workforce training, and development issues. Electronic health records are essential to preventing medical errors, increasing consumer trust and use of the health system, and improving quality and overall efficiency. Government efforts are focused on ways to accelerate the adoption and use of EHRs as a means of facilitating data sharing, protecting health information privacy and security, quickly identifying emerging public health threats, and reducing medical errors and health care costs and increasing quality of care. This article will discuss physician and nonphysician staff training before, during, and after implementation; the effective use of EHR systems' technical features; the selection of a capable and secure EHR system; and the development of collaborative system implementation. Strategies that are necessary to help health care providers achieve successful implementation of EHR systems will be addressed.

  4. 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.

  5. 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....

  6. The design of a DataBase for Natural Resources in Danube Delta Biosphere Reserve DDBR

    Directory of Open Access Journals (Sweden)

    GRIGORAS Ion

    2016-12-01

    Full Text Available Efficient use of natural resources especially in Natura 2000 sites is an essential component of Europe 2020 strategy. The use of web database is absolutely necessary for a good resource management and it will provide a good communication channel for the main stakeholders: protected area manager, scientists, resources evaluators and local community. Access to information from database is allowed according with the user competence. General information on natural resources uses in Danube Delta Biosphere Reserve (D.D.B.R. will be freely available. Different degree of information, especially regarding editing data will be applied for the main actors involved in use of natural resources. Evaluators that are mainly scientists with good biodiversity background, protected area staff that applies the regulation regarding natural resources in relation with ecological conditions, private companies or persons interested in harvesting natural resources. The user interface is realized by using OpenSource products. The web interface for tabular data was build using ExtJs Javascrip library. The web map user interface was build using Openlayers, GeoExt, and Ext. For database SQL server we chose PostgresSQL and GeoServer for maps server

  7. Brain reserve capacity in frontotemporal dementia: a voxel-based 18F-FDG PET study

    International Nuclear Information System (INIS)

    Perneczky, Robert; Diehl-Schmid, Janine; Kurz, Alexander; Drzezga, Alexander

    2007-01-01

    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 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.)

  8. 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.

  9. Impact on reserves and energy delivery of current UC-based Market-Clearing formulations

    NARCIS (Netherlands)

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

    2012-01-01

    Reserves are playing each time a more important role due to the massive penetration of renewable energy sources nowadays. Operating reserves must be used for unforeseen events. All predictable events must be directly considered in the scheduling stage otherwise there will be an inefficient and

  10. Moral distress experienced by health care professionals who provide home-based palliative care.

    Science.gov (United States)

    Brazil, Kevin; Kassalainen, Sharon; Ploeg, Jenny; Marshall, Denise

    2010-11-01

    Health care providers regularly encounter situations of moral conflict and distress in their practice. Moral distress may result in unfavorable outcomes for both health care providers and those in their care. The purpose of this study was to examine the experience of moral distress from a broad range of health care occupations that provide home-based palliative care as the initial step of addressing the issue. A critical incident approach was used in qualitative interviews to elicit the experiences on moral distress from 18 health care providers drawn from five home visiting organizations in south central Ontario, Canada. Most participants described at least two critical incidents in their interview generating a total of 47 critical incidents. Analyses of the critical incidents revealed 11 issues that triggered moral distress which clustered into three themes, (a) the role of informal caregivers, b) challenging clinical situations and (c) service delivery issues. The findings suggest that the training and practice environments for health care providers need to be designed to recognize the moral challenges related to day-to-day practice. Copyright © 2010 Elsevier Ltd. All rights reserved.

  11. 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...

  12. Tablet based simulation provides a new solution to accessing laparoscopic skills training.

    Science.gov (United States)

    Bahsoun, Ali Nehme; Malik, Mohsan Munir; Ahmed, Kamran; El-Hage, Oussama; Jaye, Peter; Dasgupta, Prokar

    2013-01-01

    Access to facilities that allow trainees to develop their laparoscopic skills is very limited in the hospital environment and courses can be very expensive. We set out to build an inexpensive yet effective trainer to allow laparoscopic skill acquisition in the home or classroom environment based on using a tablet as a replacement for the laparoscopic stack and camera. The cavity in which to train was made from a cardboard box; we left the sides and back open to allow for natural light to fill the cavity. An iPad 2 (Apple Inc.) was placed over the box to act as our camera and monitor. We provided 10 experienced laparoscopic surgeons with the task of passing a suture needle through 3 hoops; then they filled in a questionnaire to assess Face (training capacity) and Content (performance) validity. On a 5-point Likert scale, the tablet-based laparoscopic trainer scored a mean 4.2 for training capacity (hand eye coordination, development, and maintenance of lap skills) and for performance (graphics, video, and lighting quality) it scored a mean 4.1. The iPad 2-based laparoscopic trainer was successfully validated for training. It allows students and trainees to practice at their own pace and for inexpensive training on the go. Future "app-"based skills are planned. Copyright © 2013 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  13. New bidding strategy formulation for day-ahead energy and reserve markets based on evolutionary programming

    International Nuclear Information System (INIS)

    Attaviriyanupap, Pathom; Kita, Hiroyuki; Tanaka, Eiichi; Hasegawa, Jun

    2005-01-01

    In this paper, a new bidding strategy for a day-ahead market is formulated. The proposed algorithm is developed from the viewpoint of a generation company wishing to maximize a profit as a participant in the deregulated power and reserve markets. Separate power and reserve markets are considered, both are operated by clearing price auction system. The optimal bidding parameters for both markets are determined by solving an optimization problem that takes unit commitment constraints such as generating limits and unit minimum up/down time constraints into account. This is a non-convex and non-differentiable which is difficult to solve by traditional optimization techniques. In this paper, evolutionary programming is used to solve the problem. The algorithm is applied to both single-sided and double-sided auctions, numerical simulations are carried out to demonstrate the performance of the proposed scheme compared with those obtained from a sequential quadratic programming. (author)

  14. An Analytical Solution for Probabilistic Guarantees of Reservation Based Soft Real--Time Systems

    OpenAIRE

    Palopoli, Luigi; Fontanelli, Daniele; Abeni, Luca; Villalba Frias, Bernardo

    2015-01-01

    We show a methodology for the computation of the probability of deadline miss for a periodic real-time task scheduled by a resource reservation algorithm. We propose a modelling technique for the system that reduces the computation of such a probability to that of the steady state probability of an infinite state Discrete Time Markov Chain with a periodic structure. This structure is exploited to develop an efficient numeric solution where different accuracy/computation time trade-offs can be...

  15. 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

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

    Energy Technology Data Exchange (ETDEWEB)

    Huse, Einar Staale

    1999-12-31

    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.

  17. 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.

  18. Feedback to providers improves evidence-based implantable cardioverter-defibrillator programming and reduces shocks.

    Science.gov (United States)

    Silver, Marc T; Sterns, Laurence D; Piccini, Jonathan P; Joung, Boyoung; Ching, Chi-Keong; Pickett, Robert A; Rabinovich, Rafael; Liu, Shufeng; Peterson, Brett J; Lexcen, Daniel R

    2015-03-01

    Implantable cardioverter-defibrillator (ICD) shocks are associated with increased anxiety, health care utilization, and potentially mortality. The purpose of the Shock-Less Study was to determine if providing feedback reports to physicians on their adherence to evidence-based shock reduction programming could improve their programming behavior and reduce shocks. Shock-Less enrolled primary prevention (PP) and secondary prevention (SP) ICD patients between 2009 and 2012 at 118 study centers worldwide and followed patients longitudinally after their ICD implant. Center-specific therapy programming reports (TPRs) were delivered to each center 9 to 12 months after their first enrollment. The reports detailed adherence to evidence-based programming targets: number of intervals to detect ventricular fibrillation (VF NID), longest treatment interval (LTI), supraventricular tachycardia (SVT) discriminators (Wavelet, PR Logic), SVT limit, Lead Integrity Alert (LIA), and antitachycardia pacing (ATP). Clinicians programmed ICDs at their discretion. The primary outcome measure was the change in utilization of evidence-based shock reduction programming before (phase I, n = 2694 patients) and after initiation of the TPR (phase II, n = 1438 patients). Patients implanted after feedback reports (phase II) were up to 20% more likely to have their ICDs programmed in line with evidence-based shock reduction programming (eg, VF NID in PP patients 30/40 in 33.5% vs 18.6%, P programming feedback reports improves adherence to evidence-based shock reduction programming and is associated with lower risk of ICD shocks. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  19. 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.

  20. 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

  1. Myocardial perfusion imaging with a cadmium zinc telluride-based gamma camera versus invasive fractional flow reserve

    Energy Technology Data Exchange (ETDEWEB)

    Mouden, Mohamed [Isala klinieken, Department of Cardiology, Zwolle (Netherlands); Isala klinieken, Department of Nuclear Medicine, Zwolle (Netherlands); Ottervanger, Jan Paul; Timmer, Jorik R. [Isala klinieken, Department of Cardiology, Zwolle (Netherlands); Knollema, Siert; Reiffers, Stoffer; Oostdijk, Ad H.J.; Jager, Pieter L. [Isala klinieken, Department of Nuclear Medicine, Zwolle (Netherlands); Boer, Menko-Jan de [University Medical Centre Nijmegen, Department of Cardiology, Nijmegen (Netherlands)

    2014-05-15

    Recently introduced ultrafast cardiac SPECT cameras with cadmium zinc telluride-based (CZT) detectors may provide superior image quality allowing faster acquisition with reduced radiation doses. Although the level of concordance between conventional SPECT and invasive fractional flow reserve (FFR) measurement has been studied, that between FFR and CZT-based SPECT is not yet known. Therefore, we aimed to assess the level of concordance between CZT SPECT and FFR in a large patient group with stable coronary artery disease. Both invasive FFR and myocardial perfusion imaging with a CZT-based SPECT camera, using Tc-tetrofosmin as tracer, were performed in 100 patients with stable angina and intermediate grade stenosis on invasive coronary angiography. A cut-off value of <0.75 was used to define abnormal FFR. The mean age of the patients was 64 ± 11 years, and 64 % were men. SPECT demonstrated ischaemia in 31 % of the patients, and 20 % had FFR <0.75. The concordance between CZT SPECT and FFR was 73 % on a per-patient basis and 79 % on a per-vessel basis. Discordant findings were more often seen in older patients and were mainly (19 %) the result of ischaemic SPECT findings in patients with FFR ≥0.75, whereas only 8 % had an abnormal FFR without ischaemia as demonstrated by CZT SPECT. Only 20 - 30 % of patients with intermediate coronary stenoses had significant ischaemia as assessed by CZT SPECT or invasive FFR. CZT SPECT showed a modest degree of concordance with FFR, which is comparable with previous results with conventional SPECT. Further investigations are particularly necessary in patients with normal SPECT and abnormal FFR, especially to determine whether these patients should undergo revascularization. (orig.)

  2. Reserve Component Manpower Readiness and Mobilization Policy. Volume 2. Based on the Colloquium on Mobilization with Special Emphasis on Guard and Reserve Components, 1-4 November 1983

    Science.gov (United States)

    1984-03-16

    of Liberal Arts Rand Graduate Institute Syracuse Univ., College of Arts & Sciences Texas ASM Univ., College of Liberal Arts Tulane Univ., School of...and actuarial factors. Because tne Services have inadequate ,»rsonnel management data on the Reserve retiree population, inventory changes are...Manpower Data Center (DMDC) Office of the DoD Actuary and the respective service FY84-88 Program Objective Memorandum (POM). K/« cjr

  3. Reserve, thin form-factor, hypochlorite-based cells for powering portable systems: Manufacture (including MEMS processes), performance and characterization

    Energy Technology Data Exchange (ETDEWEB)

    Cardenas-Valencia, Andres M.; Langebrake, Larry [Center for Ocean Technology, University of South Florida, 140 Seventh Ave. S., St. Petersburg, FL (United States); Biver, Carl J. [Center for Ocean Technology, University of South Florida, 140 Seventh Ave. S., St. Petersburg, FL (United States); Department of Chemical Engineering, University of South Florida, 4202 E. Fowler Ave. Tampa, FL (United States)

    2007-03-30

    This work focuses on fabrication routes and performance evaluation of thin form-factors, reserve cells, as a powering alternative for expendable and/or remotely operated systems. The catalytic decomposition of sodium hypochlorite solutions is revisited herein with two cost-effective anodes: zinc and aluminum. Aluminum, even though the most expensive of the utilized anodes, constituted cells with double the energy content (up to 55 Wh kg{sup -1}) than those fabricated with zinc. Even though the hypochlorite concentration in the solution limits the cells' operational life, attractive performances (1.0 V with a current of 10 mA) for the manufactured cells are obtained. It is shown that micro fabrication processes, allowing for close electrodes interspacing, provided high faradic and columbic efficiencies of up to 70 and 100%, respectively. Obtained specific energies (50-120 Wh kg{sup -1}) are in the same order of magnitude than batteries currently used for powering deployable systems. Experimental results show that a simple model that linearly relates over potentials and the electrical load, adequately describe all the cell designs. A mathematical model based on a kinetic-mechanistic scheme that relates the current output as a function of time agrees fairly well with results obtained activating cells with various concentrations of NaOCl solutions. (author)

  4. 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

    Refrigeration is important to sustain high foodstuff quality and lifetime. Keeping the foodstuff within temperature thresholds in supermarkets is also important due to legislative requirements. Failure to do so can result in discarded foodstuff, a penalty fine to the shop owner, and health issues....... 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...

  5. Environmental Assessment: Grade and Pave Shoulders on Runway 15/33 Westover Air Reserve Base, MA

    Science.gov (United States)

    2011-11-09

    advertisement in the Sunday Republican, a general circulation newspaper in this area, on 13 November 2011. The Draft EA and Draft FONSI were also provided...mid July, and Phase YG about mid July into the fall. Adding incubation and nestling periods to nest initiation dates yields an estimated period...2011, and initiation, incubation and nestling periods from Baicich and Harrison 1997, DeGraaf and Yamasaki 2001, and Maine IFW 2011. Information

  6. Replacement of reserves zinc based on the recycling of technogenic raw materials

    Directory of Open Access Journals (Sweden)

    Olga Sergeevna Bryantseva

    2013-06-01

    Full Text Available In the article, the perspective trends of the expansion of the mineral-ore base of the Russian producers of zinc by recycling of technogenic raw materials are considered. The important role of recycling of resources for sustainable development of society and improve the environmental safety is justified. The main structural and dynamic characteristics of the use of mineral resource base for the production of zinc in Russia are considered. Raw materials opportunities and constraints for the development of zinc production are analyzed. In the paper, the structure and dynamics of the use of recycled materials by the largest producer of zinc in Russia are investigated. The methodical approach to the estimation of effectiveness of the industrial processing of technogenic metallurgical raw materials with the strategic flexibility of the implementation of projects is proposed and approved. The estimation of the effectiveness of a complex industrial processing of metallurgical zinc-containing dusts in a real production is carried out. The value of the strategic flexibility of the project of the industrial processing of the zinc-containing technogenic raw material is determined on the basis of the developed systematic approach. The value of the processes of recycling for sustainable production of zinc in Russia is revealed.

  7. Measuring Provider Performance for Physicians Participating in the Merit-Based Incentive Payment System.

    Science.gov (United States)

    Squitieri, Lee; Chung, Kevin C

    2017-07-01

    In 2017, the Centers for Medicare and Medicaid Services began requiring all eligible providers to participate in the Quality Payment Program or face financial reimbursement penalty. The Quality Payment Program outlines two paths for provider participation: the Merit-Based Incentive Payment System and Advanced Alternative Payment Models. For the first performance period beginning in January of 2017, the Centers for Medicare and Medicaid Services estimates that approximately 83 to 90 percent of eligible providers will not qualify for participation in an Advanced Alternative Payment Model and therefore must participate in the Merit-Based Incentive Payment System program. The Merit-Based Incentive Payment System path replaces existing quality-reporting programs and adds several new measures to evaluate providers using four categories of data: (1) quality, (2) cost/resource use, (3) improvement activities, and (4) advancing care information. These categories will be combined to calculate a weighted composite score for each provider or provider group. Composite Merit-Based Incentive Payment System scores based on 2017 performance data will be used to adjust reimbursed payment in 2019. In this article, the authors provide relevant background for understanding value-based provider performance measurement. The authors also discuss Merit-Based Incentive Payment System reporting requirements and scoring methodology to provide plastic surgeons with the necessary information to critically evaluate their own practice capabilities in the context of current performance metrics under the Quality Payment Program.

  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. 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.

  10. 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.

  11. Short-term Forecast of Automatic Frequency Restoration Reserve from a Renewable Energy Based Virtual Power Plant

    OpenAIRE

    Camal , Simon; Michiorri , Andrea; Kariniotakis , Georges; Liebelt , Andreas

    2017-01-01

    International audience; This paper presents the initial findings on a new forecast approach for ancillary services delivered by aggregated renewable power plants. The increasing penetration of distributed variable generators challenges grid reliability. Wind and photovoltaic power plants are technically able to provide ancillary services, but their stochastic behavior currently impedes their integration into reserve mechanisms. A methodology is developed to forecast the flexibility that a win...

  12. 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

  13. Organizational Culture and Climate and Mental Health Provider Attitudes Toward Evidence-Based Practice

    OpenAIRE

    Aarons, Gregory A.; Sawitzky, Angelina C.

    2006-01-01

    Mental health provider attitudes toward adopting evidence-based practice (EBP) are associated with organizational context and provider individual differences. Organizational culture and climate are contextual factors that can affect staff acceptance of innovation. This study examined the association of organizational culture and climate with attitudes toward adopting EBP. Participants were 301 public sector mental health service providers from 49 programs providing mental health services for ...

  14. 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.

  15. 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.

  16. 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.

  17. Providing the Public with Online Access to Large Bibliographic Data Bases.

    Science.gov (United States)

    Firschein, Oscar; Summit, Roger K.

    DIALOG, an interactive, computer-based information retrieval language, consists of a series of computer programs designed to make use of direct access memory devices in order to provide the user with a rapid means of identifying records within a specific memory bank. Using the system, a library user can be provided access to sixteen distinct and…

  18. 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...

  19. 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...

  20. 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...

  1. Psychosis screening practices in schools: A survey of school-based mental health providers.

    Science.gov (United States)

    Kline, Emily R; Chokran, Cole; Rodenhiser-Hill, Janine; Seidman, Larry J; Woodberry, Kristen A

    2018-05-04

    Many school districts in the United States employ mental health professionals to provide assessment, counselling and crisis interventions within the school setting; however, little is known about actual clinical practices of psychosis screening in schools. The aim of the present study is to examine attitudes and practices regarding psychosis screening among school mental health providers in metropolitan Boston, Massachusetts. School-based mental health clinicians (N = 100) completed an anonymous survey assessing familiarity, screening, and involvement with psychosis and psychosis risk prior to attending trainings on psychosis. Providers reported screening for psychosis less often than other mental health problems and rated themselves as less confident treating psychosis relative to other mental health concerns. Frequency of screening for psychosis was significantly associated with familiarity with psychosis assessment and case management, confidence providing treatment for individuals experiencing psychosis, and the number of students with or at risk for psychosis with whom providers had been involved. Frequency of screening for psychosis was not associated with years of practice, suggesting that both novice and experienced school-based providers may benefit from training on this issue. Community outreach via school-based provider training on assessment and management of psychosis may help to increase providers' understanding of psychosis and increase the practice of verbal or written screening for psychosis and psychosis risk within schools. © 2018 John Wiley & Sons Australia, Ltd.

  2. Fostering resilience in National Guard and Reserve families: A contextual adaptation of an evidence-based parenting program.

    Science.gov (United States)

    Pinna, Keri L M; Hanson, Sheila; Zhang, Na; Gewirtz, Abigail H

    2017-01-01

    Military deployment of a parent is a risk factor for children's internalizing and externalizing problems. This risk may be heightened in National Guard and Reserve (NG/R) families who tend to be isolated from other NG/R families and do not benefit from the centralized support system available to active duty families living on military bases. Isolation and trauma-related disorders may complicate the adjustment of military families during reintegration. An evidence-based parent training intervention was modified to meet the unique needs of recently deployed NG/R parents and their spouses, and the modified program was evaluated in a randomized controlled trial. The current study examines engagement and satisfaction with the program. Modifications such as employment of military-connected facilitators sought to maximize engagement in and satisfaction with the program. Engagement and satisfaction were examined between mothers and fathers, as well as between groups led by a military-connected facilitator and those led by civilian facilitators. Significantly greater engagement was noted for groups that were led by a military-connected facilitator (p = .01). There were no differences between genders in attendance rates, though greater positive group experiences were reported by mothers versus fathers (p = .01). Results are discussed in the context of engagement and satisfaction reported for similar programs. Implications for working with military families are also considered. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  3. 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

  4. Time providing care outside visits in a home-based primary care program.

    Science.gov (United States)

    Pedowitz, Elizabeth J; Ornstein, Katherine A; Farber, Jeffrey; DeCherrie, Linda V

    2014-06-01

    To assess how much time physicians in a large home-based primary care (HBPC) program spend providing care outside of home visits. Unreimbursed time and patient and provider-related factors that may contribute to that time were considered. Mount Sinai Visiting Doctors (MSVD) providers filled out research forms for every interaction involving care provision outside of home visits. Data collected included length of interaction, mode, nature, and with whom the interaction was for 3 weeks. MSVD, an academic home-visit program in Manhattan, New York. All primary care physicians (PCPs) in MSVD (n = 14) agreed to participate. Time data were analyzed using a comprehensive estimate and conservative estimates to quantify unbillable time. Data on 1,151 interactions for 537 patients were collected. An average 8.2 h/wk was spent providing nonhome visit care for a full-time provider. Using the most conservative estimates, 3.6 h/wk was estimated to be unreimbursed per full-time provider. No significant differences in interaction times were found between patients with and without dementia, new and established patients, and primary-panel and covered patients. Home-based primary care providers spend substantial time providing care outside home visits, much of which goes unrecognized in the current reimbursement system. These findings may help guide practice development and creation of new payment systems for HBPC and similar models of care. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

  5. 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.

  6. 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

  7. Measuring Provider Attitudes Toward Evidence-Based Practice: Consideration of Organizational Context and Individual Differences

    OpenAIRE

    Aarons, Gregory A.

    2005-01-01

    Mental health provider attitudes toward adoption of innovation in general, and toward evidence-based practice (EBP) in particular, are important in considering how best to disseminate and implement EBPs. This article first explores the role of attitudes in acceptance of innovation and proposes a model of organizational and individual factors that may affect or be affected by attitudes toward adoption of EBP. Next, a recently developed measure of mental health provider attitudes toward adoptio...

  8. Organizational Culture and Climate and Mental Health Provider Attitudes Toward Evidence-Based Practice.

    Science.gov (United States)

    Aarons, Gregory A; Sawitzky, Angelina C

    2006-02-01

    Mental health provider attitudes toward adopting evidence-based practice (EBP) are associated with organizational context and provider individual differences. Organizational culture and climate are contextual factors that can affect staff acceptance of innovation. This study examined the association of organizational culture and climate with attitudes toward adopting EBP. Participants were 301 public sector mental health service providers from 49 programs providing mental health services for youths and families. Correlation analyses and multilevel hierarchical regressions, controlling for effects of provider characteristics, showed that constructive culture was associated with more positive attitudes toward adoption of EBP and poor organizational climates with perceived divergence of usual practice and EBP. Behavioral health organizations may benefit from consideration of how culture and climate affect staff attitudes toward change in practice.

  9. 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

  10. Entering the Fray: The Role of Outdoor Education in Providing Nature-Based Experiences that Matter

    Science.gov (United States)

    Nicol, Robbie

    2014-01-01

    This article draws on different bodies of knowledge in order to review the potential role of outdoor education in providing nature-based experiences that might contribute to sustainable living. A pragmatic perspective is adopted to critique what outdoor education is, and then what it might be. Phenomenology is used to challenge the belief that…

  11. 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.

  12. 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.

  13. 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.

  14. A novel internet-based geriatric education program for emergency medical services providers.

    Science.gov (United States)

    Shah, Manish N; Swanson, Peter A; Nobay, Flavia; Peterson, Lars-Kristofer N; Caprio, Thomas V; Karuza, Jurgis

    2012-09-01

    Despite caring for large numbers of older adults, prehospital emergency medical services (EMS) providers receive minimal geriatrics-specific training while obtaining their certification. Studies have shown that they desire further training to improve their comfort level and knowledge in caring for older adults, but continuing education programs to address these needs must account for each EMS provider's specific needs, consider each provider's learning styles, and provide an engaging, interactive experience. A novel, Internet-based, video podcast-based geriatric continuing education program was developed and implemented for EMS providers, and their perceived value of the program was evaluated. They found this resource to be highly valuable and were strongly supportive of the modality and the specific training provided. Some reported technical challenges and the inability to engage in a discussion to clarify topics as barriers. It was felt that both of these barriers could be addressed through programmatic and technological revisions. This study demonstrates the proof of concept of video podcast training to address deficiencies in EMS education regarding the care of older adults, although further work is needed to demonstrate the educational effect of video podcasts on the knowledge and skills of trainees. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

  15. 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.

  16. Availability and accessibility of evidence-based information resources provided by medical libraries in Australia.

    Science.gov (United States)

    Ritchie, A; Sowter, B

    2000-01-01

    This article reports on the results of an exploratory survey of the availability and accessibility of evidence-based information resources provided by medical libraries in Australia. Although barriers impede access to evidence-based information for hospital clinicians, the survey revealed that Medline and Cinahl are available in over 90% of facilities. In most cases they are widely accessible via internal networks and the Internet. The Cochrane Library is available in 69% of cases. The Internet is widely accessible and most libraries provide access to some full-text, electronic journals. Strategies for overcoming restrictions and integrating information resources with clinical workflow are being pursued. State, regional and national public and private consortia are developing agreements utilising on-line technology. These could produce cost savings and more equitable access to a greater range of evidence-based resources.

  17. Mobile phone-based clinical guidance for rural health providers in India.

    Science.gov (United States)

    Gautham, Meenakshi; Iyengar, M Sriram; Johnson, Craig W

    2015-12-01

    There are few tried and tested mobile technology applications to enhance and standardize the quality of health care by frontline rural health providers in low-resource settings. We developed a media-rich, mobile phone-based clinical guidance system for management of fevers, diarrhoeas and respiratory problems by rural health providers. Using a randomized control design, we field tested this application with 16 rural health providers and 128 patients at two rural/tribal sites in Tamil Nadu, Southern India. Protocol compliance for both groups, phone usability, acceptability and patient feedback for the experimental group were evaluated. Linear mixed-model analyses showed statistically significant improvements in protocol compliance in the experimental group. Usability and acceptability among patients and rural health providers were very high. Our results indicate that mobile phone-based, media-rich procedural guidance applications have significant potential for achieving consistently standardized quality of care by diverse frontline rural health providers, with patient acceptance. © The Author(s) 2014.

  18. Capacity and readiness for quality improvement among home and community-based service providers.

    Science.gov (United States)

    Abrahamson, Kathleen; Myers, Jaclyn; Arling, Greg; Davila, Heather; Mueller, Christine; Abery, Brian; Cai, Yun

    2016-01-01

    The objective of this study was to explore home and community-based service (HCBS) providers' perspectives of organizational readiness for quality improvement (QI). Data were obtained from a survey of participants (N = 56) in a state-sponsored HCBS QI initiative. Quality improvement challenges included lack of time and resources, staff apprehension or resistance, resistance from consumers and families, and project sustainability. Support from leadership was viewed as an important factor in participating organizations' decision to engage in QI. Internal resources available to support QI varied widely between participating organizations, with differences observed between smaller and larger agencies, as well as between provider types and populations served.

  19. 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

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

    Science.gov (United States)

    Lipman, Ellen L; Kenny, Meghan; Marziali, Elsa

    2011-08-19

    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. 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. 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-group quantitative evaluations did not show

  1. 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

  2. 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.

  3. 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.

  4. Utilisation of evidence-based practices by ASD early intervention service providers.

    Science.gov (United States)

    Paynter, Jessica M; Ferguson, Sarah; Fordyce, Kathryn; Joosten, Annette; Paku, Sofia; Stephens, Miranda; Trembath, David; Keen, Deb

    2017-02-01

    A number of autism intervention practices have been demonstrated to be effective. However, the use of unsupported practices persists in community early intervention settings. Recent research has suggested that personal, professional and workplace factors may influence intervention choices. The aim of this research was to investigate knowledge and use of strategies, organisational culture, individual attitudes, sources of information and considerations informing intervention choices by early intervention providers. An online survey was completed by 72 early intervention providers from four organisations across Australia. Providers reported high levels of trust and access of information from internal professional development, therapists and external professional development. A range of considerations including child factors, family values and research were rated as important in informing intervention choices. Participants reported greater knowledge and use of evidence-based and emerging practices than unsupported. Levels of use were linked to levels of knowledge, as well as some organisational and attitudinal factors. Areas for future research and implications are discussed.

  5. 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.

  6. A rapid evidence-based service by librarians provided information to answer primary care clinical questions.

    Science.gov (United States)

    McGowan, Jessie; Hogg, William; Rader, Tamara; Salzwedel, Doug; Worster, Danielle; Cogo, Elise; Rowan, Margo

    2010-03-01

    A librarian consultation service was offered to 88 primary care clinicians during office hours. This included a streamlined evidence-based process to answer questions in fewer than 20 min. This included a contact centre accessed through a Web-based platform and using hand-held devices and computers with Web access. Librarians were given technical training in evidence-based medicine, including how to summarise evidence. To describe the process and lessons learned from developing and operating a rapid response librarian consultation service for primary care clinicians. Evaluation included librarian interviews and a clinician exit satisfaction survey. Clinicians were positive about its impact on their clinical practice and decision making. The project revealed some important 'lessons learned' in the clinical use of hand-held devices, knowledge translation and training for clinicians and librarians. The Just-in-Time Librarian Consultation Service showed that it was possible to provide evidence-based answers to clinical questions in 15 min or less. The project overcame a number of barriers using innovative solutions. There are many opportunities to build on this experience for future joint projects of librarians and healthcare providers.

  7. [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.

  8. 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.)

  9. Developing and providing an online (web-based) clinical research design course in Japan: lessons learned.

    Science.gov (United States)

    Clark, Glenn T; Mulligan, Roseann; Baba, Kazuyoshi

    2011-04-01

    This article reports on the lessons learned while teaching an 8-week-long online course about the principles of clinical research design in Japan. Student activity data and how it relates to performance in the course are presented. As prolog, this article focuses on the barriers and solutions to creating and delivering a web-based course and it lists and discusses the most common concerns that educators often have about this process, namely, cost of the system and time requirement of the faculty. Options that must be considered when selecting the support software and hardware needed to conduct live streaming lecture, online video-based conference course are presented. The ancillary role of e-mail based distribution lists as an essential instruction tool within an interactive, instructor-supervised online course is discussed. This article then discusses the inclusion of active learning elements within an online course as well as the pros and cons regarding open-book versus closed book, proctored testing. Lastly, copyright issues the online instructor should know about are discussed. The student tracking data show that as the course progresses, students will reduce the number for page viewings. We speculate that this reduction is due to a combination of conflicting priorities plus increasing efficiency of the students at extracting the critical information. The article also concludes that software and hardware costs to deliver an online course are relatively minor but the faculty's time requirement is initially substantially higher than teaching in a conventional face-to-face course. Copyright © 2011 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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

  16. RESEARCH ACTION: IMPLEMENTATION ZERO BASED BUDGET (ZBB IN THE PROVIDER SERVICE LEASING EQUIPAMENTS OF CARGO HANDLING.

    Directory of Open Access Journals (Sweden)

    Levi Gimenez

    2013-06-01

    Full Text Available This article aims to present the implementation of zero-based budgeting in a rental service provider of cargo handling equipment using the action research methodology. The goal was to examine the possibility of concomitant use of this instrument in service providers in need of accurate information that enables targeting at the best result in a setting avid for quick decisions and actions. Action research was used as research method. It was concluded that it is suitable for this branch, confirming its position as a useful model for restructuring and cutting costs, improving operational and financial results, and as a factor improving organizational environment (behavioral aspects, indirectly creating value to stakeholders.

  17. 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.

  18. 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.

  19. 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.

  20. Measuring the benefits of using market based approaches to provide water and sanitation in humanitarian contexts.

    Science.gov (United States)

    Martin-Simpson, S; Parkinson, J; Katsou, E

    2018-06-15

    The use of cash transfers and market based programming (CT/MBP) to increase the efficiency and effectiveness of emergency responses is gaining prominence in the humanitarian sector. However, there is a lack of existing indicators and methodologies to monitor activities designed to strengthen water and sanitation (WaSH) markets. Gender and vulnerability markers to measure the impact of such activities on different stakeholders is also missing. This study identifies parameters to monitor, evaluate and determine the added value of utilising CT/MBP to achieve WaSH objectives in humanitarian response. The results of the work revealed that CT/MBP can be used to support household, community and market level interventions to effectively reduce transmission of faeco-oral diseases. Efficiency, effectiveness, sustainability, appropriateness and equity were identified as useful parameters which correlated to widely accepted frameworks against which to evaluate humanitarian action. The parameters were found to be directly applicable to the case of increasing demand and supply of point of use water treatment technology for a) disaster resilience activities, and b) post-crisis response. The need for peer review of the parameters and indicators and pilot measurement in humanitarian contexts was recognised. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. 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.

  2. 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.

  3. Providing long-acting reversible contraception services in Seattle school-based health centers: key themes for facilitating implementation.

    Science.gov (United States)

    Gilmore, Kelly; Hoopes, Andrea J; Cady, Janet; Amies Oelschlager, Anne-Marie; Prager, Sarah; Vander Stoep, Ann

    2015-06-01

    The purpose of this study was to describe the implementation of a program that provides long-acting reversible contraception (LARC) services within school-based health centers (SBHCs) and to identify barriers and facilitators to implementation as reported by SBHC clinicians and administrators, public health officials, and community partners. We conducted 14 semistructured interviews with key informants involved in the implementation of LARC services. Key informants included SBHC clinicians and administrators, public health officials, and community partners. We used a content analysis approach to analyze interview transcripts for themes. We explored barriers to and facilitators of LARC service delivery across and within key informant groups. The most cited barriers across key informant groups were as follows: perceived lack of provider procedural skills and bias and negative attitudes about LARC methods. The most common facilitators identified across groups were as follows: clear communication strategies, contraceptive counseling practice changes, provider trainings, and stakeholder engagement. Two additional barriers emerged in specific key informant groups. Technical and logistical barriers to LARC service delivery were cited heavily by SBHC administrative staff, community partners, and public health officials. Expense and billing was a major barrier to SBHC administrative staff. LARC counseling and procedural services can be implemented in an SBHC setting to promote access to effective contraceptive options for adolescent women. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  4. Providing a secure base: parenting children in long-term foster family care.

    Science.gov (United States)

    Schofield, Gillian; Beek, Mary

    2005-03-01

    This paper reports on a longitudinal study of children growing up in long-term foster family care. It focuses attention on the challenges for foster carers in providing a secure base for foster children in middle childhood and early adolescence, who have come predominantly from backgrounds of abuse, neglect, and psychosocial adversity. Separation and loss in the children's lives, often through multiple placements, increase the likelihood of difficulties across a range of development. These children tend to be wary, distrustful, and controlling when they enter foster placements, but need from their carers many of the caregiving qualities most commonly described as providing a secure base in infancy. This study describes a model of parenting which uses four caregiving dimensions that are consistent with attachment theory and research: promoting trust in availability, promoting reflective function, promoting self-esteem, and promoting autonomy. A fifth dimension, promoting family membership, is added, as it reflects the need for children in long-term foster family care to experience the security that comes from a sense of identity and belonging. Qualitative data from the study demonstrates the usefulness of this model as a framework for analysis, but also suggests the potential use of such a framework for working with and supporting foster carers.

  5. 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.

  6. Space-based observatories providing key data for climate change applications

    Science.gov (United States)

    Lecomte, J.; Juillet, J. J.

    2016-12-01

    The Sentinel-1 & 3 mission are part of the Copernicus program, previously known as GMES (Global Monitoring for Environment and Security), whose overall objective is to support Europe's goals regarding sustainable development and global governance of the environment by providing timely and quality data, information, services and knowledge. This European Earth Observation program is led by the European Commission and the space infrastructure is developed under the European Space Agency leadership. Many services will be developed through the Copernicus program among different thematic areas. The climate change is one of this thematic area and the Sentinel-1 & 3 satellites will provide key space-based observations in this area. The Sentinel-1 mission is based on a constellation of 2 identical satellites each one embarking C-SAR Instrument and provides capability for continuous radar mapping of the Earth with enhanced revisit frequency, coverage, timeliness and reliability for operational services and applications requiring long time series. In particular, Sentinel 1 provides all-weather, day-and-night estimates of soil moisture, wind speed and direction, sea ice, continental ice sheets and glaciers. The Sentinel-3 mission will mainly be devoted to the provision of Ocean observation data in routine, long term (20 years of operations) and continuous fashion with a consistent quality and a very high level of availability. Among these data, very accurate surface temperatures and topography measurements will be provided and will constitute key indicators, once ingested in climate change models, for identifying climate drivers and expected climate impacts. The paper will briefly recall the satellite architectures, their main characteristics and performance. The inflight performance and key features of their images or data of the 3 satellites namely Sentinel 1A, 1B and 3A will be reviewed to demonstrate the quality and high scientific potential of the data as well as their

  7. Providing a USSD location based clinic finder in South Africa: did it work?

    Science.gov (United States)

    Parsons, Annie Neo; Timler, Dagmar

    2014-01-01

    A new mHealth service, Clinic Finder, was designed to provide a location-based service for any cellphone user in South Africa dialing a dedicated USSD string to find the nearest public primary health care facility. The service was funded by a European Union grant to Cell-Life to support the National Department of Health. Clinic Finder's aims were to provide a reliable and accurate service, and to assess both the most effective means of advertising the service as well as interest in the service. Users dialing the USSD string are asked to agree to geo-location (Vodacom and MTN users) or asked to enter their province, town and street (virtual network users and those choosing not to geo-locate). The service provider, AAT, sends the data to Cell-Life where an SMS with details of the nearest public primary health care facility is sent to the user by Cell-Life's open-source Communicate platform. The service was advertised on 3 days in 2014 using two different means: a newspaper ad on 20 May 2014 and Please Call Me ads on 30 July 2014 and 14 August 2014. 28.2% of unique users on 20 May 2014, 10.5% of unique users on 30 July 2014 and 92.8% of unique users on 14 August 2014 who agreed to geo-location successfully received SMSs. However, only 4.2%, 0.5%, and 2.4% of unique users responding to each advertisement who did not geo-locate then received an SMS. A small survey of users following the 20 May 2014 newspaper ad found overall interest in the idea of Clinic Finder, though unsuccessful users were more likely to dislike the service. The overall experience of using location based services and USSD for Clinic Finder suggests a need in the field of mHealth for wider availability of data on service usability and effectiveness.

  8. Military Base Realignments and Closures: Plan Needed to Monitor Challenges for Completing More Than 100 Armed Forces Reserve Centers

    National Research Council Canada - National Science Library

    Lepore, Brian J; Holman, Barry; Talbott, Laura; Arbogast, Shawn; Beers, Rachel; Coleman, Grace; Edwards, Jennifer; Matta, Julie; Perdue, Charles

    2007-01-01

    ...) and close 387 existing reserve components facilities. The Department of Defense (DoD) expects the new AFRCs to increase recruiting and retention and create greater efficiencies by fostering jointness and consolidating functions...

  9. Curriculum providing cognitive knowledge and problem-solving skills for anesthesia systems-based practice.

    Science.gov (United States)

    Wachtel, Ruth E; Dexter, Franklin

    2010-12-01

    Residency programs accredited by the ACGME are required to teach core competencies, including systems-based practice (SBP). Projects are important for satisfying this competency, but the level of knowledge and problem-solving skills required presupposes a basic understanding of the field. The responsibilities of anesthesiologists include the coordination of patient flow in the surgical suite. Familiarity with this topic is crucial for many improvement projects. A course in operations research for surgical services was originally developed for hospital administration students. It satisfies 2 of the Institute of Medicine's core competencies for health professionals: evidence-based practice and work in interdisciplinary teams. The course lasts 3.5 days (eg, 2 weekends) and consists of 45 cognitive objectives taught using 7 published articles, 10 lectures, and 156 computer-assisted problem-solving exercises based on 17 case studies. We tested the hypothesis that the cognitive objectives of the curriculum provide the knowledge and problem-solving skills necessary to perform projects that satisfy the SBP competency. Standardized terminology was used to define each component of the SBP competency for the minimum level of knowledge needed. The 8 components of the competency were examined independently. Most cognitive objectives contributed to at least 4 of the 8 core components of the SBP competency. Each component of SBP is addressed at the minimum requirement level of exemplify by at least 6 objectives. There is at least 1 cognitive objective at the level of summarize for each SBP component. A curriculum in operating room management can provide the knowledge and problem-solving skills anesthesiologists need for participation in projects that satisfy the SBP competency.

  10. 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

  11. 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.

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

    Directory of Open Access Journals (Sweden)

    C. R. Shapiro

    2018-01-01

    Full Text Available This paper is an extended version of our paper presented at the 2016 TORQUE conference (Shapiro et al., 2016. We investigate the use of wind farms to provide secondary frequency regulation for a power grid using a model-based receding horizon control 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 wake interactions, both of which play an important role in wind farm power production. In order to test the control strategy, it is implemented in a large-eddy simulation (LES model of an 84-turbine wind farm using the actuator disk turbine representation. Rotor-averaged velocity measurements at each turbine are used to provide feedback for error correction. The importance of including the dynamics of wake advection in the underlying wake model is tested by comparing the performance of this dynamic-model control approach to a comparable static-model control approach that relies on a modified Jensen model. We compare the performance of both control approaches using two types of regulation signals, RegA and RegD, which are used by PJM, an independent system operator in the eastern United States. The poor performance of the static-model control relative to the dynamic-model control demonstrates that modeling the dynamics of wake advection is key to providing the proposed type of model-based coordinated control of large wind farms. We further explore the performance of the dynamic-model control via composite performance scores used by PJM to qualify plants for regulation services or markets. Our results demonstrate that the dynamic-model-controlled wind farm consistently performs well, passing the qualification threshold for all fast-acting RegD signals. For the RegA signal, which changes over slower timescales, the dynamic-model control leads to average performance that surpasses the qualification threshold, but further

  13. 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.

  14. 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.

  15. Adoption of Evidence-Based Practices Among Substance Abuse Treatment Providers*

    Science.gov (United States)

    Haug, Nancy A.; Shopshire, Michael; Tajima, Barbara; Gruber, Valerie; Guydish, Joseph

    2009-01-01

    This research was conducted at a Substance Abuse Forum designed to address local community needs by focusing on Evidence-Based Practices (EBPs) in addiction treatment. The purpose of the study was to assess substance abuse treatment professionals’ readiness to adopt EBPs, experience with EBPs, and attitudes toward EBPs, as well as agency support for EBPs. A total of 119 addiction treatment providers completed pre-test measures, and 82% completed a post-test. Eighty-three percent of participants reported using some EBPs in the past year, and 75% reported currently using EBPs. Participants who were currently licensed or certified in addictions had less negative attitudes toward EBPs than those without credentials. While respondents reported agency support for EBPs, most expressed interest in further training. This study underscores the movement toward EBPs in addiction treatment and the need for effective dissemination and training in this area. PMID:18724657

  16. 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

  17. Relationship between office-based provider visits and emergency department encounters among publicly-insured adults with epilepsy.

    Science.gov (United States)

    Lekoubou, Alain; Bishu, Kinfe G; Ovbiagele, Bruce

    2018-03-01

    The proportion of adults with epilepsy using the emergency department (ED) is high. Among this patient population, increased frequency of office-based provider visits may be associated with lesser frequency of ED encounters, and key patient features may be linked to more ED encounters. We analyzed the Medical Expenditure Panel Survey Household Component (MEPS-HC) dataset for years 2003-2014, which represents a weighted sample of 842,249 publicly-insured US adults aged ≥18years. The Hurdle Poisson model that accommodates excess zeros was used to estimate the association between office-based and ED visits. Annual mean ED and office-based visits for publicly-insured adults with epilepsy were 0.70 and 10.8 respectively. Probability of at least one ED visit was 0.4% higher for every unit of office-based visit. Individuals in the high income category were less likely to visit the ED at least once while women with epilepsy had a higher likelihood of visiting the ED at least once. Among those who visited the ED at least once, there was a 0.3% higher likelihood of visiting the ED for every unit of office-based visit. Among individuals who visited the ED at least once, being aged 45-64years, residing in the West, and the year 2011/14 were associated with higher ED visits. In this representative sample of publicly-insured adults with epilepsy, higher frequency of office visits was not associated with lower ED utilization, which may be due to underlying greater disease severity or propensity for more treatment complications. Copyright © 2018 Elsevier Inc. All rights reserved.

  18. 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.

  19. 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.

  20. [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.

  1. 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)

  2. 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.

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

    Science.gov (United States)

    2012-01-01

    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 one CCOP organization

  4. Phytantriol based liquid crystal provide sustained release of anticancer drug as a novel embolic agent.

    Science.gov (United States)

    Qin, Lingzhen; Mei, Liling; Shan, Ziyun; Huang, Ying; Pan, Xin; Li, Ge; Gu, Yukun; Wu, Chuanbin

    2016-01-01

    Phytantriol has received increasing amount of attention in drug delivery system, however, the ability of the phytantriol based liquid crystal as a novel embolic agent to provide a sustained release delivery system is yet to be comprehensively demonstrated. The purpose of this study was to prepare a phytantriol-based cubic phase precursor solution loaded with anticancer drug hydroxycamptothecine (HCPT) and evaluate its embolization properties, in vitro drug release and cytotoxicity. Phase behavior of the phytantriol-solvent-water system was investigated by visual inspection and polarized light microscopy, and no phase transition was observed in the presence of HCPT within the studied dose range. Water uptake by the phytantriol matrices was determined gravimetrically, suggesting that the swelling complied with the second order kinetics. In vitro evaluation of embolic efficacy indicated that the isotropic solution displayed a satisfactory embolization effect. In vitro drug release results showed a sustained-release up to 30 days and the release behavior was affected by the initial composition and drug loading. Moreover, the in vitro cytotoxicity and anticancer activity were evaluated by MTT assay. No appreciable mortality was observed for NIH 3T3 cells after 48 h exposure to blank formulations, and the anticancer activity of HCPT-loaded formulations to HepG2 and SMMC7721 cells was strongly dependent on the drug loading and treatment time. Taken together, these results indicate that phytantriol-based cubic phase embolic gelling solution is a promising potential carrier for HCPT delivery to achieve a sustained drug release by vascular embolization, and this technology may be potential for clinical applications.

  5. 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.

  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. Improving Science and IT Literacy by Providing Urban-Based Environmental Science Research Opportunities

    Science.gov (United States)

    Cuff, K. E.; Corazza, L.; Liang, J.

    2007-12-01

    A U.C. Berkeley-based outreach program known as Environmental Science Information Technology Activities has been in operation over the past four years. The primary aim of the program is to provide opportunities for grades 9 and 10 students in diverse East San Francisco Bay Area communities to develop deeper understandings of the nature and conduct of science, which will increase their capacity to enroll and perform successfully in science, technology, engineering, and mathematics (STEM) courses in the future. Design of the program has been informed by recent research that indicates a close relationship between educational activities that promote the perception of STEM as being relevant and the ability to foster development of deeper conceptual understandings among teens. Accordingly, ESITA includes an important student-led environmental science research project component, which provides participants with opportunities to engage in research investigations that are directly linked to relevant, real-world environmental problems and issues facing their communities. Analysis of evidence gleaned from questionnaires, interviews with participants and specific assessment/evaluation instruments indicates that ESITA program activities, including after-school meetings, summer and school year research projects, and conference preparations and presentations has provided students with high-quality inquiry science experiences that increased their knowledge of STEM and IT concepts, as well as their understanding of the nature of the scientific enterprise. In addition, the program has achieved a high degree of success in that it has: enhanced participants' intellectual self-confidence with regard to STEM; developed deeper appreciation of how scientific research can contribute to the maintenance of healthy local environments; developed a greater interest in participating in STEM-related courses of study and after school programs; and improved attitudes toward STEM. Overall

  8. 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…

  9. Determining Nurse Aide Staffing Requirements to Provide Care Based on Resident Workload: A Discrete Event Simulation Model.

    Science.gov (United States)

    Schnelle, John F; Schroyer, L Dale; Saraf, Avantika A; Simmons, Sandra F

    2016-11-01

    percentile based on resident ADL care needs and compare the simulated staffing projections to the NH reported staffing levels. The percentage of scheduled care time that was omitted was estimated by the simulation model for each of the 65 workload scenarios using optimistic assumptions about staff productivity and efficiency. There was a low correlation between ADL workload and reported nurse aide staffing (Pearson = .11; P < .01), which suggests that most of the 13,500 NHs were not using ADL acuity to determine nurse aide staffing levels. Based on the DES model, the nurse aide staffing required for ADL care that would result in a rate of care omissions below 10% ranged from 2.8 hours/resident/day for NHs with a low workload (5th percentile) to 3.6 hours/resident/day for NHs with a high workload (95th percentile). In contrast, NHs reported staffing levels that ranged from an average of 2.3 to 2.5 hours/resident/day across all 5 workload percentiles. Higher workload NHs had the largest discrepancies between reported and predicted nurse aide staffing levels. The average nurse aide staffing levels reported by NHs falls below the level of staffing predicted as necessary to provide consistent ADL care to all residents in need. DES methodology can be used to determine nurse aide staffing requirements to provide ADL care and simulate management interventions to improve care efficiency and quality. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  10. 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.

  11. Development and initial validation of primary care provider mental illness management and team-based care self-efficacy scales.

    Science.gov (United States)

    Loeb, Danielle F; Crane, Lori A; Leister, Erin; Bayliss, Elizabeth A; Ludman, Evette; Binswanger, Ingrid A; Kline, Danielle M; Smith, Meredith; deGruy, Frank V; Nease, Donald E; Dickinson, L Miriam

    Develop and validate self-efficacy scales for primary care provider (PCP) mental illness management and team-based care participation. We developed three self-efficacy scales: team-based care (TBC), mental illness management (MIM), and chronic medical illness (CMI). We developed the scales using Bandura's Social Cognitive Theory as a guide. The survey instrument included items from previously validated scales on team-based care and mental illness management. We administered a mail survey to 900 randomly selected Colorado physicians. We conducted exploratory principal factor analysis with oblique rotation. We constructed self-efficacy scales and calculated standardized Cronbach's alpha coefficients to test internal consistency. We calculated correlation coefficients between the MIM and TBC scales and previously validated measures related to each scale to evaluate convergent validity. We tested correlations between the TBC and the measures expected to correlate with the MIM scale and vice versa to evaluate discriminant validity. PCPs (n=402, response rate=49%) from diverse practice settings completed surveys. Items grouped into factors as expected. Cronbach's alphas were 0.94, 0.88, and 0.83 for TBC, MIM, and CMI scales respectively. In convergent validity testing, the TBC scale was correlated as predicted with scales assessing communications strategies, attitudes toward teams, and other teamwork indicators (r=0.25 to 0.40, all statistically significant). Likewise, the MIM scale was significantly correlated with several items about knowledge and experience managing mental illness (r=0.24 to 41, all statistically significant). As expected in discriminant validity testing, the TBC scale had only very weak correlations with the mental illness knowledge and experience managing mental illness items (r=0.03 to 0.12). Likewise, the MIM scale was only weakly correlated with measures of team-based care (r=0.09 to.17). This validation study of MIM and TBC self-efficacy scales

  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. Application of activity-based costing (ABC) for a Peruvian NGO healthcare provider.

    Science.gov (United States)

    Waters, H; Abdallah, H; Santillán, D

    2001-01-01

    This article describes the application of activity-based costing (ABC) to calculate the unit costs of the services for a health care provider in Peru. While traditional costing allocates overhead and indirect costs in proportion to production volume or to direct costs, ABC assigns costs through activities within an organization. ABC uses personnel interviews to determine principal activities and the distribution of individual's time among these activities. Indirect costs are linked to services through time allocation and other tracing methods, and the result is a more accurate estimate of unit costs. The study concludes that applying ABC in a developing country setting is feasible, yielding results that are directly applicable to pricing and management. ABC determines costs for individual clinics, departments and services according to the activities that originate these costs, showing where an organization spends its money. With this information, it is possible to identify services that are generating extra revenue and those operating at a loss, and to calculate cross subsidies across services. ABC also highlights areas in the health care process where efficiency improvements are possible. Conclusions about the ultimate impact of the methodology are not drawn here, since the study was not repeated and changes in utilization patterns and the addition of new clinics affected applicability of the results. A potential constraint to implementing ABC is the availability and organization of cost information. Applying ABC efficiently requires information to be readily available, by cost category and department, since the greatest benefits of ABC come from frequent, systematic application of the methodology in order to monitor efficiency and provide feedback for management. The article concludes with a discussion of the potential applications of ABC in the health sector in developing countries.

  17. 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

  18. 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...

  19. Research on Logistics Service Providers Selection Based on AHP and VIKOR

    Science.gov (United States)

    Shan, Lu

    The logistics service providers supply a kind of service which is a service product, thus there is a plenty of uncertainty and fuzzy in selecting logistics service providers. AHP is first used to calculate the weights of logistics services providers evaluations and then VIKOR method developed for multi-criteria optimization determining a compromise solution is applied to select the logistics services providers. The latter method provides a maximum "group utility" for the "majority" and minimum of an individual regret for the "opponent". This decision making process of logistics services providers selection is verified to be scientific and feasible through the empirical research.

  20. 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.

  1. Providing radiometric traceability for the calibration home base of DLR by PTB

    Energy Technology Data Exchange (ETDEWEB)

    Taubert, D. R.; Hollandt, J.; Sperfeld, P.; Pape, S.; Hoepe, A.; Hauer, K.-O. [Physikalisch-Technische Bundesanstalt, Braunschweig und Berlin, 10587 Berlin (Germany); Gege, P.; Schwarzmaier, T.; Lenhard, K.; Baumgartner, A. [Deutsches Zentrum fuer Luft- und Raumfahrt, Institut fuer Methodik der Fernerkundung, 82234 Oberpfaffenhofen (Germany)

    2013-05-10

    A dedicated calibration technique was applied for the calibration of the spectral radiance transfer standard (RASTA) of the German Aerospace Center (DLR) at the Physikalisch-Technische Bundesanstalt (PTB), consisting of two independent but complementing calibration procedures to provide redundancy and smallest possible calibration uncertainties. Procedure I included two calibration steps: In a first step the optical radiation source of RASTA, an FEL lamp, was calibrated in terms of its spectral irradiance E{sub {lambda}}({lambda}) in the wavelength range from 350 nm to 2400 nm using the PTB Spectral Irradiance Calibration Equipment (SPICE), while in a second step the spectral radiance factor {beta}{sub 0 Degree-Sign :45 Degree-Sign }({lambda}) of the RASTA reflection standard was calibrated in a 0 Degree-Sign :45 Degree-Sign -viewing geometry in the wavelength range from 350 nm to 1700 nm at the robot-based gonioreflectometer facility of PTB. The achieved relative standard uncertainties (k= 1) range from 0.6 % to 3.2 % and 0.1 % to 0.6 % respectively. Procedure II was completely independent from procedure I and allowed to cover the entire spectral range of RASTA from 350 nm to 2500 nm. In the second procedure, the 0 Degree-Sign :45 Degree-Sign -viewing geometry spectral radiance L{sub {lambda},0 Degree-Sign :45 Degree-Sign }({lambda}) of RASTA was directly calibrated at the Spectral Radiance Comparator Facility (SRCF) of PTB. The relative uncertainties for this calibration procedure range from 0.8 % in the visible up to 7.5 % at 2500 nm (k= 1). In the overlapping spectral range of both calibration procedures the calculated spectral radiance L{sub {lambda},0 Degree-Sign :45 Degree-Sign ,calc}({lambda}) from procedure I is in good agreement with the direct measurement of procedure II, i.e. well within the combined expanded uncertainties (k= 2) of both procedures.

  2. Knowledge and Use of Intervention Practices by Community-Based Early Intervention Service Providers

    Science.gov (United States)

    Paynter, Jessica M.; Keen, Deb

    2015-01-01

    This study investigated staff attitudes, knowledge and use of evidence-based practices (EBP) and links to organisational culture in a community-based autism early intervention service. An EBP questionnaire was completed by 99 metropolitan and regionally-based professional and paraprofessional staff. Participants reported greater knowledge and use…

  3. 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

  4. 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.

  5. 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.

  6. 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…

  7. Automated topic spotting provides added efficiency in a chat based tutoring environment

    CSIR Research Space (South Africa)

    Butgereit, L

    2012-05-01

    Full Text Available Dr Math is a mobile, online tutoring project which allows primary and secondary school pupils to contact tutors in mathematics using text based chat systems on their cell phones. The tutors use traditional Internet based workstations. Dr Math...

  8. 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.…

  9. 44 CFR 65.14 - Remapping of areas for which local flood protection systems no longer provide base flood protection.

    Science.gov (United States)

    2010-10-01

    ... local flood protection systems no longer provide base flood protection. 65.14 Section 65.14 Emergency... § 65.14 Remapping of areas for which local flood protection systems no longer provide base flood... process of restoring a flood protection system that was: (i) Constructed using Federal funds; (ii...

  10. Geodatabase of environmental information for Air Force Plant 4 and Naval Air Station-Joint Reserve Base Carswell Field, Fort Worth, Texas, 1990-2004

    Science.gov (United States)

    Shah, Sachin D.; Quigley, Sean M.

    2005-01-01

    Air Force Plant 4 (AFP4) and adjacent Naval Air Station-Joint Reserve Base (NAS-JRB) at Fort Worth, Tex., constitute a government-owned, contractor-operated (GOCO) facility that has been in operation since 1942. Contaminants from the facility, primarily volatile organic compounds (VOCs) and metals, have entered the groundwater-flow system through leakage from waste-disposal sites (landfills and pits) and from manufacturing processes (U.S. Air Force, Aeronautical Systems Center, 1995). The U.S. Geological Survey (USGS), in cooperation with the U.S. Air Force (USAF), Aeronautical Systems Center, Environmental Management Directorate (ASC/ENVR), developed a comprehensive database (or geodatabase) of temporal and spatial environmental information associated with the geology, hydrology, and water quality at AFP4 and NAS-JRB. The database of this report provides information about the AFP4 and NAS-JRB study area including sample location names, identification numbers, locations, historical dates, and various measured hydrologic data. This database does not include every sample location at the site, but is limited to an aggregation of selected digital and hardcopy data of the USAF, USGS, and various consultants who have previously or are currently working at the site.

  11. Performance Comparison of Reservation Based and Instant Access One-Way Car Sharing Service through Discrete Event Simulation

    Directory of Open Access Journals (Sweden)

    Ganjar Alfian

    2015-09-01

    Full Text Available A car sharing service has been highlighted as a new urban transport alternative for an environmentally friendly economy. As the demand for the service from customers increases, car sharing operators need to introduce a new service such as a one-way option that will allow customers to return the car to different stations. Due to the complexity of the one-way system, it needs to be managed and optimized for real cases. This paper focuses on developing a simulation model in order to help operators evaluate the performance of the one-way service. In addition, this research demonstrates a strategy for an open one-way service that can increase revenue and customer satisfaction. A real case dataset is used for investigation to find the best result from the simulation. The result showed that the total number of cars, number of one-way reservations and station size have an impact on one-way performance. Thus, company profit and customer satisfaction can be maximized by optimizing these factors.

  12. 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.

  13. Thyroid autoimmunity, hypothyroidism and ovarian reserve: a cross-sectional study of 5000 women based on age-specific AMH values.

    Science.gov (United States)

    Polyzos, Nikolaos P; Sakkas, Evangelos; Vaiarelli, Alberto; Poppe, Kris; Camus, Michel; Tournaye, Herman

    2015-07-01

    .8 versus 1.6%, P = 0.004, respectively). On the contrary, no significant differences were observed in the prevalence of hypothyroidism between genetic causes and iatrogenic causes (P = 0.316) and between iatrogenic and unexplained causes (P = 0.219) of low ovarian reserve. This is a cross-sectional analysis based on retrospective data collection. Due to the retrospective design of this study, the presence of biases related to such a study design cannot be excluded. Furthermore, this study assessed only the association of TAI, and not autoimmunity in general, with ovarian reserve. TAI and hypothyroidism are not associated with low ovarian reserve. Future research should focus on examining underlying mechanisms, other than TAI, which may have an effect on ovarian reserve. No external funding was used for this study. No conflicts of interest are declared. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  14. An open-loop, physiologic model-based decision support system can provide appropriate ventilator settings

    DEFF Research Database (Denmark)

    Karbing, Dan Stieper; Spadaro, Savino; Dey, Nilanjan

    2018-01-01

    OBJECTIVES: To evaluate the physiologic effects of applying advice on mechanical ventilation by an open-loop, physiologic model-based clinical decision support system. DESIGN: Prospective, observational study. SETTING: University and Regional Hospitals' ICUs. PATIENTS: Varied adult ICU population...

  15. Agricultural implications of providing soil-based constraints on urban expansion: Land use forecasts to 2050.

    Science.gov (United States)

    Smidt, Samuel J; Tayyebi, Amin; Kendall, Anthony D; Pijanowski, Bryan C; Hyndman, David W

    2018-07-01

    Urbanization onto adjacent farmlands directly reduces the agricultural area available to meet the resource needs of a growing society. Soil conservation is a common objective in urban planning, but little focus has been placed on targeting soil value as a metric for conservation. This study assigns commodity and water storage values to the agricultural soils across all of the watersheds in Michigan's Lower Peninsula to evaluate how cities might respond to a soil conservation-based urbanization strategy. Land Transformation Model (LTM) simulations representing both traditional and soil conservation-based urbanization, are used to forecast urban area growth from 2010 to 2050 at five year intervals. The expansion of urban areas onto adjacent farmland is then evaluated to quantify the conservation effects of soil-based development. Results indicate that a soil-based protection strategy significantly conserves total farmland, especially more fertile soils within each soil type. In terms of revenue, ∼$88 million (in current dollars) would be conserved in 2050 using soil-based constraints, with the projected savings from 2011 to 2050 totaling more than $1.5 billion. Soil-based urbanization also increased urban density for each major metropolitan area. For example, there were 94,640 more acres directly adjacent to urban land by 2050 under traditional development compared to the soil-based urbanization strategy, indicating that urban sprawl was more tightly contained when including soil value as a metric to guide development. This study indicates that implementing a soil-based urbanization strategy would better satisfy future agricultural resource needs than traditional urban planning. Copyright © 2018. Published by Elsevier Ltd.

  16. 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.

  17. 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

  18. US uranium reserves

    International Nuclear Information System (INIS)

    Hansen, M.V.

    1981-01-01

    The current low level of demand, compounded by rapidly rising costs and low prices, has caused a significant reduction in drilling for uranium in the United States, and the trend is likely to continue for a few more years. The effect on uranium reserves will be fewer additions to reserves because less exploration is being done. Further reductions will occur, especially in low-cost reserves, because of increasing costs, continuing depletion through production, and erosion through the high grading of deposits to fulfill previous contractual commitments. During the past several years, it has been necessary to increase the upper reserve cost level twice to compensate for rising costs. Rising costs are reducing the $15 reserves, the cost category corresponding most closely to the present market price, to an insignificant level. An encouraging factor related to US uranium reserves is that the US position internationally, as far as quantity is concerned, is not bad for the longer term. Also, there is a general opinion that US consumers would rather contract for domestic uranium than for foreign because of greater assurance of supply. Still another factor, nearly impossible to assess, is what effect rising costs in other countries will have on their uranium reserves. The annual conferences between the Grand Junction Area Office staff and major uranium companies provide a broad overview of the industry's perception of the future. It is not optimistic for the short term. Many companies are reducing their exploration and mining programs; some are switching to other more marketable mineral commodities, and a few are investing more heavily in foreign ventures. However, there is general optimism for the long term, and many predict a growth in demand in the mid-1980s. If the industry can survive the few lean years ahead, rising prices may restore its viability to former levels

  19. Final Environmental Assessment Realignment of Jenkins Armed Forces Reserve Center (AFRC), Kirtland Air Force Base, New Mexico, BRAC 2005

    Science.gov (United States)

    2007-05-01

    cryptoleucus Northern mockingbird Mimus polyglottos Black-throated sparrow Amphispiza bilineata Eastern meadowlark Sturnella magna House finch...Americans- and ealii~ kills 5,000 each year. :ses1 The network combines nub lie e sJ\\ awareness with an Internet- based information service and -qnd...scientists agree that p;roper cooking · will kill HEAL:: s most kinds of harmful bacteria, nobody is convinced that the bulk of consumers know what

  20. Activity-based funding model provides foundation for province-wide best practices in renal care.

    Science.gov (United States)

    Levin, Adeera; Lo, Clifford; Noel, Kevin; Djurdjev, Ogjnenka; Amano, Erlyn C

    2013-01-01

    British Columbia has a unique funding model for renal care in Canada. Patient care is delivered through six health authorities, while funding is administered by the Provincial Renal Agency using an activity-based funding model. The model allocates funding based on a schedule of costs for every element of renal care, excluding physician fees. Accountability, transparency of allocation and tracking of outcomes are key features that ensure successful implementation. The model supports province-wide best practices and equitable care and fosters innovation. Since its introduction, the outpatient renal services budget has grown less than the population, while maintaining or improving clinical outcomes. Copyright © 2013 Longwoods Publishing.

  1. Utilization of services provided by village based ethnic minority midwives in mountainous villages of Vietnam

    Directory of Open Access Journals (Sweden)

    Doan DTT

    2016-10-01

    Full Text Available Doan Thi Thuy Duong,1 Bui Thi Thu Ha,1 Le Minh Thi,1 Duong Minh Duc,1 Luu Thi Hong,2 Tuan Anh Dinh,2 Tolib Mirzoev3 1Department of Reproductive Health, Hanoi School of Public Health, 2Department of Maternal and Child Health, Ministry of Health, Hanoi, Vietnam; 3Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK Introduction: Since 2011, the Vietnam’s Ministry of Health implemented the ethnic minority midwives (EMMs scheme in order to increase the utilization of maternal health services by women from ethnic minorities and those living in hard-to-reach mountainous areas. This paper analyzes the utilization of antenatal, delivery, and postpartum care provided by EMMs and reports the key determinants of utilization of EMM services as perceived by service users. Methods: A structured questionnaire was administered in 2015 to all mothers (n=320 who gave birth to a live-born during a 1-year period in 31 villages which had EMM in two provinces, Dien Bien and Kon Tum. A multivariate logistic regression model was used to examine the association between all potential factors and the use of services provided by EMMs. Results: We found that EMMs provided more antenatal care and postnatal care as compared with delivery services, which corresponded to their job descriptions. The results also showed that utilization of antenatal care provided by EMMs was lower than that of postnatal care. The proportion of those who never heard about EMM was high (24%. Among the mothers who knew about EMM services, 33.4% had antenatal checkups, 20.1% were attended during home deliveries, and 57.3% had postnatal visits by an EMM. Key factors that determined the use of EMM services included knowledge of the location of EMM’s house, being aware about EMMs by health workers, trust in services provided by EMMs, and perception that many others mothers in a village also knew about EMM services. Conclusion

  2. The impacts of DRG-based payments on health care provider behaviors under a universal coverage system: a population-based study.

    Science.gov (United States)

    Cheng, Shou-Hsia; Chen, Chi-Chen; Tsai, Shu-Ling

    2012-10-01

    To examine the impacts of diagnosis-related group (DRG) payments on health care provider's behavior under a universal coverage system in Taiwan. This study employed a population-based natural experiment study design. Patients who underwent coronary artery bypass graft surgery or percutaneous transluminal coronary angioplasty, which were incorporated in the Taiwan version of DRG payments in 2010, were defined as the intervention group. The comparison group consisted of patients who underwent cardiovascular procedures which were paid for by fee-for-services schemes and were selected by propensity score matching from patients treated by the same group of surgeons. The generalized estimating equations model and difference-in-difference analysis was used in this study. The introduction of DRG payment resulted in a 10% decrease (pDRG-based payment resulted in reduced intensity of care and shortened length of stay. The findings might be valuable to other countries that are developing or reforming their payment system under a universal coverage system. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  3. 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...

  4. Violence Prevention and Students with Disabilities: Thinking Functionally and Providing Evidence Based Supports and Accommodations

    Science.gov (United States)

    Rosenberg, Michael S.

    2012-01-01

    Students with disabilities who engage in high rates of challenging behaviors require educators who employ function-based thinking and have a particular sensitivity to the wide range of factors that influence student behavior. In essence, educators working with special needs students need to know what makes their instruction "special"; they must…

  5. 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

  6. 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.

  7. Inquiry-based Investigation in Biology Laboratories: Does Neem Provide Bioprotection against Bean Beetles?

    Science.gov (United States)

    Pearce, Amy R.; Sale, Amanda Lovelace; Srivatsan, Malathi; Beck, Christopher W.; Blumer, Lawrence S.; Grippo, Anne A.

    2013-01-01

    We developed an inquiry-based biology laboratory exercise in which undergraduate students designed experiments addressing whether material from the neem tree ("Azadirachta indica") altered bean beetle ("Callosobruchus maculatus") movements and oviposition. Students were introduced to the bean beetle life cycle, experimental…

  8. Australian Rural Accountants' Views on How Locally Provided CPD Compares with City-Based Provision

    Science.gov (United States)

    Halabi, Abdel K.

    2015-01-01

    This paper analyses Australian rural accountants' attitudes and levels of satisfaction with continuing professional development (CPD), based on whether the CPD was delivered by a professional accounting body in a rural or metropolitan area. The paper responds to prior research that finds rural accountants are dissatisfied with professional…

  9. 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

    2016-02-10

    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. Programme leaders of 30 hospital-based forensic nursing-led sexual assault and domestic violence treatment centres. 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. 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. 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 that are considering the provision of a dedicated response to the abuse of older women and men

  10. [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.

  11. Evaluating the Implementation of Home-Based Videoconferencing for Providing Mental Health Services.

    Science.gov (United States)

    Interian, Alejandro; King, Arlene R; St Hill, Lauren M; Robinson, Claire H; Damschroder, Laura J

    2018-01-01

    The Veterans Health Administration (VHA) has recently implemented video-to-home (V2H) telehealth as part of a strategy to improve access to mental health treatment. Implementation research of this modality is needed, given that V2H telehealth transforms the traditional face-to-face delivery of mental health services. To address this need, V2H implementation was evaluated by examining barriers and facilitators that were associated with level of staff V2H experience and factors that differentiated facilities with various levels of V2H performance. Semistructured interviews with VHA personnel (N=33) from three facilities were conducted. The facilities were selected by overall number of mental health V2H visits during fiscal year (FY) 2015 as well as by growth in number of visits from FY 2014 through FY 2015. Factors influencing implementation were identified through qualitative analyses that contrasted responses by groups of participants with three different levels of V2H experience (no experience, limited experience, most experience) as well as three facilities that differed in V2H productivity (high visit count, high visit growth, and low visit count and low visit growth). Providers seemed to encounter different barriers and facilitators depending on their level of experience with V2H. Site-level analyses illustrated the importance of logistical support, especially for providers who are newly adopting the technology. Other factors that differentiated the facilities were also identified and described. Key factors related to implementation of V2H telehealth pertained to provider buy-in and logistical support. Facility-level strategies that address these factors may enhance provider progression from nonuse to sustained use.

  12. Development of Web-Based Remote Desktop to Provide Adaptive User Interfaces in Cloud Platform

    OpenAIRE

    Shuen-Tai Wang; Hsi-Ya Chang

    2014-01-01

    Cloud virtualization technologies are becoming more and more prevalent, cloud users usually encounter the problem of how to access to the virtualized remote desktops easily over the web without requiring the installation of special clients. To resolve this issue, we took advantage of the HTML5 technology and developed web-based remote desktop. It permits users to access the terminal which running in our cloud platform from anywhere. We implemented a sketch of web interfac...

  13. 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,…

  14. 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.

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

    Science.gov (United States)

    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

    2015-01-01

    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. Fragment-based drug discovery is a target-based approach that typically involves the screening of a relatively small number of fragment-like (molecular weight <300) molecules that efficiently cover chemical space. Here, we report a fragment screening on TbrPDEB1, an essential cyclic nucleotide phosphodiesterase (PDE) from Trypanosoma brucei, and human PDE4D, an off-target, in a workflow in which fragment hits and a series of close analogs are subsequently screened for antiparasitic activity in a phenotypic panel. The phenotypic panel contained T. brucei, Trypanosoma cruzi, Leishmania infantum, and Plasmodium falciparum, the causative agents of human African trypanosomiasis (sleeping sickness), Chagas disease, leishmaniasis, and malaria, respectively, as well as MRC-5 human lung cells. This hybrid screening workflow has resulted in the discovery of various benzhydryl ethers with antiprotozoal activity and low toxicity, representing interesting starting points for further antiparasitic optimization. © 2014 Society for Laboratory Automation and Screening.

  16. 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

  17. 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

  18. 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

  19. 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

  20. Performance, body fat reserves and plasma metabolites in Brown Swiss dairy cows: Indoor feeding versus pasture-based feeding.

    Science.gov (United States)

    Frey, H-J; Gross, J J; Petermann, R; Probst, S; Bruckmaier, R M; Hofstetter, P

    2018-04-01

    Feeding dairy cows indoors or on pasture affects not only labour, machinery and housing costs, but also animals' performance and metabolism. This study investigates the effects of indoor feeding (IF) with a partial-mixed ration (PMR) versus pasture-based feeding (PF) on milk production, fertility, backfat thickness (BFT), body weight (BW) loss and energy metabolism of Brown Swiss (BS) dairy cows with similar genetic production potential. The IF herd consisted of 13 cows fed a PMR composed of maize and grass silage plus protein concentrate according to each cow's requirements. The PF herd consisted of 14 cows offered barn-ventilated hay ad libitum after calving from January until March and grazed on semi-continuous pastures during the vegetation period. The IF cows produced more energy-corrected milk (ECM) per standard lactation (9,407 vs. 5,960 kg; p dairy cows in our trial seem to have a high capacity for metabolic adaptation to different production systems. © 2017 Blackwell Verlag GmbH.

  1. 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

  2. Preparing for fieldwork: Students' perceptions of their readiness to provide evidence-based practice.

    Science.gov (United States)

    Evenson, Mary E

    2013-01-01

    The purpose of this study was to explore students' perceptions of their confidence to use research evidence to complete a client case analysis assignment in preparation for participation in fieldwork and future practice. A convenience sample of 42 entry-level occupational therapy Masters students, included 41 females and one male, ages 24 to 35. A quasi-experimental pretest-posttest design was used. Students participated in a problem-based learning approach supported by educational technology. Measures included a pre- and post-semester confidence survey, a post-semester satisfaction survey, and an assignment rubric. Based on paired t-tests and Wilcoxin Signed Ranks Tests, statistically significant differences in pre- and post-test scores were noted for all 18 items on the confidence survey (plearning methods were significantly associated with students' perceptions of their confidence to use research evidence to analyze a client case. These results cannot necessarily be generalized due to the limitations of using non-standardized measures with a convenience sample, without a control group, within the context of a single course as part of one academic program curriculum.

  3. Providing a New Model for Discovering Cloud Services Based on Ontology

    Directory of Open Access Journals (Sweden)

    B. Heydari

    2017-12-01

    Full Text Available Due to its efficient, flexible, and dynamic substructure in information technology and service quality parameters estimation, cloud computing has become one of the most important issues in computer world. Discovering cloud services has been posed as a fundamental issue in reaching out high efficiency. In order to do one’s own operations in cloud space, any user needs to request several various services either simultaneously or according to a working routine. These services can be presented by different cloud producers or different decision-making policies. Therefore, service management is one of the important and challenging issues in cloud computing. With the advent of semantic web and practical services accordingly in cloud computing space, access to different kinds of applications has become possible. Ontology is the core of semantic web and can be used to ease the process of discovering services. A new model based on ontology has been proposed in this paper. The results indicate that the proposed model has explored cloud services based on user search results in lesser time compared to other models.

  4. 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.

  5. 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.

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

    Science.gov (United States)

    Moran, John L; Solomon, Patricia J

    2010-04-19

    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. 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,(maximum)1]), via the econometric technique of stochastic frontier analysis. For each descriptor, multivariate correlation-relationships between indices and summed mortality probability were determined. 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 (>or= 7.8 days) and TE (>or= 0.74) were maximal in tertiary-ICUs. For non-survivors, AUC was maximal in tertiary-ICUs, but TMAX (>or= 4.2 days) and TE (>or= 0.69) were maximal in for-profit ICUs. Across descriptors, significant differences in indices were demonstrated (analysis-of-variance, P variance, for survivors (0.89) and non-survivors (0.89), was maximized by combinations of indices demonstrating a low correlation with

  7. 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

  8. Strontium isotopes provide clues for a process shift in base cation dynamics in young volcanic soils

    Science.gov (United States)

    Bingham, N.; Jackson, M. G.; Bookhagen, B.; Maher, K.; Chadwick, O.

    2015-12-01

    Despite advances in soil development theory based on studies of old soils or over long timescales, little is known about soil thresholds (dramatic changes in soil properties associated with only small shifts in external forcing factors) that might be expressed in young soils (less than 10 kyr). Therefore, we seek to understand infant soil development in a tropical environment through the sourcing of plant available base cations by measuring the strontium (Sr) isotopic composition of the soil exchange complex. Our sampling strategy spans soils in three different precipitation ranges (950-1060 mm, 1180-1210 mm, and 1450-1500) and an array of soil ages from 500 to 7500 years in the Kona region on the island of Hawaii. In Hawaiian soils, 87Sr/86Sr values are determined by a mixture of three components: a mantle-derived component from the lava (0.7034), a rainfall component (0.7093) and a component from continental dust (0.720). Elevation-controlled leaching intensity in the wettest localities produces a decline in the concentration of base cations supplied by basalt and a dilute resupply by rainfall. In the driest sites, where leaching intensity is dramatically reduced, there is a buildup of rainfall-derived extractable Sr in the soil over time. Slow rock weathering rates produce a small rock-derived cation input to the soil. Thus, Sr isotope signatures reflect both the input of rainfall-derived cations and rock-derived cations with values that fall between rainfall and basaltic signatures. Soils in the intermediate precipitation range have Sr isotopic signatures consistent with both the wet and dry trends; suggesting that they lie close to the critical precipitation amount that marks a shift between these two processes. For the Kona region, this transition seems to occur at 1200 mm /yr. In contrast to the clear-cut differentiation in strontium isotopes with precipitation shifts observed in older soils, patterns on these young soils in Kona are complicated by low soil

  9. 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...

  10. Assessing the effects of marine protected area (MPA) on a reef fish assemblage in a northwestern Mediterranean marine reserve: Identifying community-based indicators

    OpenAIRE

    Claudet, Joachim; Pelletier, Dominique; Jouvenel, J.y; Bachet, F; Galzin, R

    2006-01-01

    Marine protected areas (MPAs) are increasingly envisaged as a tool to manage coastal ecosystems and fisheries. Assessment of their performance with respect to management objectives is therefore important. A number of WAS provided conservation benefits for fished species. Observed benefits do not apply to all species at all times, and responses to protection are also highly variable among fish taxa. Among the many empirical studies on marine reserves, only a few designs considered 'before and ...

  11. 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.

  12. Method of App Selection for Healthcare Providers Based on Consumer Needs.

    Science.gov (United States)

    Lee, Jisan; Kim, Jeongeun

    2018-01-01

    Mobile device applications can be used to manage health. However, healthcare providers hesitate to use them because selection methods that consider the needs of health consumers and identify the most appropriate application are rare. This study aimed to create an effective method of identifying applications that address user needs. Women experiencing dysmenorrhea and premenstrual syndrome were the targeted users. First, we searched for related applications from two major sources of mobile applications. Brainstorming, mind mapping, and persona and scenario techniques were used to create a checklist of relevant criteria, which was used to rate the applications. Of the 2784 applications found, 369 were analyzed quantitatively. Of those, five of the top candidates were evaluated by three groups: application experts, clinical experts, and potential users. All three groups ranked one application the highest; however, the remaining rankings differed. The results of this study suggest that the method created is useful because it considers not only the needs of various users but also the knowledge of application and clinical experts. This study proposes a method for finding and using the best among existing applications and highlights the need for nurses who can understand and combine opinions of users and application and clinical experts.

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

    KAUST Repository

    Ghaffar, Farhan A.; Shamim, Atif

    2015-01-01

    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. 42 CFR 413.65 - Requirements for a determination that a facility or an organization has provider-based status.

    Science.gov (United States)

    2010-10-01

    ... provider-based status maintains a reporting relationship with the chief medical officer or other similar... adjacent to the provider's main buildings, other areas and structures that are not strictly contiguous to the main buildings but are located within 250 yards of the main buildings, and any other areas...

  15. 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.

  16. 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.

  17. 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

  18. 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.

  19. 18 CFR 284.505 - Market-based rates for storage providers without a market-power determination.

    Science.gov (United States)

    2010-04-01

    ... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Market-based rates for storage providers without a market-power determination. 284.505 Section 284.505 Conservation of Power and... UNDER THE NATURAL GAS POLICY ACT OF 1978 AND RELATED AUTHORITIES Applications for Market-Based Rates for...

  20. The Relationship of Adverse Childhood Experiences to PTSD, Depression, Poly-Drug Use and Suicide Attempt in Reservation-Based Native American Adolescents and Young Adults.

    Science.gov (United States)

    Brockie, Teresa N; Dana-Sacco, Gail; Wallen, Gwenyth R; Wilcox, Holly C; Campbell, Jacquelyn C

    2015-06-01

    Adverse childhood experiences (ACEs) are associated with numerous risk behaviors and mental health outcomes among youth. This study examines the relationship between the number of types of exposures to ACEs and risk behaviors and mental health outcomes among reservation-based Native Americans. In 2011, data were collected from Native American (N = 288; 15-24 years of age) tribal members from a remote plains reservation using an anonymous web-based questionnaire. We analyzed the relationship between six ACEs, emotional, physical, and sexual abuse, physical and emotional neglect, witness to intimate partner violence, for those drug use, and suicide attempt. Seventy-eight percent of the sample reported at least one ACE and 40 % reported at least two. The cumulative impact of the ACEs were significant (p suicide attempt (37 %), poly-drug use (51 %), PTSD symptoms (55 %), and depression symptoms (57 %). To address these findings culturally appropriate childhood and adolescent interventions for reservation-based populations must be developed, tested and evaluated longitudinally.

  1. 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

  2. Individualized FSH dosing based on ovarian reserve testing in women starting IVF/ICSI: a multicentre trial and cost-effectiveness analysis

    OpenAIRE

    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.

    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 does not improve live birth rates or reduce costs as compared to a standard FSH dose. WHAT IS KNOWN ALREADY: In IVF or ICSI, ovarian reserve testing is often used to adjust the FSH dose in order to no...

  3. Providers' perspectives of factors influencing implementation of evidence-based treatments in a community mental health setting: A qualitative investigation of the training-practice gap.

    Science.gov (United States)

    Marques, Luana; Dixon, Louise; Valentine, Sarah E; Borba, Christina P C; Simon, Naomi M; Wiltsey Stirman, Shannon

    2016-08-01

    This study aims to elucidate relations between provider perceptions of aspects of the consolidated framework for implementation research (Damschroder et al., 2009) and provider attitudes toward the implementation of evidence-based treatments (EBTs) in an ethnically diverse community health setting. Guided by directed content analysis, we analyzed 28 semistructured interviews that were conducted with providers during the pre-implementation phase of a larger implementation study for cognitive processing therapy for posttraumatic stress disorder (Resick et al., 2008). Our findings extend the existing literature by also presenting provider-identified client-level factors that contribute to providers' positive and negative attitudes toward EBTs. Provider-identified client-level factors include the following: client motivation to engage in treatment, client openness to EBTs, support networks of family and friends, client use of community and government resources, the connection and relationship with their therapist, client treatment adherence, client immediate needs or crises, low literacy or illiteracy, low levels of education, client cognitive limitations, and misconceptions about therapy. These results highlight the relations between provider perceptions of their clients, provider engagement in EBT training, and subsequent adoption of EBTs. We present suggestions for future implementation research in this area. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  4. 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

  5. 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.

  6. Development of a web-based pharmaceutical care plan to facilitate collaboration between healthcare providers and patients

    Directory of Open Access Journals (Sweden)

    Marlies ME Geurts

    2014-02-01

    Full Text Available Background To facilitate collaboration between different healthcare providers and to exchange patient data we developed a paper-based tool, which also enabled to plan interventions and follow-up activities: the PCP. Interviews with participating healthcare providers concluded the PCP was a very useful tool to collect and share patient data. A disadvantage was the time spent to collect all information. We therefore developed our PCP into a web-based tool: the web-based PCP (W-PCP.Objectives Development of a W-PCP to (1 provide healthcare providers with information from pharmacist- and GP computer systems and (2 facilitate collaboration between healthcare providers and patients.Method The W-PCP was used in three research lines, two in primary care and one in a hospital setting. Outcomes measures were defined as satisfaction about efficiency and effectiveness during data sharing and documentation in providing care and conducting medication reviews using the W-PCP.First experiences concerning the use of W-PCP in a primary care setting were collected by a questionnaire and interviews with pharmacists and GPs using the W-PCP.Results A questionnaire was sent to 38 healthcare providers. 17 healthcare providers returned the questionnaire. The use of W-PCP resulted in positive experiences from participating healthcare providers. On the basis of experiences and requirements collected, the application will be further developed.Conclusions The W-PCP application can potentially support successful collaboration between different healthcare providers and patients, which is important for medication therapy management. With this application, a successful collaboration between different healthcare providers and patients could be achieved.

  7. 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)

  8. 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 <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.

  9. 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

    2014-02-01

    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 subdisciplines (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. PsycINFO Database Record (c) 2014 APA, all rights reserved.

  10. Replacing reserve requirements

    OpenAIRE

    Edward J. Stevens

    1993-01-01

    An examination of the fading significance of the Federal Reserve System's reserve requirements and the recent flowering of required clearing balances, a rapidly growing feature of Reserve Bank operations.

  11. 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....... Applying person-centredness in practice requires continuous training and supervision, but HCPs often have minimum support for developing person-centred communication skills. Techniques based on motivational communication, psychosocial methods and facilitating group processes are effective person...

  12. Provider-agency fit in substance abuse treatment organizations: implications for learning climate, morale, and evidence-based practice implementation.

    Science.gov (United States)

    Ramsey, Alex T; van den Berk-Clark, Carissa

    2015-05-12

    Substance abuse agencies have been slow to adopt and implement evidence-based practices (EBPs), due in part to poor provider morale and organizational climates that are not conducive to successful learning and integration of these practices. Person-organization fit theory suggests that alignment, or fit, between provider- and agency-level characteristics regarding the implementation of EBPs may influence provider morale and organizational learning climate and, thus, implementation success. The current study hypothesized that discrepancies, or lack of fit, between provider- and agency-level contextual factors would negatively predict provider morale and organizational learning climate, outcomes shown to be associated with successful EBP implementation. Direct service providers (n = 120) from four substance abuse treatment agencies responded to a survey involving provider morale, organizational learning climate, agency expectations for EBP use, agency resources for EBP use, and provider attitudes towards EBP use. Difference scores between combinations of provider- and agency-level factors were computed to model provider-agency fit. Quadratic regression analyses were conducted to more adequately and comprehensively model the level of the dependent variables across the entire "fit continuum". Discrepancies, or misfit, between agency expectations and provider attitudes and between agency resources and provider attitudes were associated with poorer provider morale and weaker organizational learning climate. For all hypotheses, the curvilinear model of provider-agency discrepancies significantly predicted provider morale and organizational learning climate, indicating that both directions of misfit (provider factors more favorable than agency factors, and vice-versa) were detrimental to morale and climate. However, outcomes were most negative when providers viewed EBPs favorably, but perceived that agency expectations and resources were less supportive of EBP use. The

  13. Individualized FSH dosing based on ovarian reserve testing in women starting IVF/ICSI: a multicentre trial and cost-effectiveness analysis.

    Science.gov (United States)

    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

    2017-12-01

    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? In women initiating IVF/ICSI, AFC-based individualized FSH dosing does not improve live birth rates or reduce costs as compared to a standard FSH dose. In IVF or ICSI, ovarian reserve testing is often used to adjust the FSH dose in order to normalize ovarian response and optimize live birth rates. However, no robust evidence for the (cost-)effectiveness of this practice exists. Between May 2011 and May 2014 we performed a multicentre prospective cohort study with two embedded RCTs in women scheduled for IVF/ICSI. Based on the AFC, women entered into one of the two RCTs (RCT1: AFC 15) or the cohort (AFC 11-15). The primary outcome was ongoing pregnancy achieved within 18 months after randomization resulting in a live birth (delivery of at least one live foetus after 24 weeks of gestation). Data from the cohort with weight 0.5 were combined with both RCTs in order to conduct a strategy analysis. Potential half-integer numbers were rounded up. Differences in costs and effects between the two treatment strategies were compared by bootstrapping. In both RCTs women were randomized to an individualized (RCT1:450/225 IU, RCT2:100 IU) or standard FSH dose (150 IU). Women in the cohort all received the standard dose (150 IU). Anti-Müllerian hormone (AMH) was measured to assess AMH post-hoc as a biomarker to individualize treatment. For RCT1 dose adjustment was allowed in subsequent cycles based on pre-specified criteria in the standard group only. For RCT2 dose adjustment was allowed in subsequent cycles in both groups. Both effectiveness and cost-effectiveness of the strategies were evaluated from an intention-to-treat perspective. We included 1515 women, of whom 483 (31.9%) entered the cohort, 511 (33.7%) RCT1 and 521 (34.4%) RCT2. Live births occurred in 420/747 (56.3%) women

  14. Windowed correlation: a suitable tool for providing dynamic fMRI-based functional connectivity neurofeedback on task difficulty.

    Directory of Open Access Journals (Sweden)

    Anna Zilverstand

    Full Text Available The goal of neurofeedback training is to provide participants with relevant information on their ongoing brain processes in order to enable them to change these processes in a meaningful way. Under the assumption of an intrinsic brain-behavior link, neurofeedback can be a tool to guide a participant towards a desired behavioral state, such as a healthier state in the case of patients. Current research in clinical neuroscience regarding the most robust indicators of pathological brain processes in psychiatric and neurological disorders indicates that fMRI-based functional connectivity measures may be among the most important biomarkers of disease. The present study therefore investigated the general potential of providing fMRI neurofeedback based on functional correlations, computed from short-window time course data at the level of single task periods. The ability to detect subtle changes in task performance with block-wise functional connectivity measures was evaluated based on imaging data from healthy participants performing a simple motor task, which was systematically varied along two task dimensions representing two different aspects of task difficulty. The results demonstrate that fMRI-based functional connectivity measures may provide a better indicator for an increase in overall (motor task difficulty than activation level-based measures. Windowed functional correlations thus seem to provide relevant and unique information regarding ongoing brain processes, which is not captured equally well by standard activation level-based neurofeedback measures. Functional connectivity markers, therefore, may indeed provide a valuable tool to enhance and monitor learning within an fMRI neurofeedback setup.

  15. 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…

  16. 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...

  17. 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).

  18. 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.

  19. HIV prevention among street-based sex workers (SSWs) in Chongqing, China: interviews with SSWs, clients and healthcare providers.

    Science.gov (United States)

    Zeng, Huan; Zhang, Lei; Zhao, Yong; Liu, Hui; Guo, Hang; Wang, Yang; Zhang, Zhen; Mao, Limin

    2016-11-01

    Street-based female sex workers (SSWs) are subjected to a relatively high risk of HIV transmission, even higher than establishment-based female sex workers in China. However, very few HIV intervention programmes have targeted this particular group to date. Based in Southwest China, this study aims to identify perceived barriers, demands and suggestions on HIV prevention from the perspectives of SSWs, clients and healthcare providers in Chongqing. Face-to-face, in-depth interviews were conducted in July 2008 with 23 participants. They were recruited by purposive, convenience sampling and included 12 SSWs, 5 male clients, 4 government healthcare providers and 2 outreach workers from a community-based non-governmental organisation. Thematic analysis was used. SSWs were largely rural-to-urban migrants with a low socioeconomic status. Most of their clients shared a similar background. Both SSWs and their clients demonstrated a low awareness of HIV infection and a lack of understanding of effective preventive strategies. Financial hardships, lack of family support, fear of police arrest and stigma in relation to sex work were identified as SSWs' major barriers for accessing healthcare services. Both SSWs and their clients indicated an urgent demand for accessing adequate HIV prevention and care programmes. On the other hand, government organisations trying to provide services to this group have also encountered obstacles, specifically their limited ability to establish mutual trust. Programmes provided by community-based non-governmental organisation, however, were perceived to be more attractive. In conclusion, there remains a substantial gap between the need of adequate HIV prevention services for SSWs and their clients and what is currently available. Strengthening inter-sectoral collaboration, providing specifically tailored health services, actively involving SSW peers and their clients, and reducing stigma in the society are keys to meet this urgent demand by SSWs

  20. 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.

  1. 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.

  2. 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.

  3. 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.

  4. Translating knowledge into practice: An exploratory study of dementia-specific training for community-based service providers.

    Science.gov (United States)

    O'Sullivan, Grace; Hocking, Clare; McPherson, Kathryn

    2017-08-01

    Objective To develop, deliver, and evaluate dementia-specific training designed to inform service delivery by enhancing the knowledge of community-based service providers. Methods This exploratory qualitative study used an interdisciplinary, interuniversity team approach to develop and deliver dementia-specific training. Participants included management, care staff, and clients from three organizations funded to provide services in the community. Data on the acceptability, applicability, and perceived outcomes of the training were gathered through focus group discussions and individual interviews. Transcripts were analyzed to generate open codes which were clustered into themes and sub-themes addressing the content, delivery, and value of the training. Findings Staff valued up-to-date knowledge and "real stories" grounded in practice. Clients welcomed the strengths-based approach. Contractual obligations impact on the application of knowledge in practice. Implications The capacity to implement new knowledge may be limited by the legislative policies which frame service provision, to the detriment of service users.

  5. Seven novel probe systems for real-time PCR provide absolute single-base discrimination, higher signaling, and generic components.

    Science.gov (United States)

    Murray, James L; Hu, Peixu; Shafer, David A

    2014-11-01

    We have developed novel probe systems for real-time PCR that provide higher specificity, greater sensitivity, and lower cost relative to dual-labeled probes. The seven DNA Detection Switch (DDS)-probe systems reported here employ two interacting polynucleotide components: a fluorescently labeled probe and a quencher antiprobe. High-fidelity detection is achieved with three DDS designs: two internal probes (internal DDS and Flip probes) and a primer probe (ZIPR probe), wherein each probe is combined with a carefully engineered, slightly mismatched, error-checking antiprobe. The antiprobe blocks off-target detection over a wide range of temperatures and facilitates multiplexing. Other designs (Universal probe, Half-Universal probe, and MacMan probe) use generic components that enable low-cost detection. Finally, single-molecule G-Force probes employ guanine-mediated fluorescent quenching by forming a hairpin between adjacent C-rich and G-rich sequences. Examples provided show how these probe technologies discriminate drug-resistant Mycobacterium tuberculosis mutants, Escherichia coli O157:H7, oncogenic EGFR deletion mutations, hepatitis B virus, influenza A/B strains, and single-nucleotide polymorphisms in the human VKORC1 gene. Copyright © 2014 American Society for Investigative Pathology and the Association for Molecular Pathology. Published by Elsevier Inc. All rights reserved.

  6. Reserves Represented by Random Walks

    International Nuclear Information System (INIS)

    Filipe, J A; Ferreira, M A M; Andrade, M

    2012-01-01

    The reserves problem is studied through models based on Random Walks. Random walks are a classical particular case in the analysis of stochastic processes. They do not appear only to study reserves evolution models. They are also used to build more complex systems and as analysis instruments, in a theoretical feature, of other kind of systems. In this work by studying the reserves, the main objective is to see and guarantee that pensions funds get sustainable. Being the use of these models considering this goal a classical approach in the study of pensions funds, this work concluded about the problematic of reserves. A concrete example is presented.

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

    OpenAIRE

    Walter Fuertes; Francisco Reyes; Paúl Valladares; Freddy Tapia; Theofilos Toulkeridis; Ernesto Pérez

    2017-01-01

    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, bein...

  8. 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.

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

    Science.gov (United States)

    Palmer, Richard C; Samson, Raquel; Triantis, Maria; Mullan, Irene D

    2011-08-15

    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. 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. 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 training was an appropriate tool to train healthcare providers about cultural competency and health disparities. 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.

  10. 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.

  11. 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.

  12. 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.

  13. A Classical Based Derivation of Time Dilation Providing First Order Accuracy to Schwarzschild's Solution of Einstein's Field Equations

    Science.gov (United States)

    Austin, Rickey W.

    In Einstein's theory of Special Relativity (SR), one method to derive relativistic kinetic energy is via applying the classical work-energy theorem to relativistic momentum. This approach starts with a classical based work-energy theorem and applies SR's momentum to the derivation. One outcome of this derivation is relativistic kinetic energy. From this derivation, it is rather straight forward to form a kinetic energy based time dilation function. In the derivation of General Relativity a common approach is to bypass classical laws as a starting point. Instead a rigorous development of differential geometry and Riemannian space is constructed, from which classical based laws are derived. This is in contrast to SR's approach of starting with classical laws and applying the consequences of the universal speed of light by all observers. A possible method to derive time dilation due to Newtonian gravitational potential energy (NGPE) is to apply SR's approach to deriving relativistic kinetic energy. It will be shown this method gives a first order accuracy compared to Schwarzschild's metric. The SR's kinetic energy and the newly derived NGPE derivation are combined to form a Riemannian metric based on these two energies. A geodesic is derived and calculations compared to Schwarzschild's geodesic for an orbiting test mass about a central, non-rotating, non-charged massive body. The new metric results in high accuracy calculations when compared to Einsteins General Relativity's prediction. The new method provides a candidate approach for starting with classical laws and deriving General Relativity effects. This approach mimics SR's method of starting with classical mechanics when deriving relativistic equations. As a compliment to introducing General Relativity, it provides a plausible scaffolding method from classical physics when teaching introductory General Relativity. A straight forward path from classical laws to General Relativity will be derived. This derivation

  14. 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

  15. 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.

  16. 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

    1999-04-01

    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). 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. 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). 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. 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.

  17. 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

  18. Reservation system with graphical user interface

    KAUST Repository

    Mohamed, Mahmoud A. Abdelhamid; Jamjoom, Hani T.; Podlaseck, Mark E.; Qu, Huiming; Shae, Zon-Yin; Sheopuri, Anshul

    2012-01-01

    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

  19. 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.

  20. 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.

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

    Science.gov (United States)

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

    2017-08-22

    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. Ethnographic fieldwork in a municipal and a hospital setting in Denmark. The two programmes included 21 participants and 10 HCPs and were observed over 5 weeks. Additionally, 10 in-depth semi-structured interviews were conducted with patients (n = 7) and HCPs (n = 3). Data were analysed using systematic text condensation. Hindering approaches included a teacher-centred focus on delivering disease-specific information. Communication was dialog based, but HCPs primarily asked closed-ended questions with one correct answer. Additional hindering approaches included ignoring participants with suboptimal health behaviours and a tendency to moralize that resulted in feelings of guilt among participants. Supporting approaches included letting participants set the agenda using broad, open-ended questions. Healthcare providers are often socialized into a biomedical approach and trained to be experts. However, person-centredness involves redefined roles and responsibilities. Applying person-centredness in practice requires continuous training and supervision, but HCPs often have minimum support for developing person-centred communication skills. Techniques based on motivational communication, psychosocial methods and facilitating group processes are effective person-centred approaches in a group context. Teacher-centredness undermined person-centredness because HCPs primarily delivered disease-specific recommendations, leading to biomedical information overload for participants. © 2017 Nordic College of Caring Science.

  2. 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

  3. 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)

  4. 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.

  5. 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.

  6. 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

  7. Developing a community based service model for disability: Listening to the needs of all beneficiaries and providers.

    Science.gov (United States)

    Collins, Katrina

    2017-12-11

    To inform the strategic and operational development of a community based service model at the Crann Centre, Cork, Ireland for SB children, adults, their families and providers. A needs assessment was conducted by gathering the views of multiple stakeholder perspectives within the SB community in the geographical region the Centre will serve. The intention is to create project deliverables that are responsive to the needs highlighted through this research. The study used a multi method design with a participatory research approach to explore the needs of SB individuals, families and providers. This involved in depth interviews, focus groups and online surveys. One hundred and fifty-nine respondents contributed to this qualitative needs assessment. The research established a range of psychosocial, clinical, vocational and educational issues causing ongoing difficulties for SB individuals and families. Providers highlighted supports that would benefit the social and clinical wellbeing of persons with SB. Collectively participants in the study reported that there was an absence of coordinated, continuous and comprehensive service delivery for the SB community in the region. This was amplified by geographical location of services and access to relevant supports. Consensus across stakeholders in this research pointed to the necessity for an innovative model of community based provision at the Crann Centre. This was described as offering a service with family at the core of an assets based model of practice. A key finding was the lack of importance placed on the social and emotional development of SB individuals. Traditionally participants described a singular focus on physical health through clinically defined treatment models. The desire for a social model of disability that informed health and wellbeing of SB individuals and families emerged as a prominent recommendation from the research.

  8. 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.

  9. 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...... from combined treatments. The purpose of this article is to describe which outcomes PwMS have experienced from combination treatment based on collaboration between conventional healthcare providers and CAM practitioners. A second purpose is to identify and study aspects of the courses of treatment...... that have generally characterized the achieved outcomes. During the course of their treatment, 59 PwMS participated in semi-structured individual or group interviews. The analyses show that the participants’ experienced outcomes can be classified in four ways 1) short-term positive outcomes; 2) long...

  10. 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.

  11. Joint energy and spinning reserve dispatching and pricing

    International Nuclear Information System (INIS)

    Rashidinejad, M.; Song, Y.-H.; Javidi Dasht-Bayaz, M.H.

    2000-01-01

    Unpredictable load demand variations, and also sudden generation interruption, may cause imbalance in power systems. To prevent any blackout and to reduce such total power imbalance, spinning reserve can provide electric power system ability to respond. Adequate amount of spinning reserve should be based on economy and risk as an optimal decision making. This paper uses Quadratic Programming (QP) method to solve Joint Energy and Spinning Reserve Dispatch (JESRD) problem and derives the optimal price of spinning reserve. In JESRD, Unserved Energy Cost (UEC) is considered as an Opportunity Cost of Spinning Reserve (OCSR). To distribute the System Reserve Requirements (SRR) among generation units, two different models, Fixed Reserve Percentage (FRP) or fixed allocation model and Non-Fixed Reserve Percentage (NFRP) or flexible allocation model has been investigated. Numerical results on a 5-bus test system and the 30-bus IEEE standard system, considering FRP and NFRP models are included. (author)

  12. 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.

  13. Manoomin: place-based research with Native American students on wild rice lakes on the Fond du Lac Band of Lake Superior Chippewa Reservation, northern Minnesota

    Science.gov (United States)

    Ito, E.; Myrbo, A.; Dalbotten, D. M.; Pellerin, H.; Greensky, L.; Howes, T.; Wold, A.; McEathron, M. A.; Shanker, V.

    2010-12-01

    The manoomin project is a collaboration between Fond du Lac Tribal and Community College (Cloquet, MN), the Reservation’s Resource Management Division, and the University of Minnesota funded by the NSF GEO-OEDG Program. It builds on a successful seven-year history of collaboration between these parties, including regular science camps (gidaakiimanaanimigawig, Our Earth Lodge) for students of a wide range of ages. We are working as a team with Native students to study the history of wild rice (manoomin; Zizania palustris), a culturally important resource, growing on Reservation lakes. The joint project takes two main approaches: study of sediment core samples collected from Reservation lakes; and the collection of traditional knowledge about wild rice from the Elders. Science campers collect lake cores during winter with the assistance of the U of MN’s LacCore (National Lacustrine Core Facility) and Resource Management and visit LacCore to log, split and describe cores soon thereafter. Academic mentors with a range of specialties (phytoliths, pollen, plant macrofossils, sedimentology, geochemistry, magnetics) spend 1-2 weeks during the summer with small groups of college-age (>18, many nontraditional) student interns working on a particular paleoenvironmental proxy from the sediment cores. Younger students (middle and high school) also work in small teams in half day units with the same mentors. All campers become comfortable in an academic setting, gain experience working in research labs learning and practicing techniques, and jointly interpret collective results. The continuation of the project over five years (2009-2014) will allow these students to develop relationships with scientists and to receive mentoring beyond the laboratory as they make transitions into 2- and 4-year colleges and into graduate school. Their research provides historical and environmental information that is relevant to their own land that will be used by Resource Management which is

  14. 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.

  15. Integrating Medication Therapy Management (MTM Services Provided by Community Pharmacists into a Community-Based Accountable Care Organization (ACO

    Directory of Open Access Journals (Sweden)

    Brian Isetts

    2017-10-01

    Full Text Available (1 Background: As the U.S. healthcare system evolves from fee-for-service financing to global population-based payments designed to be accountable for both quality and total cost of care, the effective and safe use of medications is gaining increased importance. The purpose of this project was to determine the feasibility of integrating medication therapy management (MTM services provided by community pharmacists into the clinical care teams and the health information technology (HIT infrastructure for Minnesota Medicaid recipients of a 12-county community-based accountable care organization (ACO. (2 Methods: The continuous quality improvement evaluation methodology employed in this project was the context + mechanism = outcome (CMO model to account for the fact that programs only work insofar as they introduce promising ideas, solutions and opportunities in the appropriate social and cultural contexts. Collaborations between a 12-county ACO and 15 community pharmacies in Southwest Minnesota served as the social context for this feasibility study of MTM referrals to community pharmacists. (3 Results: All 15 community pharmacy sites were integrated into the HIT infrastructure through Direct Secure Messaging, and there were 32 recipients who received MTM services subsequent to referrals from the ACO at 5 of the 15 community pharmacies over a 1-year implementation phase. (4 Conclusion: At the conclusion of this project, an effective electronic communication and MTM referral system was activated, and consideration was given to community pharmacists providing MTM in future ACO shared savings agreements.

  16. Games policy makers and providers play: introducing case-mix-based payment to hospital chronic care units in Japan.

    Science.gov (United States)

    Ikegami, Naoki

    2009-06-01

    Case-mix-based payment was developed for hospital chronic care units in Japan to replace the flat per diem rate and encourage the admission of patients with higher medical acuity and was part of a policy initiative to make the tariff more evidence based. However, although the criteria for grouping patients were developed from a statistical analysis of resource use, the tariff was subsequently set below costs, particularly for the groups with the lowest medical acuity, both because of the prime minister's decision to decrease total health expenditures and because of the health ministry's decision to target the reductions on chronic care units. Providers quickly adapted to the new payment system mainly by reclassifying their patients to higher medical acuity groups. Some hospitals reported high prevalence rates of urinary tract infections and pressure ulcers. The government responded by issuing directives to providers to calculate the prevalence rates and document the care that has been mandated for the patients at risk. However, in order to monitor compliance and to evaluate whether the patient is being billed for the appropriate case-mix group, the government must invest in developing a comprehensive patient-level database and in training staff for making on-site inspections.

  17. 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.

  18. 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...

  19. Efficacy Of The Repetitions In Reserve-Based Rating Of Perceived Exertion For The Bench Press In Experienced And Novice Benchers.

    Science.gov (United States)

    Ormsbee, Michael J; Carzoli, Joseph P; Klemp, Alex; Allman, Brittany R; Zourdos, Michael C; Kim, Jeong-Su; Panton, Lynn B

    2017-03-13

    Autoregulation (AR) is the practice of adjusting training variables in response to athlete feedback. One component of AR postulated to enhance resistance training adaptations involves implementing a resistance training-specific rating of perceived exertion (RPE) scale measuring repetitions in reserve (RIR). The purpose of this study was to examine the efficacy of this method using the bench press exercise. Twenty-seven college-aged men were assigned to one of two groups based upon training age: experience benchers (EB) (n=14, training age: 4.7±2.0 yrs) and novice benchers (NB) (n=13, training age: 1.1±0.6 yrs). Subjects performed one-repetition maximum (1RM) followed by single-repetition sets with loads corresponding to 60, 75, and 90% of 1RM and an 8-repetition set at 70% 1RM. Subjects reported a corresponding RPE, based on RIR, for every set. Average velocity was recorded for each single-repetition set along with the first and last repetitions of the 8-repetition set at 70% 1RM. Average velocity at 100% of 1RM in EB was slower (0.14±0.04 m[BULLET OPERATOR]s) compared to NB (0.20±0.05 m[BULLET OPERATOR]s) (pvelocity or RPE at any other intensity. Both EB (r=0.85, pvelocity and RPE at all intensities. Our findings suggest that the RIR-based RPE scale may be an efficacious approach for AR of bench press training load and volume in college-aged men.

  20. Preliminary Investigation of Workplace-Provided Compressed Mindfulness-Based Stress Reduction with Pediatric Medical Social Workers.

    Science.gov (United States)

    Trowbridge, Kelly; Mische Lawson, Lisa; Andrews, Stephanie; Pecora, Jodi; Boyd, Sabra

    2017-11-01

    Mindfulness practices, including mindfulness meditation, show promise for decreasing stress among health care providers. This exploratory study investigates the feasibility of a two-day compressed mindfulness-based stress reduction (cMBSR) course provided in the hospital workplace with pediatric health care social workers. The standard course of Jon Kabat-Zinn's MBSR requires a participant commitment to eight weeks of instruction consisting of one 2.5-hour-per-week class, a single day retreat, and 45 minutes of practice for six of seven days each week. Commitments to family, work, caregiving, education, and so on, as well as limitations such as distance, may prevent health care providers from participating in a standard MBSR course. Using t tests, researchers measured the effect of cMBSR on (a) positive and negative experiences in pediatric social work, (b) perceived stress, (c) mindfulness, and (d) caring self-efficacy (as a component of patient- and family-centered care). Results included significant differences between the pre- and post-intervention outcome variables on the Professional Quality of Life Secondary Traumatic Stress subscale, the Mindful Attention and Awareness Scale, and the Caring Efficacy Scale. Findings found adequate evidence for the feasibility of cMBSR design and for a need of a more rigorous study of the effects of the cMBSR intervention. © 2017 National Association of Social Workers.

  1. Example-based learning: comparing the effects of additionally providing three different integrative learning activities on physiotherapy intervention knowledge.

    Science.gov (United States)

    Dyer, Joseph-Omer; Hudon, Anne; Montpetit-Tourangeau, Katherine; Charlin, Bernard; Mamede, Sílvia; van Gog, Tamara

    2015-03-07

    Example-based learning using worked examples can foster clinical reasoning. Worked examples are instructional tools that learners can use to study the steps needed to solve a problem. Studying worked examples paired with completion examples promotes acquisition of problem-solving skills more than studying worked examples alone. Completion examples are worked examples in which some of the solution steps remain unsolved for learners to complete. Providing learners engaged in example-based learning with self-explanation prompts has been shown to foster increased meaningful learning compared to providing no self-explanation prompts. Concept mapping and concept map study are other instructional activities known to promote meaningful learning. This study compares the effects of self-explaining, completing a concept map and studying a concept map on conceptual knowledge and problem-solving skills among novice learners engaged in example-based learning. Ninety-one physiotherapy students were randomized into three conditions. They performed a pre-test and a post-test to evaluate their gains in conceptual knowledge and problem-solving skills (transfer performance) in intervention selection. They studied three pairs of worked/completion examples in a digital learning environment. Worked examples consisted of a written reasoning process for selecting an optimal physiotherapy intervention for a patient. The completion examples were partially worked out, with the last few problem-solving steps left blank for students to complete. The students then had to engage in additional self-explanation, concept map completion or model concept map study in order to synthesize and deepen their knowledge of the key concepts and problem-solving steps. Pre-test performance did not differ among conditions. Post-test conceptual knowledge was higher (P example and completion example strategies to foster intervention selection.

  2. 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

  3. 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)

  4. Mixed Methods for Implementation Research: Application to Evidence-Based Practice Implementation and Staff Turnover in Community Based Organizations Providing Child Welfare Services

    Science.gov (United States)

    Aarons, Gregory A.; Fettes, Danielle L.; Sommerfeld, David H.; Palinkas, Lawrence

    2013-01-01

    Many public sector services systems and provider organizations are in some phase of learning about or implementing evidence-based interventions. Child welfare service systems represent a context where implementation spans system, management, and organizational concerns. Research utilizing mixed methods that combine qualitative and quantitative design, data collection, and analytic approaches are particularly well-suited to understanding both the process and outcomes of dissemination and implementation efforts in child welfare systems. This paper describes the process of using mixed methods in implementation research and provides an applied example of an examination of factors impacting staff retention during an evidence-based intervention implementation in a statewide child welfare system. We integrate qualitative data with previously published quantitative analyses of job autonomy and staff turnover during this statewide implementation project in order to illustrate the utility of mixed method approaches in providing a more comprehensive understanding of opportunities and challenges in implementation research. PMID:22146861

  5. Mixed methods for implementation research: application to evidence-based practice implementation and staff turnover in community-based organizations providing child welfare services.

    Science.gov (United States)

    Aarons, Gregory A; Fettes, Danielle L; Sommerfeld, David H; Palinkas, Lawrence A

    2012-02-01

    Many public sector service systems and provider organizations are in some phase of learning about or implementing evidence-based interventions. Child welfare service systems represent a context where implementation spans system, management, and organizational concerns. Research utilizing mixed methods that combine qualitative and quantitative design, data collection, and analytic approaches are particularly well suited to understanding both the process and outcomes of dissemination and implementation efforts in child welfare systems. This article describes the process of using mixed methods in implementation research and provides an applied example of an examination of factors impacting staff retention during an evidence-based intervention implementation in a statewide child welfare system. The authors integrate qualitative data with previously published quantitative analyses of job autonomy and staff turnover during this statewide implementation project in order to illustrate the utility of mixed method approaches in providing a more comprehensive understanding of opportunities and challenges in implementation research.

  6. 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.

  7. 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

    Directory of Open Access Journals (Sweden)

    Alessandra Torina

    2018-02-01

    Full Text Available 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.

  8. 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

  9. Continuous quality improvement programs provide new opportunities to drive value innovation initiatives in hospital-based radiology practices.

    Science.gov (United States)

    Steele, Joseph R; Schomer, Don F

    2009-07-01

    Imaging services constitute a huge portion of the of the total dollar investment within the health care enterprise. Accordingly, this generates competition among medical specialties organized along service lines for their pieces of the pie and increased scrutiny from third-party payers and government regulators. These market and political forces create challenge and opportunity for a hospital-based radiology practice. Clearly, change that creates or builds greater value for patients also creates sustainable competitive advantage for a radiology practice. The somewhat amorphous concept of quality constitutes a significant value driver for innovation in this scenario. Quality initiatives and programs seek to define and manage this amorphous concept and provide tools for a radiology practice to create or build more value. Leadership and the early adoption of these inevitable programs by a radiology practice strengthens relationships with hospital partners and slows the attrition of imaging service lines to competitors.

  10. Does surgery or radiation provide the best overall survival in Ewing's sarcoma? A review of the National Cancer Data Base.

    Science.gov (United States)

    Miller, Benjamin J; Gao, Yubo; Duchman, Kyle R

    2017-09-01

    There is continuing debate regarding the ideal modality for local control of the primary tumor for patients with Ewing's sarcoma. The primary aim of this study is to investigate the impact of the method of local control on overall survival in patients with Ewing's sarcoma. The National Cancer Data Base was used to identify patients Ewing's sarcoma of bone. A Kaplan-Meier survival analysis was performed at 2, 5, and 10 years. Factors with a level of significance of P 8 cm, and male sex while controlling for tumor site. Surgery alone was consistently the method of local control that resulted in the highest overall survival. Surgery alone resulted in the best overall survival for patients with Ewing's sarcoma of bone. The results of this investigation provide support to the approach of surgical resection with negative margins when possible. © 2017 Wiley Periodicals, Inc.

  11. Environmental Data Store: A Web-Based System Providing Management and Exploitation for Multi-Data-Type Environmental Data

    Science.gov (United States)

    Ji, P.; Piasecki, M.

    2012-12-01

    With the rapid growth in data volumes, data diversity and data demands from multi-disciplinary research effort, data management and exploitation are increasingly facing significant challenges for environmental scientific community. We describe Environmental data store (EDS), a system we are developing that is a web-based system following an open source implementation to manage and exploit multi-data-type environmental data. EDS provides repository services for the six fundamental data types, which meet the demands of multi-disciplinary environmental research. These data types are: a) Time Series Data, b) GeoSpatial data, c) Digital Data, d) Ex-Situ Sampling data, e) Modeling Data, f) Raster Data. Through data portal, EDS allows for efficient consuming these six types of data placed in data pool, which is made up of different data nodes corresponding to different data types, including iRODS, ODM, THREADS, ESSDB, GeoServer, etc.. EDS data portal offers unified submission interface for the above different data types; provides fully integrated, scalable search across content from the above different data systems; also features mapping, analysis, exporting and visualization, through integration with other software. EDS uses a number of developed systems, follows widely used data standards, and highlights the thematic, semantic, and syntactic support on the submission and search, in order to advance multi-disciplinary environmental research. This system will be installed and develop at the CrossRoads initiative at the City College of New York.

  12. Primary Care Provider Views About Usefulness and Dissemination of a Web-Based Depression Treatment Information Decision Aid.

    Science.gov (United States)

    Beaulac, Julie; Westmacott, Robin; Walker, John R; Vardanyan, Gohar

    2016-06-08

    Decisions related to mental health are often complex, problems often remain undetected and untreated, information unavailable or not used, and treatment decisions frequently not informed by best practice or patient preferences. The objective of this paper was to obtain the opinions of health professionals working in primary health care settings about a Web-based information decision aid (IDA) for patients concerning treatment options for depression and the dissemination of the resources in primary care settings. Participants were recruited from primary care clinics in Winnipeg and Ottawa, Canada, and included 48 family physicians, nurses, and primary care staff. The study design was a qualitative framework analytic approach of 5 focus groups. Focus groups were conducted during regular staff meetings, were digitally recorded, and transcripts created. Analysis involved a content and theme analysis. Seven key themes emerged including the key role of the primary care provider, common questions about treatments, treatment barriers, sources of patient information, concern about quality and quantity of available information, positive opinions about the IDA, and disseminating the IDA. The most common questions mentioned were about medication and side effects and alternatives to medication. Patients have limited access to alternative treatment options owing to cost and availability. Practitioners evaluated the IDA positively. The resources were described as useful, supportive of providers' messages, and accessible for patients. There was unanimous consensus that information needs to be available electronically through the Internet.

  13. A blueprint-based case study analysis of nutrition services provided in a midterm care facility for the elderly.

    Science.gov (United States)

    Paquet, Catherine; St-Arnaud-Mckenzie, Danielle; Ferland, Guylaine; Dubé, Laurette

    2003-03-01

    Ensuring nutritionally adequate food intake in institutions is a complex and important challenge for dietitians. To tackle this problem, we argue that dietitians need to adopt a systematic, integrative, and patient-centered approach to identify and manage more effectively organizational determinants of the quality of food intake under their control. In this study, we introduce such an approach, the blueprint-based case study, that we applied in the context of a midterm care facility for elderly patients. Data gathered through interviews and field observations were used to develop, from the perspective of key patient encounters, detailed representations of the food, nutrition, and nursing activities necessary to ensure adequate food intake. These service "blueprints" were developed to illustrate all activities that might potentially impact on the nutritional, sensory, functional, and social quality of patients' meals. They were also used as roadmaps to develop a case study analysis in which critical areas were identified and opportunities for improvement put forth, while considering services' resources and priorities. By providing a precise, objective, yet comprehensive mapping of the service operations and management, the blueprint-based case study approach represents a valuable tool to determine the optimal allocation of resources to insure nutritionally adequate food intake to patients.

  14. GUIdock-VNC: using a graphical desktop sharing system to provide a browser-based interface for containerized software.

    Science.gov (United States)

    Mittal, Varun; Hung, Ling-Hong; Keswani, Jayant; Kristiyanto, Daniel; Lee, Sung Bong; Yeung, Ka Yee

    2017-04-01

    Software container technology such as Docker can be used to package and distribute bioinformatics workflows consisting of multiple software implementations and dependencies. However, Docker is a command line-based tool, and many bioinformatics pipelines consist of components that require a graphical user interface. We present a container tool called GUIdock-VNC that uses a graphical desktop sharing system to provide a browser-based interface for containerized software. GUIdock-VNC uses the Virtual Network Computing protocol to render the graphics within most commonly used browsers. We also present a minimal image builder that can add our proposed graphical desktop sharing system to any Docker packages, with the end result that any Docker packages can be run using a graphical desktop within a browser. In addition, GUIdock-VNC uses the Oauth2 authentication protocols when deployed on the cloud. As a proof-of-concept, we demonstrated the utility of GUIdock-noVNC in gene network inference. We benchmarked our container implementation on various operating systems and showed that our solution creates minimal overhead. © The Authors 2017. Published by Oxford University Press.

  15. 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.

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

    Science.gov (United States)

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

    2018-06-01

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

  17. 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

  18. 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

  19. 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...

  20. Measuring hepatic functional reserve using T1 mapping of Gd-EOB-DTPA enhanced 3T MR imaging: A preliminary study comparing with 99mTc GSA scintigraphy and signal intensity based parameters.

    Science.gov (United States)

    Nakagawa, Masataka; Namimoto, Tomohiro; Shimizu, Kie; Morita, Kosuke; Sakamoto, Fumi; Oda, Seitaro; Nakaura, Takeshi; Utsunomiya, Daisuke; Shiraishi, Shinya; Yamashita, Yasuyuki

    2017-07-01

    To determine the utility of liver T1-mapping on gadolinium-ethoxybenzyl-diethylenetriamine-pentaacetic acid (Gd-EOB-DTPA) enhanced magnetic resonance (MR) imaging for the measurement of liver functional reserve compared with the signal intensity (SI) based parameters, technetium-99m-galactosyl serum albumin ( 99m Tc-GSA) scintigraphy and indocyanine green (ICG) clearance. This retrospective study included 111 patients (Child-Pugh-A 90; -B 21) performed with both Gd-EOB-DTPA enhanced liver MR imaging and 99m Tc-GSA (76 patients with ICG). Receiver operating characteristic (ROC) curve analysis was performed to compare diagnostic performances of T1-relaxation-time parameters [pre-(T1pre) and post-contrast (T1hb) Gd-EOB-DTPA], SI based parameters [relative enhancement (RE), liver-to-muscle-ratio (LMR), liver-to-spleen-ratio (LSR)] and 99m Tc-GSA scintigraphy blood clearance index (HH15)] for Child-Pugh classification. Pearson's correlation was used for comparisons among T1-relaxation-time parameters, SI-based parameters, HH15 and ICG. A significant difference was obtained for Child-Pugh classification with T1hb, ΔT1, all SI based parameters and HH15. T1hb had the highest AUC followed by RE, LMR, LSR, ΔT1, HH15 and T1pre. The correlation coefficients with HH15 were T1pre 0.22, T1hb 0.53, ΔT1 -0.38 of T1 relaxation parameters; RE -0.44, LMR -0.45, LSR -0.43 of SI-based parameters. T1hb was highest for correlation with HH15. The correlation coefficients with ICG were T1pre 0.29, T1hb 0.64, ΔT1 -0.42 of T1 relaxation parameters; RE -0.50, LMR -0.61, LSR -0.58 of SI-based parameters; 0.64 of HH15. Both T1hb and HH15 were highest for correlation with ICG. T1 relaxation time at post-contrast of Gd-EOB-DTPA (T1hb) was strongly correlated with ICG clearance and moderately correlated HH15 with 99m Tc-GSA. T1hb has the potential to provide robust parameter of liver functional reserve. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. 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.

  2. A Study on PolInSAR Coherence Based Regression Analysis of Forest Biomass (BARKOT Reserve Forest India), Using RADARSAT-2 Datasets

    Science.gov (United States)

    Singh, J.; Kumar, S.; Kushwaha, S. P. S.

    2015-04-01

    Forests cover 30% of the world's land surface, and are home to around 90% of the world's flora and fauna. They serve as one of the world's largest carbon sinks, absorbing 2.4 million tons of CO2 each year and storing billions more in form of biomass. Around 6 million hectares of forest is lost or changed each year and as much as a fifth of global emissions are estimated to come from deforestation. Hence accurate estimation of forest biophysical variables is necessary as it is a key parameter in determination of forest inventories, vegetation modeling and global carbon cycle. SAR Remote sensing technique is capable of providing accurate and reliable information about forest parameters. The present work aims to explore the potential of C-band Radarsat-2 Polarimetric Interferometric Synthetic Aperture Radar (PolinSAR) technique for developing a relationship between complex coherence and forest aboveground biomass (t/ha). In order to attain our objective Radarsat-2 satellite interferometric pair of 4th March 2013(master image) and 28th March 2013(slave image) were acquired for Barkot Reserve Forest, Dehradun, India. Field inventory was done for 30 plots (31.62m x 31.62m) and tree height and stem diameter were procured for each plot which were later utilized in calculation of aboveground biomass(AGB).Work emphasizes on the application of PolinSAR coherence instead of using SAR backscatter which saturates after a certain value of biomass content. Complex coherence values for different polarization channels were computed with the help of polarimetric interferometric coherence matrix. Retrieved complex coherences were investigated individually and then regression analysis was carried with the field estimated aboveground biomass. R2 value of HV+VH complex coherence component was found to be relatively higher than other polarization channel components

  3. 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.

  4. Providing Home-Based HIV Testing and Counseling for Transgender Youth (Project Moxie): Protocol for a Pilot Randomized Controlled Trial.

    Science.gov (United States)

    Stephenson, Rob; Metheny, Nicholas; Sharma, Akshay; Sullivan, Stephen; Riley, Erin

    2017-11-28

    Transgender and gender nonconforming people experience some of the highest human immunodeficiency virus (HIV) rates in the United States, and experience many structural and behavioral barriers that may limit their engagement in HIV testing, prevention, and care. Evidence suggests that transgender and gender nonconforming youth (TY) are especially vulnerable to acquiring HIV, yet there is little research on TY and few services are targeted towards HIV testing, prevention, and care for this population. Telehealth presents an opportunity to mitigate some structural barriers that TY experience in accessing HIV testing, allowing TY to engage in HIV testing and counseling in a safe and nonjudgmental space of their choosing. Project Moxie is an HIV prevention intervention that pairs the use of HIV self-testing with remote video-based counseling and support from a trained, gender-affirming counselor. This study aims to offer a more positive HIV testing and counseling experience, with the goal of improving HIV testing frequency. Project Moxie involves a pilot randomized controlled trial (RCT) of 200 TY aged 15-24 years, who are randomized on a 1:1 basis to control or intervention arms. The aim is to examine whether the addition of counseling provided via telehealth, coupled with home-based HIV testing, can create gains in routine HIV testing among TY over a six-month follow-up period. This study implements a prospective pilot RCT of 200 TY recruited online. Participants in the control arm will receive one HIV self-testing kit and will be asked to report their results via the study's website. Participants in the experimental arm will receive one HIV self-testing kit and will test with a remotely-located counselor during a prescheduled video-counseling session. Participants are assessed at baseline, and at three and six months posttesting. Project Moxie was launched in June 2017 and recruitment is ongoing. As of August 21, 2017, the study had enrolled 130 eligible

  5. 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

  6. 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...

  7. 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.

  8. 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 system not adapted to their specific professional practice (P = system (P = 0.041). We found that in particular the received relative advantages of the CPOE system were estimated to be significantly (P 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

  9. Resilience-based Diabetes Self-management Education: Perspectives From African American Participants, Community Leaders, and Healthcare Providers.

    Science.gov (United States)

    Lehrer, H Matthew; Dubois, Susan K; Brown, Sharon A; Steinhardt, Mary A

    2017-08-01

    Purpose The purpose of this qualitative, focus group study was to further refine the Resilience-based Diabetes Self-management Education (RB-DSME) recruitment process and intervention, build greater trust in the community, and identify strategies to enhance its sustainability as a community-based intervention in African American church settings. Methods Six 2-hour focus groups (N = 55; 10 men and 45 women) were led by a trained moderator with a written guide to facilitate discussion. Two sessions were conducted with individuals diagnosed with type 2 diabetes mellitus (T2DM) who participated in previous RB-DSME pilot interventions and their family members, two sessions with local church leaders, and two sessions with community healthcare providers who care for patients with T2DM. Two independent reviewers performed content analysis to identify major themes using a grounded theory approach. The validity of core themes was enhanced by external review and subsequent discussions with two qualitative methods consultants. Results There was expressed interest and acceptability of the RB-DSME program. Church connection and pastor support were noted as key factors in building trust and enhancing recruitment, retention, and sustainability of the program. Core themes across all groups included the value of incentives, the need for foundational knowledge shared with genuine concern, teaching with visuals, dealing with denial, balancing the reality of adverse consequences with hope, the importance of social support, and addressing healthcare delivery barriers. Conclusion Focus groups documented the feasibility and potential effectiveness of RB-DSME interventions to enhance diabetes care in the African American community. In clinical practice, inclusion of these core themes may enhance T2DM self-care and treatment outcomes.

  10. 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.

  11. 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.

  12. Provider cost analysis supports results-based contracting out of maternal and newborn health services: an evidence-based policy perspective.

    Science.gov (United States)

    Hatcher, Peter; Shaikh, Shiraz; Fazli, Hassan; Zaidi, Shehla; Riaz, Atif

    2014-11-13

    There is dearth of evidence on provider cost of contracted out services particularly for Maternal and Newborn Health (MNH). The evidence base is weak for policy makers to estimate resources required for scaling up contracting. This paper ascertains provider unit costs and expenditure distribution at contracted out government primary health centers to inform the development of optimal resource envelopes for contracting out MNH services. This is a case study of provider costs of MNH services at two government Rural Health Centers (RHCs) contracted out to a non-governmental organization in Pakistan. It reports on four selected Basic Emergency Obstetrical and Newborn Care (BEmONC) services provided in one RHC and six Comprehensive Emergency Obstetrical and Newborn Care (CEmONC) services in the other. Data were collected using staff interviews and record review to compile resource inputs and service volumes, and analyzed using the CORE Plus tool. Unit costs are based on actual costs of MNH services and are calculated for actual volumes in 2011 and for volumes projected to meet need with optimal resource inputs. The unit costs per service for actual 2011 volumes at the BEmONC RHC were antenatal care (ANC) visit USD$ 18.78, normal delivery US$ 84.61, newborn care US$ 16.86 and a postnatal care (PNC) visit US$ 13.86; and at the CEmONC RHC were ANC visit US$ 45.50, Normal Delivery US$ 148.43, assisted delivery US$ 167.43, C-section US$ 183.34, Newborn Care US$ 41.07, and PNC visit US$ 27.34. The unit costs for the projected volumes needed were lower due to optimal utilization of resources. The percentage distribution of expenditures at both RHCs was largest for salaries of technical staff, followed by salaries of administrative staff, and then operating costs, medicines, medical and diagnostic supplies. The unit costs of MNH services at the two contracted out government rural facilities remain higher than is optimal, primarily due to underutilization. Provider cost analysis

  13. Daily activity patterns of large and medium-sized mammals based on camera traps data in the Central Forest Nature Reserve, Valdai Upland, Russia

    Directory of Open Access Journals (Sweden)

    Sergey S. Ogurtsov

    2018-06-01

    Full Text Available Here are presented the results of the analysis of daily activity patterns obtained from the data of camera traps for five large mammals (elk Alces alces, wild boar Sus scrofa, brown bear Ursus arctos, grey wolf Canis lupus, Eurasian lynx Lynx lynx and three medium ones (European badger Meles meles, raccoon dog Nyctereutes procyonoides, mountain hare Lepus timidus for the territory of the Central Forest Nature Reserve, Valdai Upland, Russia. Data were collected in the period 2010–2017 and the trap effort was 30 158 camera days from 21 locations. Most of the mammals surveyed showed activity at night and twilight hours (71% of the pictures. The hare was most active among all and dominant at night. In many respects it is similar to the activity of a raccoon dog, which type can be defined as nocturnal too. Unlike a hare, a raccoon dog has a weak peak in the daytime and less activity in the night. Badgers movements are confined to the twilight and nighttime. The share of nocturnal activity of large ungulates such as elk and wild boar was approximately the same and amounted to about 45% of all registrations. The wild boar is slightly more active during the day and in the evening and is not active at all in the morning. The elk is active in the morning, and in the daytime and to a lesser extent in the evening. The lynx and the bear have similar cathemeral activity patterns: almost half of all their meetings occurred at daylight hours and only slightly – less than 40% – at night. The brown bear had the maximum number of registrations in the daytime among all the studied species. Despite the fact that the main object of lynx feeding in the reserve is the hare, there was no high degree of overlap between them (γˆ = 0.75. In the group of large carnivores, the wolf was noticeably distinguished, more than half of its registrations were at night, and a third – on daytime. Daily activities of the wolf and its main prey elk showed a large overlap (

  14. 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...

  15. 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.

  16. 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.

  17. 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)

  18. Brazilian uranium reserves

    International Nuclear Information System (INIS)

    Marques, J.P.M.

    1981-01-01

    Due to a growing demand of electric power to support Brasil's development, the use of nuclear energy will be indispensable. The nuclear fuel cycle for the production of energy, starts with the uranium exploration. The work performed in this field led to the discovery of several deposits in the country, which to-date totalize a reserve of 236,300t of U 308 , ranking Brazil in the 6th place among the nations of the western world holding uranium reserves. (Author) [pt

  19. 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

  20. 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...

  1. 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)

  2. 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 ...

  3. 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…

  4. Uranium reserves fall: AAEC

    International Nuclear Information System (INIS)

    Anon.

    1982-01-01

    Figures released by the AAEC show that Australia's reasonably assured resources of uranium recoverable at US$80 a kg fell by 5,000 tonnes during 1980-81. Reserves at 30 June 1981 totalled 294,000 tonnes. This represented 17 per cent of the Western World's low cost reasonably assured resources

  5. 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

  6. 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

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

    Science.gov (United States)

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

    2014-09-01

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

  8. Insurer Provide Rating Software and Competitive Advantage: An Evaluation Based on BOP Insurance Applications at Wisconsin Agencies

    OpenAIRE

    Thomas A. Aiuppa; William E. Wehrs

    1993-01-01

    This research examines whether a competitive advantage exists for insurers which provide independent agencies with rating software to generate price quotes. Data relative to the Business Owners line of insurance were collected from several Wisconsin agencies which represent several BOP insurers, some of which provide software for rating BOP applications. The results indicate that providing rating software did not increase insurers’ business volumes, but may decrease their underwriting costs. ...

  9. Updated subsurface data base for Bear Creek Valley, Chestnut Ridge, and parts of Bethel Valley on the U.S. Department of Energy Oak Ridge Reservation. Revision 3

    International Nuclear Information System (INIS)

    Jones, S.B.; Thompson, B.K.; Field, S.M.

    1995-07-01

    Construction and hydrogeological data for 1,173 boreholes and wells installed through May 1995 at the Oak Ridge Y-12 Plant and in the surrounding vicinity are summarized in this document. This document represents the third revision to Y/TS-881 and is the sixth update of a previous compilation. General data about boreholes and wells included in the data base are survey coordinates, elevations, alternative names and well status. 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 include depth to weathered and fresh bedrock, formations penetrated, sampling history, 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 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 hydrogeological review of selected sites prior to the initiation of remedial actions

  10. 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

  11. 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

  12. Providing affinity

    DEFF Research Database (Denmark)

    Guglielmi, Michel; Johannesen, Hl

    2004-01-01

    , Essex, Hertfordshire, Norfolk and Suffolk. Research found that there was a lack of identity or sense of belonging and nothing anchoring people to the region as a whole. Common affinity is somehow forced to the people of East England and thereby we came to the conclusion that a single landmark...... and potential situations but also virtual events that calls for an undeterminated process of resolution. This process is activated by the user who co-produces the actualisation as an answer to a virtual reality that we defined at the first place. The potential situations or the possible it is a fantomatic real....... The possible is like the real. It is determinated and it only lakes existence. While the possible is already made, the virtual is like a problematic which needs to be resolved and actualized. Our installations are based on high tech interactivity where we use sensors and remote communication to offer a sense...

  13. 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.

  14. 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

  15. 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...

  16. 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)

    OpenAIRE

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

    2018-01-01

    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 dr...

  17. 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...

  18. Combined culture-based and culture-independent approaches provide insights into diversity of jakobids, an extremely plesiomorphic eukaryotic lineage

    Directory of Open Access Journals (Sweden)

    Tomáš ePánek

    2015-11-01

    Full Text Available We used culture-based and culture-independent approaches to discover diversity and ecology of anaerobic jakobids (Excavata: Jakobida, an overlooked, deep-branching lineage of free-living nanoflagellates related to Euglenozoa. Jakobids are among a few lineages of nanoflagellates frequently detected in anoxic habitats by PCR-based studies, however only two strains of a single jakobid species have been isolated from those habitats. We recovered 712 environmental sequences and cultured 21 new isolates of anaerobic jakobids that collectively represent at least ten different species in total, from which four are uncultured. Two cultured species have never been detected by environmental, PCR-based methods. Surprisingly, culture-based and culture-independent approaches were able to reveal a relatively high proportion of overall species diversity of anaerobic jakobids - 60 % or 80 %, respectively. Our phylogenetic analyses based on SSU rDNA and six protein-coding genes showed that anaerobic jakobids constitute a clade of morphologically similar, but genetically and ecologically diverse protists – Stygiellidae fam. nov. Our investigation combines culture-based and environmental molecular-based approaches to capture a wider extent of species diversity and shows Stygiellidae as a group that ordinarily inhabits anoxic, sulfide- and ammonium-rich marine habitats worldwide.

  19. The challenges of launching a crowd based platform : A single case study of a Swedish service provider

    OpenAIRE

    Eliasson, Robert; Viklund, Tobias

    2013-01-01

    Using the concept of open innovation companies have started to look beyond their own borders using the crowd as a source for labour, knowledge and innovation. During the last few years the phenomena of crowdsourcing and crowdfunding have become increasingly popular as sources of competitive advantage through the crowd. While several studies have examined crowd based platforms focusing on the users, little attention has been brought to the companies starting these crowd based services. This st...

  20. 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.

  1. 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 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.

  2. 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.

  3. 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

  4. Un/Paid Labor: Medicaid Home and Community Based Services Waivers That Pay Family as Personal Care Providers

    Science.gov (United States)

    Friedman, Carli; Rizzolo, Mary C.

    2016-01-01

    The United States long-term services and supports system is built on largely unpaid (informal) labor. There are a number of benefits to allowing family caregivers to serve as paid personal care providers including better health and satisfaction outcomes, expanded workforces, and cost effectiveness. The purpose of this study was to examine how…

  5. 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.

  6. 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.

  7. 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.

  8. Development of a web-based pharmaceutical care plan to facilitate collaboration between healthcare providers and patients

    NARCIS (Netherlands)

    Geurts, Marlies M E; Ivens, Martijn; van Gelder, Egbert; de Gier, Johan J

    2013-01-01

    BACKGROUND: In medication therapy management there is a need for a tool to document medication reviews and pharmaceutical care plans (PCPs) as well as facilitate collaboration and sharing of patient data between different healthcare providers. Currently, pharmacists and general practitioners (GPs)

  9. The Impact of Providing Web-Based PowerPoint Slides as Study Guides in Undergraduate Business Classes

    Science.gov (United States)

    Frank, Jonathan; Shaw, Lewis; Wilson, Elizabeth

    2009-01-01

    This study examines undergraduate business students' use of PowerPoint slides provided as a supplement to class attendance, textbook reading, and other traditional course resources. We survey students in 4 diverse (accounting, marketing, management, and information systems) lower-level undergraduate courses in which the instructor provided…

  10. Barriers and enablers in the implementation of a provider-based intervention to stimulate culturally appropriate hypertension education

    NARCIS (Netherlands)

    Beune, Erik J. A. J.; Haafkens, Joke A.; Bindels, Patrick J. E.

    2011-01-01

    Objective: To identify barriers and enablers influencing the implementation of an intervention to stimulate culturally appropriate hypertension education (CANE) among health care providers in primary care. Methods: The intervention was piloted in three Dutch health centers. It consists of a toolkit

  11. 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…

  12. The limits of market-based reforms in the NHS: the case of alternative providers in primary care.

    Science.gov (United States)

    Coleman, Anna; Checkland, Kath; McDermott, Imelda; Harrison, Stephen

    2013-01-01

    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). 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. 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 in primary care provision, including the trade-offs between

  13. Incorporating technology buying behaviour into UK-based long term domestic stock energy models to provide improved policy analysis

    International Nuclear Information System (INIS)

    Lee, Timothy; Yao, Runming

    2013-01-01

    The UK has a target for an 80% reduction in CO 2 emissions by 2050 from a 1990 base. Domestic energy use accounts for around 30% of total emissions. This paper presents a comprehensive review of existing models and modelling techniques and indicates how they might be improved by considering individual buying behaviour. Macro (top-down) and micro (bottom-up) models have been reviewed and analysed. It is found that bottom-up models can project technology diffusion due to their higher resolution. The weakness of existing bottom-up models at capturing individual green technology buying behaviour has been identified. Consequently, Markov chains, neural networks and agent-based modelling are proposed as possible methods to incorporate buying behaviour within a domestic energy forecast model. Among the three methods, agent-based models are found to be the most promising, although a successful agent approach requires large amounts of input data. A prototype agent-based model has been developed and tested, which demonstrates the feasibility of an agent approach. This model shows that an agent-based approach is promising as a means to predict the effectiveness of various policy measures. - Highlights: ► Long term energy models are reviewed with a focus on UK domestic stock models. ► Existing models are found weak in modelling green technology buying behaviour. ► Agent models, Markov chains and neural networks are considered as solutions. ► Agent-based modelling (ABM) is found to be the most promising approach. ► A prototype ABM is developed and testing indicates a lot of potential.

  14. 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

  15. 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

  16. Example-based learning: comparing the effects of additionally providing three different integrative learning activities on physiotherapy intervention knowledge

    NARCIS (Netherlands)

    J.-O. Dyer (Joseph-Omer); A. Hudon (Anne); K. Montpetit-Tourangeau (Katherine); B. Charlin (Bernard); S. Mamede (Silvia); T.A.J.M. van Gog (Tamara)

    2015-01-01

    textabstractBACKGROUND: Example-based learning using worked examples can foster clinical reasoning. Worked examples are instructional tools that learners can use to study the steps needed to solve a problem. Studying worked examples paired with completion examples promotes acquisition of

  17. 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…

  18. 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)…

  19. 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

  20. Enhancing the relationship and improving communication between adolescents and their health care providers: a school based intervention by medical students.

    Science.gov (United States)

    Towle, Angela; Godolphin, William; Van Staalduinen, Samantha

    2006-08-01

    To develop, implement and evaluate a workshop to help adolescents develop independent and active relationships with their physicians. A needs-assessment survey informed the development of a workshop delivered by medical student volunteers and incorporated into the career and personal planning curriculum of high schools in Vancouver, Canada. Over a 6-year period, 64 workshops were delivered by 181 medical students to 1651 high school students in six schools. The workshop is acceptable, do-able, effective and sustainable, characteristics that arise from the mutual benefits to all the groups involved: the medical school, the school board, the medical students, the high school teachers and students. The workshop provides a model for providing health care education to adolescents in the community. Teaching adolescents the importance of good doctor-patient communication encourages them to take ongoing responsibility for their health care and is an alternative route to direct health care education.

  1. 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

  2. A Web-Based Toolkit to Provide Evidence-Based Resources About Crystal Methamphetamine for the Australian Community: Collaborative Development of Cracks in the Ice.

    Science.gov (United States)

    Champion, Katrina Elizabeth; Chapman, Cath; Newton, Nicola Clare; Brierley, Mary-Ellen; Stapinski, Lexine; Kay-Lambkin, Frances; Nagle, Jack; Teesson, Maree

    2018-03-20

    , improving the ease of navigation, and balancing a "low prevalence of use, yet high impact" message. A total of 9138 users visited the website in the 3 months immediately post launch, and over 25,000 hard-copy Cracks in the Ice booklets and flyers were distributed across Australia. Of these resources, 60.93% (15,525/25,480) were distributed to relevant organizations and mailing list subscribers, and 39.07% (9955/25,480) were ordered directly by individuals, services, and community groups via the Cracks in the Ice website. The codevelopment process resulted in an engaging Web-based resource for the Australian community to access up-to-date and evidence-based resources about crystal methamphetamine. The Cracks in the Ice Community Toolkit provides much-needed information and support for individuals, families, and communities. ©Katrina Elizabeth Champion, Cath Chapman, Nicola Clare Newton, Mary-Ellen Brierley, Lexine Stapinski, Frances Kay-Lambkin, Jack Nagle, Maree Teesson. Originally published in JMIR Mental Health (http://mental.jmir.org), 20.03.2018.

  3. 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

  4. 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

  5. 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

    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....

  6. Intra-session repeatability of iridocorneal angle measurements provided by a Scheimpflug photography-based system in healthy eyes

    OpenAIRE

    Ruiz-Belda, Clara; Piñero, David P.; Ruiz Fortes, Pedro; Soto-Negro, Roberto; Moya, Myriam; Pérez Cambrodí, Rafael J.; Artola, Alberto

    2016-01-01

    Purpose: The purpose of this study was to evaluate intra-session repeatability of measurements of the iridocorneal angle at different meridians in the nasal and temporal areas in healthy eyes using the Sirius Scheimpflug photography-based system in glaucoma analysis mode. Methods: A total of 43 eyes of 43 patients ranging in age from 36 to 79 years were enrolled in the study. All eyes received a comprehensive ophthalmologic examination including a complete anterior segment analysis with the C...

  7. 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.

  8. 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

  9. Service guidelines based on Resource Utilization Groups Version III for Home Care provide decision-making support for case managers.

    Science.gov (United States)

    Collister, Barbara; Stein, Glenda; Katz, Deborah; DeBruyn, Joan; Andrusiw, Linda; Cloutier, Sheila

    2012-01-01

    Increasing costs and budget reductions combined with increasing demand from our growing, aging population support the need to ensure that the scarce resources allocated to home care clients match client needs. This article details how Integrated Home Care for the Calgary Zone of Alberta Health Services considered ethical and economic principles and used data from the Resident Assessment Instrument for Home Care (RAI-HC) and case mix indices from the Resource Utilization Groups Version III for Home Care (RUG-III/HC) to formulate service guidelines. These explicit service guidelines formalize and support individual resource allocation decisions made by case managers and provide a consistent and transparent method of allocating limited resources.

  10. 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

  11. 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.

  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. Global mass spectrometry and transcriptomics array based drug profiling provides novel insight into glucosamine induced endoplasmic reticulum stress

    DEFF Research Database (Denmark)

    Carvalho, Ana Sofia; Ribeiro, Helena; Voabil, Paula

    2014-01-01

    We investigated the molecular effects of glucosamine supplements, a popular and safe alternative to nonsteroidal anti-inflammatory drugs, for decreasing pain, inflammation, and maintaining healthy joints. Numerous studies have reported an array of molecular effects after glucosamine treatment. We...... questioned whether the differences in the effects observed in previous studies were associated with the focus on a specific subproteome or with the use of specific cell lines or tissues. To address this question, global mass spectrometry- and transcription array-based glucosamine drug profiling was performed....... Further, we hypothesize that O-HexNAcylation induced by glucosamine treatment enhances protein trafficking....

  14. Quantum-dot-based immunofluorescent imaging of HER2 and ER provides new insights into breast cancer heterogeneity

    International Nuclear Information System (INIS)

    Chen Chuang; Li Yan; Peng Jun; Xu Hao; Tang Hongwu; Zhang Zhiling; Pang Daiwen; Xia Heshun; Wu Qiongshui; Zeng Libo; Zhu Xiaobo

    2010-01-01

    Breast cancer (BC) is a heterogeneous tumor, and better understanding of its heterogeneity is essential to improving treatment effect. Quantum dot (QD)-based immunofluorescent nanotechnology (QD-IHC) for molecular pathology has potential advantages in delineating tumor heterogeneity. This potential is explored in this paper by QD-IHC imaging of HER2 and ER. BC heterogeneity can be displayed more clearly and sensitively by QD-IHC than conventional IHC in BC tissue microarrays. Furthermore, the simultaneous imaging of ER and HER2 might help understand their interactions during the process of evolution of heterogeneous BC.

  15. Hepatitis B virus vaccination booster does not provide additional protection in adolescents: a cross-sectional school-based study.

    Science.gov (United States)

    Chang, Yung-Chieh; Wang, Jen-Hung; Chen, Yu-Sheng; Lin, Jun-Song; Cheng, Ching-Feng; Chu, Chia-Hsiang

    2014-09-23

    Current consensus does not support the use of a universal booster of hepatitis B virus (HBV) vaccine because there is an anamnestic response in almost all children 15 years after universal infant HBV vaccination. We aimed to provide a booster strategy among adolescents as a result of their changes in lifestyle and sexual activity. This study comprised a series of cross-sectional serological surveys of HBV markers in four age groups between 2004 and 2012. The seropositivity rates of hepatitis B surface antigen (HBsAg) and its reciprocal antibody (anti-HBs) for each age group were collected. There were two parts to this study; age-specific HBV seroepidemiology and subgroup analysis, including effects of different vaccine types, booster response for immunogenicity at 15 years of age, and longitudinal follow-up to identify possible additional protection by HBV booster. Within the study period, data on serum anti-HBs and HBsAg in a total of 6950 students from four age groups were collected. The overall anti-HBs and HBsAg seropositivity rates were 44.3% and 1.2%, respectively. The anti-HBs seropositivity rate in the plasma-derived subgroup was significantly higher in both 15- and 18-year age groups. Overall response rate in the double-seronegative recipients at 15 years of age was 92.5% at 6 weeks following one recombinant HBV booster dose. Among the 24 recipients showing anti-HBs seroconversion at 6 weeks after booster, seven subjects (29.2%) had lost their anti-HBs seropositivity again within 3 years. Increased seropositivity rates and titers of anti-HBs did not provide additional protective effects among subjects comprehensively vaccinated against HBV in infancy. HBV booster strategy at 15 years of age was the main contributor to the unique age-related phenomenon of anti-HBs seropositivity rate and titer. No increase in HBsAg seropositivity rates within different age groups was observed. Vaccination with plasma-derived HBV vaccines in infancy provided higher

  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. 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.

  18. Protein Based Molecular Markers Provide Reliable Means to Understand Prokaryotic Phylogeny and Support Darwinian Mode of Evolution

    Directory of Open Access Journals (Sweden)

    Vaibhav eBhandari

    2012-07-01

    Full Text Available The analyses of genome sequences have led to the proposal that lateral gene transfers (LGTs among prokaryotes are so widespread that they disguise the interrelationships among these organisms. This has led to questioning whether the Darwinian model of evolution is applicable to the prokaryotic organisms. In this review, we discuss the usefulness of taxon-specific molecular markers such as conserved signature indels (CSIs and conserved signature proteins (CSPs for understanding the evolutionary relationships among prokaryotes and to assess the influence of LGTs on prokaryotic evolution. The analyses of genomic sequences have identified large numbers of CSIs and CSPs that are unique properties of different groups of prokaryotes ranging from phylum to genus levels. The species distribution patterns of these molecular signatures strongly support a tree-like vertical inheritance of the genes containing these molecular signatures that is consistent with phylogenetic trees. Recent detailed studies in this regard on Thermotogae and Archaea, which are reviewed here, have identified large numbers of CSIs and CSPs that are specific for the species from these two taxa and a number of their major clades. The genetic changes responsible for these CSIs (and CSPs initially likely occurred in the common ancestors of these taxa and then vertically transferred to various descendants. Although some CSIs and CSPs in unrelated groups of prokaryotes were identified, their small numbers and random occurrence has no apparent influence on the consistent tree-like branching pattern emerging from other markers. These results provide evidence that although LGT is an important evolutionary force, it does not mask the tree-like branching pattern of prokaryotes or understanding of their evolutionary relationships. The identified CSIs and CSPs also provide novel and highly specific means for identification of different groups of microbes and for taxonomical and biochemical

  19. Protein based molecular markers provide reliable means to understand prokaryotic phylogeny and support Darwinian mode of evolution.

    Science.gov (United States)

    Bhandari, Vaibhav; Naushad, Hafiz S; Gupta, Radhey S

    2012-01-01

    The analyses of genome sequences have led to the proposal that lateral gene transfers (LGTs) among prokaryotes are so widespread that they disguise the interrelationships among these organisms. This has led to questioning of whether the Darwinian model of evolution is applicable to prokaryotic organisms. In this review, we discuss the usefulness of taxon-specific molecular markers such as conserved signature indels (CSIs) and conserved signature proteins (CSPs) for understanding the evolutionary relationships among prokaryotes and to assess the influence of LGTs on prokaryotic evolution. The analyses of genomic sequences have identified large numbers of CSIs and CSPs that are unique properties of different groups of prokaryotes ranging from phylum to genus levels. The species distribution patterns of these molecular signatures strongly support a tree-like vertical inheritance of the genes containing these molecular signatures that is consistent with phylogenetic trees. Recent detailed studies in this regard on the Thermotogae and Archaea, which are reviewed here, have identified large numbers of CSIs and CSPs that are specific for the species from these two taxa and a number of their major clades. The genetic changes responsible for these CSIs (and CSPs) initially likely occurred in the common ancestors of these taxa and then vertically transferred to various descendants. Although some CSIs and CSPs in unrelated groups of prokaryotes were identified, their small numbers and random occurrence has no apparent influence on the consistent tree-like branching pattern emerging from other markers. These results provide evidence that although LGT is an important evolutionary force, it does not mask the tree-like branching pattern of prokaryotes or understanding of their evolutionary relationships. The identified CSIs and CSPs also provide novel and highly specific means for identification of different groups of microbes and for taxonomical and biochemical studies.

  20. 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.

  1. 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.

  2. 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

    2013-03-13

    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.

  3. Coalescent-Based Analyses of Genomic Sequence Data Provide a Robust Resolution of Phylogenetic Relationships among Major Groups of Gibbons

    Science.gov (United States)

    Shi, Cheng-Min; Yang, Ziheng

    2018-01-01

    Abstract The phylogenetic relationships among extant gibbon species remain unresolved despite numerous efforts using morphological, behavorial, and genetic data and the sequencing of whole genomes. A major challenge in reconstructing the gibbon phylogeny is the radiative speciation process, which resulted in extremely short internal branches in the species phylogeny and extensive incomplete lineage sorting with extensive gene-tree heterogeneity across the genome. Here, we analyze two genomic-scale data sets, with ∼10,000 putative noncoding and exonic loci, respectively, to estimate the species tree for the major groups of gibbons. We used the Bayesian full-likelihood method bpp under the multispecies coalescent model, which naturally accommodates incomplete lineage sorting and uncertainties in the gene trees. For comparison, we included three heuristic coalescent-based methods (mp-est, SVDQuartets, and astral) as well as concatenation. From both data sets, we infer the phylogeny for the four extant gibbon genera to be (Hylobates, (Nomascus, (Hoolock, Symphalangus))). We used simulation guided by the real data to evaluate the accuracy of the methods used. Astral, while not as efficient as bpp, performed well in estimation of the species tree even in presence of excessive incomplete lineage sorting. Concatenation, mp-est and SVDQuartets were unreliable when the species tree contains very short internal branches. Likelihood ratio test of gene flow suggests a small amount of migration from Hylobates moloch to H. pileatus, while cross-genera migration is absent or rare. Our results highlight the utility of coalescent-based methods in addressing challenging species tree problems characterized by short internal branches and rampant gene tree-species tree discordance. PMID:29087487

  4. A qualitative study of patient and provider perspectives on using web-based pain coping skills training to treat persistent cancer pain.

    Science.gov (United States)

    Rini, Christine; Vu, Maihan B; Lerner, Hannah; Bloom, Catherine; Carda-Auten, Jessica; Wood, William A; Basch, Ethan M; Voorhees, Peter M; Reeder-Hayes, Katherine E; Keefe, Francis J

    2018-04-01

    Persistent pain is common and inadequately treated in cancer patients. Behavioral pain interventions are a recommended part of multimodal pain treatments, but they are underused in clinical care due to barriers such as a lack of the resources needed to deliver them in person and difficulties coordinating their use with clinical care. Pain coping skills training (PCST) is an evidence-based behavioral pain intervention traditionally delivered in person. Delivering this training via the web would increase access to it by addressing barriers that currently limit its use. We conducted a patient pilot study of an 8-week web-based PCST program to determine the acceptability of this approach to patients and the program features needed to meet their needs. Focus groups with healthcare providers identified strategies for coordinating the use of web-based PCST in clinical care. Participants included 7 adults with bone pain due to multiple myeloma or metastasized breast or prostate cancer and 12 healthcare providers (4 physicians and 8 advanced practice providers) who treat cancer-related bone pain. Patients completed web-based PCST at home and then took part in an in-depth qualitative interview. Providers attended focus groups led by a trained moderator. Qualitative analyses identified themes in the patient and provider data. Patients reported strongly favorable responses to web-based PCST and described emotional and physical benefits. They offered suggestions for adapting the approach to better fit their needs and to overcome barriers to completion. Focus groups indicated a need to familiarize healthcare providers with PCST and to address concerns about overburdening patients. Providers would recommend the program to patients they felt could benefit. They suggested applying a broad definition of cancer pain and having various types of providers help coordinate program its use with clinical care. Web-based PCST was acceptable to patients and providers. Our findings suggest

  5. 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.

  6. 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

  7. Providing Policy Implication Based on the R and D Portfolio Analysis in Advanced Countries in the Nuclear Technology

    Energy Technology Data Exchange (ETDEWEB)

    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.

    2013-08-15

    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.

  8. Comparing the Substance-Dependents’ Profile of the Family Environment with Ordinary Persons for Providing Family Base Intervention

    Directory of Open Access Journals (Sweden)

    F NavabiNejad

    2014-12-01

    Full Text Available Objective: This study was conducted to compare the environment of families with and without substance-dependent members to investigatethe functioning of families with substance-dependent members and also provide them with appropriate treatment strategies. Method: A causative-comparative method followed by an ex post facto design was used in this study. A sample of 50-person suffering from substance-dependent disorder referring to outpatient treatment centers, located in west and east of Tehran, constituted the participants of the study. As well, another 50-person group not suffering from the disorder participated in this study as the former group’s counterpart. The participants answered the questions of environment of family scale (EFS (Moos & Moos, 1986. Findings: The results showed that there was a significant difference between two groups in dimensions of cohesion, conflict, achievement orientation, intellectual-cultural orientation, religious orientation, organization, and control whereas therewas no significant difference between the two groups in dimension of expressiveness, independency, and recreational orientation. Conclusion: The study recommendsthe authorities the application of efficient interventionist treatment strategies appropriate to the characteristics of families having drug-dependent member.

  9. 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.

  10. 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.

  11. 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…

  12. Assessment of Body Reserves in Camels

    Directory of Open Access Journals (Sweden)

    B. Faye

    2002-01-01

    Full Text Available Herbivores manage their body reserves in a way that helps them respond to variations in the quality and accessibility of feed resources. Assessing these reserves provides farmers with a decision-making tool. Almost no data are available on these aspects of the camel. The present article summarizes several works on weight estimations that are used to assess the volume and weight of the hump (main location of fat reserves, relationships between hump measurements and carcass weight, and between hump weight and perirenal fat weight. Assessing the number and size of adipocytes is a means to test the relevance of these types of fat storage. There is in particular a positive relationship between the size and number of adipocytes in the hump and those in the perirenal fat. The age and sex effects were very pronounced for some of the criteria. A body condition score was established for this species based on the assessment of selected body parts. Results however showed that the hump was not a good bodycondition indicator because of variations in its weight as well as in the size of its adipocytes.

  13. 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)

  14. Providing Databases for Different Indoor Positioning Technologies: Pros and Cons of Magnetic Field and Wi-Fi Based Positioning

    Directory of Open Access Journals (Sweden)

    Joaquín Torres-Sospedra

    2016-01-01

    Full Text Available Localization is one of the main pillars for indoor services. However, it is still very difficult for the mobile sensing community to compare state-of-the-art indoor positioning systems due to the scarcity of publicly available databases. To make fair and meaningful comparisons between indoor positioning systems, they must be evaluated in the same situation, or in the same sets of situations. In this paper, two databases are introduced for studying the performance of magnetic field and Wi-Fi fingerprinting based positioning systems in the same environment (i.e., indoor area. The “magnetic” database contains more than 40,000 discrete captures (270 continuous samples, whereas the “Wi-Fi” one contains 1,140 ones. The environment and both databases are fully detailed in this paper. A set of experiments is also presented where two simple but effective baselines have been developed to test the suitability of the databases. Finally, the pros and cons of both types of positioning techniques are discussed in detail.

  15. Field-Based Metabolomics of Vitis vinifera L. Stems Provides New Insights for Genotype Discrimination and Polyphenol Metabolism Structuring

    Directory of Open Access Journals (Sweden)

    Kévin Billet

    2018-06-01

    Full Text Available Grape accumulates numerous polyphenols with abundant health benefit and organoleptic properties that in planta act as key components of the plant defense system against diseases. Considerable advances have been made in the chemical characterization of wine metabolites particularly volatile and polyphenolic compounds. However, the metabotyping (metabolite-phenotype characterization of grape varieties, from polyphenolic-rich vineyard by-product is unprecedented. As this composition might result from the complex interaction between genotype, environment and viticultural practices, a field experiment was setting up with uniform pedo-climatic factors and viticultural practices of growing vines to favor the genetic determinism of polyphenol expression. As a result, UPLC-MS-based targeted metabolomic analyses of grape stems from 8 Vitis vinifera L. cultivars allowed the determination of 42 polyphenols related to phenolic acids, flavonoids, procyanidins, and stilbenoids as resveratrol oligomers (degree of oligomerization 1–4. Using a partial least-square discriminant analysis approach, grape stem chemical profiles were discriminated according to their genotypic origin showing that polyphenol profile express a varietal signature. Furthermore, hierarchical clustering highlights various degree of polyphenol similarity between grape varieties that were in agreement with the genetic distance using clustering analyses of 22 microsatellite DNA markers. Metabolite correlation network suggested that several polyphenol subclasses were differently controlled. The present polyphenol metabotyping approach coupled to multivariate statistical analyses might assist grape selection programs to improve metabolites with both health-benefit potential and plant defense traits.

  16. GSHR, a Web-Based Platform Provides Gene Set-Level Analyses of Hormone Responses in Arabidopsis

    Directory of Open Access Journals (Sweden)

    Xiaojuan Ran

    2018-01-01

    Full Text Available Phytohormones regulate diverse aspects of plant growth and environmental responses. Recent high-throughput technologies have promoted a more comprehensive profiling of genes regulated by different hormones. However, these omics data generally result in large gene lists that make it challenging to interpret the data and extract insights into biological significance. With the rapid accumulation of theses large-scale experiments, especially the transcriptomic data available in public databases, a means of using this information to explore the transcriptional networks is needed. Different platforms have different architectures and designs, and even similar studies using the same platform may obtain data with large variances because of the highly dynamic and flexible effects of plant hormones; this makes it difficult to make comparisons across different studies and platforms. Here, we present a web server providing gene set-level analyses of Arabidopsis thaliana hormone responses. GSHR collected 333 RNA-seq and 1,205 microarray datasets from the Gene Expression Omnibus, characterizing transcriptomic changes in Arabidopsis in response to phytohormones including abscisic acid, auxin, brassinosteroids, cytokinins, ethylene, gibberellins, jasmonic acid, salicylic acid, and strigolactones. These data were further processed and organized into 1,368 gene sets regulated by different hormones or hormone-related factors. By comparing input gene lists to these gene sets, GSHR helped to identify gene sets from the input gene list regulated by different phytohormones or related factors. Together, GSHR links prior information regarding transcriptomic changes induced by hormones and related factors to newly generated data and facilities cross-study and cross-platform comparisons; this helps facilitate the mining of biologically significant information from large-scale datasets. The GSHR is freely available at http://bioinfo.sibs.ac.cn/GSHR/.

  17. 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.

  18. 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

  19. Treatability Study in Support of the Intrinsic Remediation Option at the Current Fire Training Area, Westover Air Reserves Base, Chicopee, Massachusetts

    Science.gov (United States)

    1997-02-01

    Winter, 1987, p. 64-71. Bartha , R., 1986, Biotechnology of petroleum pollutant biodegradation: Microbial Ecology , vol. 12, p. 155-172. Bauman, B., 1991...Prepared for Air Force Systems Command, Wright-Patterson Air Force Base, Ohio, June. Atlas , R.M., 1981, Microbial degradation of petroleum hydrocarbons...of jet fuel and gasoline, including the BTEX compounds (e.g., lamison et at., 1975; Atlas , 1981, 1984, 1988; Gibson and Subramanian, 1984; Reinhard et

  20. Light sheet-based fluorescence microscopy (LSFM) reduces phototoxic effects and provides new means for the modern life sciences

    Science.gov (United States)

    Pampaloni, Francesco; Ansari, Nari; Girard, Philippe; Stelzer, Ernst H. K.

    2011-07-01

    Most optical technologies are applied to flat, basically two-dimensional cellular systems. However, physiological meaningful information relies on the morphology, the mechanical properties and the biochemistry of a cell's context. A cell requires the complex three-dimensional relationship to other cells. However, the observation of multi-cellular biological specimens remains a challenge. Specimens scatter and absorb light, thus, the delivery of the probing light and the collection of the signal light become inefficient; many endogenous biochemical compounds also absorb light and suffer degradation of some sort (photo-toxicity), which induces malfunction of a specimen. In conventional and confocal fluorescence microscopy, whenever a single plane, the entire specimen is illuminated. Recording stacks of images along the optical Z-axis thus illuminates the entire specimen once for each plane. Hence, cells are illuminated 10-20 and fish 100-300 times more often than they are observed. This can be avoided by changing the optical arrangement. The basic idea is to use light sheets, which are fed into the specimen from the side and overlap with the focal plane of a wide-field fluorescence microscope. In contrast to an epi-fluorescence arrangement, such an azimuthal fluorescence arrangement uses two independently operated lenses for illumination and detection. Optical sectioning and no photo-toxic damage or photo-bleaching outside a small volume close to the focal plane are intrinsic properties. Light sheet-based fluorescence microscopy (LSFM) takes advantage of modern camera technologies. LSFM can be operated with laser cutters and for fluorescence correlation spectroscopy. During the last few years, LSFM was used to record zebrafish development from the early 32-cell stage until late neurulation with sub-cellular resolution and short sampling periods (60-90 sec/stack). The recording speed was five 4-Megapixel large frames/sec with a dynamic range of 12-14 bit. We followed

  1. 77 FR 21846 - Reserve Requirements of Depository Institutions: Reserves Simplification

    Science.gov (United States)

    2012-04-12

    ... Requirements of Depository Institutions: Reserves Simplification AGENCY: Board of Governors of the Federal Reserve System. ACTION: Final rule. SUMMARY: The Board is amending Regulation D, Reserve Requirements of Depository Institutions, to simplify the administration of reserve requirements. The final rule creates a...

  2. Alternative measures of the Federal Reserve Banks' cost of equity capital

    OpenAIRE

    Barnes, Michelle L.; Lopez, Jose A.

    2005-01-01

    The Monetary Control Act of 1980 requires the Federal Reserve System to provide payment services to depository institutions through the twelve Federal Reserve Banks at prices that fully reflect the costs a private-sector provider would incur, including a cost of equity capital (COE). Although Fama and French (1997) conclude that COE estimates are “woefully” and “unavoidably” imprecise, the Reserve Banks require such an estimate every year. We examine several COE estimates based on the Capital...

  3. 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

  4. The design and development of GRASS file reservation system

    International Nuclear Information System (INIS)

    Huang Qiulan; Zhu Suijiang; Cheng Yaodong; Chen Gang

    2010-01-01

    GFRS (GRASS File Reservation System) is designed to improve the file access performance of GRASS (Grid-enabled Advanced Storage System) which is a Hierarchical Storage Management (HSM) system developed at Computing Center, Institute of High Energy Physics. GRASS can provide massive storage management and data migration, but the data migration policy is simply based factors such as pool water level, the intervals for migration and so on, so it is short of precise control over files. As for that, we design GFRS to implement user-based file reservation which is to reserve and keep the required files on disks for High Energy physicists. CFRS can improve file access speed for users by avoiding migrating frequently accessed files to tapes. In this paper we first give a brief introduction of GRASS system and then detailed architecture and implementation of GFRS. Experiments results from GFRS have shown good performance and a simple analysis is made based on it. (authors)

  5. Implementing Internet-Based Self-Care Programs in Primary Care: Qualitative Analysis of Determinants of Practice for Patients and Providers.

    Science.gov (United States)

    Hermes, Eric; Burrone, Laura; Perez, Elliottnell; Martino, Steve; Rowe, Michael

    2018-05-18

    Access to evidence-based interventions for common mental health conditions is limited due to geographic distance, scheduling, stigma, and provider availability. Internet-based self-care programs may mitigate these barriers. However, little is known about internet-based self-care program implementation in US health care systems. The objective of this study was to identify determinants of practice for internet-based self-care program use in primary care by eliciting provider and administrator perspectives on internet-based self-care program implementation. The objective was explored through qualitative analysis of semistructured interviews with primary care providers and administrators from the Veterans Health Administration. Participants were identified using a reputation-based snowball design. Interviews focused on identifying determinants of practice for the use of internet-based self-care programs at the point of care in Veterans Health Administration primary care. Qualitative analysis of transcripts was performed using thematic coding. A total of 20 physicians, psychologists, social workers, and nurses participated in interviews. Among this group, internet-based self-care program use was relatively low, but support for the platform was assessed as relatively high. Themes were organized into determinants active at patient and provider levels. Perceived patient-level determinants included literacy, age, internet access, patient expectations, internet-based self-care program fit with patient experiences, interest and motivation, and face-to-face human contact. Perceived provider-level determinants included familiarity with internet-based self-care programs, changes to traditional care delivery, face-to-face human contact, competing demands, and age. This exploration of perspectives on internet-based self-care program implementation among Veterans Health Administration providers and administrators revealed key determinants of practice, which can be used to develop

  6. A provider based accounting architecture

    NARCIS (Netherlands)

    Parhonyi, R.; Quartel, D.; Pras, A.

    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

  7. Resource utilization and cost-effectiveness of counselor- vs. provider-based rapid point-of-care HIV screening in the emergency department.

    Directory of Open Access Journals (Sweden)

    Rochelle P Walensky

    Full Text Available Routine HIV screening in emergency department (ED settings may require dedicated personnel. We evaluated the outcomes, costs and cost-effectiveness of HIV screening when offered by either a member of the ED staff or by an HIV counselor.We employed a mathematical model to extend data obtained from a randomized clinical trial of provider- vs. counselor-based HIV screening in the ED. We compared the downstream survival, costs, and cost-effectiveness of three HIV screening modalities: 1 no screening program; 2 an ED provider-based program; and 3 an HIV counselor-based program. Trial arm-specific data were used for test offer and acceptance rates (provider offer 36%, acceptance 75%; counselor offer 80%, acceptance 71%. Undiagnosed HIV prevalence (0.4% and linkage to care rates (80% were assumed to be equal between the screening modalities. Personnel costs were derived from trial-based resource utilization data. We examined the generalizability of results by conducting sensitivity analyses on offer and acceptance rates, undetected HIV prevalence, and costs.Estimated HIV screening costs in the provider and counselor arms averaged $8.10 and $31.00 per result received. The Provider strategy (compared to no screening had an incremental cost-effectiveness ratio of $58,700/quality-adjusted life year (QALY and the Counselor strategy (compared to the Provider strategy had an incremental cost-effectiveness ratio of $64,500/QALY. Results were sensitive to the relative offer and acceptance rates by strategy and the capacity of providers to target-screen, but were robust to changes in undiagnosed HIV prevalence and programmatic costs.The cost-effectiveness of provider-based HIV screening in an emergency department setting compares favorably to other US screening programs. Despite its additional cost, counselor-based screening delivers just as much return on investment as provider based-screening. Investment in dedicated HIV screening personnel is justified in

  8. Resource utilization and cost-effectiveness of counselor- vs. provider-based rapid point-of-care HIV screening in the emergency department.

    Science.gov (United States)

    Walensky, Rochelle P; Morris, Bethany L; Reichmann, William M; Paltiel, A David; Arbelaez, Christian; Donnell-Fink, Laurel; Katz, Jeffrey N; Losina, Elena

    2011-01-01

    Routine HIV screening in emergency department (ED) settings may require dedicated personnel. We evaluated the outcomes, costs and cost-effectiveness of HIV screening when offered by either a member of the ED staff or by an HIV counselor. We employed a mathematical model to extend data obtained from a randomized clinical trial of provider- vs. counselor-based HIV screening in the ED. We compared the downstream survival, costs, and cost-effectiveness of three HIV screening modalities: 1) no screening program; 2) an ED provider-based program; and 3) an HIV counselor-based program. Trial arm-specific data were used for test offer and acceptance rates (provider offer 36%, acceptance 75%; counselor offer 80%, acceptance 71%). Undiagnosed HIV prevalence (0.4%) and linkage to care rates (80%) were assumed to be equal between the screening modalities. Personnel costs were derived from trial-based resource utilization data. We examined the generalizability of results by conducting sensitivity analyses on offer and acceptance rates, undetected HIV prevalence, and costs. Estimated HIV screening costs in the provider and counselor arms averaged $8.10 and $31.00 per result received. The Provider strategy (compared to no screening) had an incremental cost-effectiveness ratio of $58,700/quality-adjusted life year (QALY) and the Counselor strategy (compared to the Provider strategy) had an incremental cost-effectiveness ratio of $64,500/QALY. Results were sensitive to the relative offer and acceptance rates by strategy and the capacity of providers to target-screen, but were robust to changes in undiagnosed HIV prevalence and programmatic costs. The cost-effectiveness of provider-based HIV screening in an emergency department setting compares favorably to other US screening programs. Despite its additional cost, counselor-based screening delivers just as much return on investment as provider based-screening. Investment in dedicated HIV screening personnel is justified in situations

  9. 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.

  10. 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.

  11. Evaluation of phylogenetic reconstruction methods using bacterial whole genomes: a simulation based study [version 1; referees: 1 approved, 2 approved with reservations

    Directory of Open Access Journals (Sweden)

    John A. Lees

    2018-03-01

    Full Text Available Background: Phylogenetic reconstruction is a necessary first step in many analyses which use whole genome sequence data from bacterial populations. There are many available methods to infer phylogenies, and these have various advantages and disadvantages, but few unbiased comparisons of the range of approaches have been made. Methods: We simulated data from a defined “true tree” using a realistic evolutionary model. We built phylogenies from this data using a range of methods, and compared reconstructed trees to the true tree using two measures, noting the computational time needed for different phylogenetic reconstructions. We also used real data from Streptococcus pneumoniae alignments to compare individual core gene trees to a core genome tree. Results: We found that, as expected, maximum likelihood trees from good quality alignments were the most accurate, but also the most computationally intensive. Using less accurate phylogenetic reconstruction methods, we were able to obtain results of comparable accuracy; we found that approximate results can rapidly be obtained using genetic distance based methods. In real data we found that highly conserved core genes, such as those involved in translation, gave an inaccurate tree topology, whereas genes involved in recombination events gave inaccurate branch lengths. We also show a tree-of-trees, relating the results of different phylogenetic reconstructions to each other. Conclusions: We recommend three approaches, depending on requirements for accuracy and computational time. Quicker approaches that do not perform full maximum likelihood optimisation may be useful for many analyses requiring a phylogeny, as generating a high quality input alignment is likely to be the major limiting factor of accurate tree topology. We have publicly released our simulated data and code to enable further comparisons.

  12. 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.

  13. 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

    Background: 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. Objectives: This study is designed to assess the effectiveness of class lecture versus workshop-based teaching of BLS on acquiring the practice skills on mannequin. Methods: 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). Conclusion: Workshop-based BLS teaching is more effective and lecture-based class teaching better is replaced in medical education curriculum. PMID:27308252

  14. Uniform Reserve Training and Retirement Category Administration

    National Research Council Canada - National Science Library

    Kohner, D

    1997-01-01

    This Instruction implement policy as provided in DoD Directive 1215.6, assigns responsibilities and prescribes procedures that pertain to the designation and use of uniform Reserve component (RC) categories (RCCs...

  15. Reserve selection with land market feedbacks.

    Science.gov (United States)

    Butsic, Van; Lewis, David J; Radeloff, Volker C

    2013-01-15

    How to best site reserves is a leading question for conservation biologists. Recently, reserve selection has emphasized efficient conservation: maximizing conservation goals given the reality of limited conservation budgets, and this work indicates that land market can potentially undermine the conservation benefits of reserves by increasing property values and development probabilities near reserves. Here we propose a reserve selection methodology which optimizes conservation given both a budget constraint and land market feedbacks by using a combination of econometric models along with stochastic dynamic programming. We show that amenity based feedbacks can be accounted for in optimal reserve selection by choosing property price and land development models which exogenously estimate the effects of reserve establishment. In our empirical example, we use previously estimated models of land development and property prices to select parcels to maximize coarse woody debris along 16 lakes in Vilas County, WI, USA. Using each lake as an independent experiment, we find that including land market feedbacks in the reserve selection algorithm has only small effects on conservation efficacy. Likewise, we find that in our setting heuristic (minloss and maxgain) algorithms perform nearly as well as the optimal selection strategy. We emphasize that land market feedbacks can be included in optimal reserve selection; the extent to which this improves reserve placement will likely vary across landscapes. Copyright © 2012 Elsevier Ltd. All rights reserved.

  16. When human immunodeficiency virus (HIV) treatment goals conflict with guideline-based opioid prescribing: A qualitative study of HIV treatment providers.

    Science.gov (United States)

    Starrels, Joanna L; Peyser, Deena; Haughton, Lorlette; Fox, Aaron; Merlin, Jessica S; Arnsten, Julia H; Cunningham, Chinazo O

    2016-01-01

    Human immunodeficiency virus (HIV)-infected patients have a high prevalence of chronic pain and opioid use, making HIV care a critical setting for improving the safety of opioid prescribing. Little is known about HIV treatment providers' perspectives about opioid prescribing to patients with chronic pain. The authors administered a questionnaire and conducted semistructured telephone interviews with 18 HIV treatment providers (infectious disease specialists, general internists, family medicine physicians, nurse practitioners, and physician assistants) in Bronx, NY. Open-ended interview questions focused on providers' experiences, beliefs, and attitudes about opioid prescribing and about the use of guideline-based opioid prescribing practices (conservative prescribing, and monitoring for and responding to misuse). Transcripts were thematically analyzed using a modified grounded theory approach. Eighteen HIV treatment providers included 13 physicians, four nurse practitioners, and one physician assistant. They were 62% female, 56% white, and practiced as HIV treatment providers for a mean of 14.6 years. Most reported always or almost always using opioid treatment agreements (56%) and urine drug testing (61%) with their patients on long-term opioid therapy. HIV treatment providers tended to view opioid prescribing for chronic pain within the "HIV paradigm," a set of priorities and principles defined by three key themes: (1) primacy of HIV goals, (2) familiarity with substance use, and (3) the clinician as ally. The HIV paradigm sometimes supported, and sometimes conflicted with, guideline-based opioid prescribing practices. For HIV treatment providers, perceived alignment with the HIV paradigm determined whether and how guideline-based opioid prescribing practices were adopted. For example, the primacy of HIV goals superseded conservative opioid prescribing when providers prescribed opioids with the goal of retaining patients in HIV care. These findings highlight

  17. 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

  18. Status of fossil fuel reserves

    International Nuclear Information System (INIS)

    Laherrere, J.

    2005-01-01

    Reserves represent the sum of past and future productions up to the end of production. In most countries the reserve data of fields are confidential. Therefore, fossil fuel reserves are badly known because the published data are more political than technical and many countries make a confusion between resources and reserves. The cumulated production of fossil fuels represents only between a third and a fifth of the ultimate reserves. The production peak will take place between 2020 and 2050. In the ultimate reserves, which extrapolate the past, the fossil fuels represent three thirds of the overall energy. This document analyses the uncertainties linked with fossil fuel reserves: reliability of published data, modeling of future production, comparison with other energy sources, energy consumption forecasts, reserves/production ratio, exploitation of non-conventional hydrocarbons (tar sands, extra-heavy oils, bituminous shales, coal gas, gas shales, methane in overpressure aquifers, methane hydrates), technology impacts, prices impact, and reserves growth. (J.S.)

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

    OpenAIRE

    Jacobs, M.

    2015-01-01

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

  20. 77 FR 66361 - Reserve Requirements of Depository Institutions: Reserves Simplification

    Science.gov (United States)

    2012-11-05

    ... Requirements of Depository Institutions: Reserves Simplification AGENCY: Board of Governors of the Federal... (Reserve Requirements of Depository Institutions) published in the Federal Register on April 12, 2012. The... simplifications related to the administration of reserve requirements: 1. Create a common two-week maintenance...

  1. 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

  2. Demographics of cleft care providers in Africa and reported experience in training and practice: direct analysis of continent-based practitioners.

    Science.gov (United States)

    Adetayo, Oluwaseun A; Martin, Mark C

    2012-05-01

    To elucidate the impact of several geographic, cultural, and socioeconomic variables on cleft care delivery in Africa, and to investigate the current status of cleft care delivery in Africa. Survey of practitioners attending the second Pan-African Congress on Cleft Lip and Palate (PACCLIP). The annual PACCLIP conference in Ibadan, Nigeria, West Africa, February 2007. To provide an analysis of the demographics and training experience of cleft care providers in Africa by collating information directly from the continent-based practitioners. Plastic surgeons and oral and maxillofacial surgeons provide the majority of cleft care. Most of the participants reported availability of formal training programs in their respective countries. The predominant practice settings were university and government-based. During training, half of the providers had encountered up to 30 cleft cases, and a quarter had managed more than 100 cases. Representation of visiting surgeons were equally distributed between African and non-African countries. This study provides initial and detailed analysis crucial to understanding the underlying framework of cleft care composition teams, demographics of providers, and training and practice experience. This awareness will further enable North American and other non-African plastic surgeons to effectively partner with African cleft care providers to have a further reaching impact in the region.

  3. 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

  4. The information content of supplemental reserve-based replacement measures relative to that of historical cost income and its cash and accrual components of oil and gas producing companies

    International Nuclear Information System (INIS)

    Spear, N.A.

    1992-01-01

    The empirical analysis indicated that two of the three reserve-based quantity replacement measures are very useful, in terms of explaining the security returns of full cost oil and gas producing companies during the release week of the 1982-1986 annual reports or 10-K filings of these companies. The analysis also indicated that two of the three reserve-based value replacement measures are very useful, in terms of explaining the security returns of full cost oil and gas producing companies during the release week of the 1984-1986 annual reports or 10-K filings. For the period 1987-1988, the empirical analysis indicated that all of the reserve-based quantity and value replacement measures are not useful, in terms of explaining the security returns of full cost oil and gas producing companies during the release week of the annual reports or 10-K filings. The empirical analysis showed no consistent evidence to indicate any systematic difference between the implications of the cash and accrual components of earnings of either the full cost or the successful efforts oil and gas producing companies during the release week of the annual report or 10-K filings

  5. 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.

  6. 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

  7. 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

  8. 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…

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

    NARCIS (Netherlands)

    Jacobs, M.

    2015-01-01

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

  10. Base-stock policies with reservations

    NARCIS (Netherlands)

    van Foreest, Nicky D.; Teunter, Ruud H.; Syntetos, Aris A.

    2018-01-01

    All intensively studied and widely applied inventory control policies satisfy demand in accordance with the First-Come-First-Served (FCFS) rule, whether this demand is in backorder or not. Interestingly, this rule is sub-optimal when the fill-rate is constrained or when the backorder cost structure

  11. MAX Provider Characteristics

    Data.gov (United States)

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

  12. A Comparative Analysis of Outstanding Claim Reserves

    Directory of Open Access Journals (Sweden)

    Zlata Djuric

    2017-12-01

    Full Text Available The key processes in the business of insurance companies which define the financial viability of their business activities, as the most important element, are the adequate amount of technical reserves. A qualitative assessment of the technical reserves level is the basic support to the management of the key business processes and proper strategic and financial decision-making in order to maximize the viability, profitability, competitiveness, and further development of the company. Based on the data on the operations of an insurance company, within a single line of insurance, different, in practice, most frequently used methods were applied in order to determine the deviation amplitude of the projected amounts from the actual claims. Another direction of research focuses on actuarial practice in non-life insurance companies operating in the territory of the Republic of Serbia. The comparative analysis of the obtained projection points to the fact that the chosen methods, commonly used in actuarial practice in the Republic of Serbia, should be monitored and reviewed. The results of the multidirectional research and detection of the existing problems provide a useful framework and a stimulating mechanism, as well as the guidelines to improve the operations and better positioning of insurance in the commercial and economic environment of the Republic of Serbia.

  13. Accounting for uncertainty in marine reserve design.

    Science.gov (United States)

    Halpern, Benjamin S; Regan, Helen M; Possingham, Hugh P; McCarthy, Michael A

    2006-01-01

    Ecosystems and the species and communities within them are highly complex systems that defy predictions with any degree of certainty. Managing and conserving these systems in the face of uncertainty remains a daunting challenge, particularly with respect to developing networks of marine reserves. Here we review several modelling frameworks that explicitly acknowledge and incorporate uncertainty, and then use these methods to evaluate reserve spacing rules given increasing levels of uncertainty about larval dispersal distances. Our approach finds similar spacing rules as have been proposed elsewhere - roughly 20-200 km - but highlights several advantages provided by uncertainty modelling over more traditional approaches to developing these estimates. In particular, we argue that uncertainty modelling can allow for (1) an evaluation of the risk associated with any decision based on the assumed uncertainty; (2) a method for quantifying the costs and benefits of reducing uncertainty; and (3) a useful tool for communicating to stakeholders the challenges in managing highly uncertain systems. We also argue that incorporating rather than avoiding uncertainty will increase the chances of successfully achieving conservation and management goals.

  14. 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

  15. Development of a geodatabase and conceptual model of the hydrogeologic units beneath air force plant 4 and Naval Air Station-Joint Reserve Base Carswell Field, Fort Worth, Texas

    Science.gov (United States)

    Shah, Sachin D.

    2004-01-01

    Air Force Plant 4 and adjacent Naval Air Station-Joint Reserve Base Carswell Field at Fort Worth, Texas, constitute a government-owned, contractor-operated facility that has been in operation since 1942. Contaminants from AFP4, primarily volatile organic compounds and metals, have entered the ground-water-flow system through leakage from waste-disposal sites and from manufacturing processes. The U.S. Geological Survey developed a comprehensive geodatabase of temporal and spatial environmental information associated with the hydrogeologic units (alluvial aquifer, Goodland-Walnut confining unit, and Paluxy aquifer) beneath the facility and a three-dimensional conceptual model of the hydrogeologic units integrally linked to the geodatabase. The geodatabase design uses a thematic layer approach to create layers of feature data using a geographic information system. The various features are separated into relational tables in the geodatabase on the basis of how they interact and correspond to one another. Using the geodatabase, geographic data at the site are manipulated to produce maps, allow interactive queries, and perform spatial analyses. The conceptual model for the study area comprises computer-generated, three-dimensional block diagrams of the hydrogeologic units. The conceptual model provides a platform for visualization of hydrogeologic-unit sections and surfaces and for subsurface environmental analyses. The conceptual model is based on three structural surfaces and two thickness configurations of the study area. The three structural surfaces depict the altitudes of the tops of the three hydrogeologic units. The two thickness configurations are those of the alluvial aquifer and the Goodland-Walnut confining unit. The surface of the alluvial aquifer was created using a U.S. Geological Survey 10-meter digital elevation model. The 2,130 point altitudes of the top of the Goodland-Walnut unit were compiled from lithologic logs from existing wells, available soil

  16. Pricing of reserves. Valuing system reserve capacity against spot prices in electricity markets

    International Nuclear Information System (INIS)

    Just, Sebastian; Weber, Christoph

    2008-01-01

    This paper models the interdependencies between markets for secondary reserve capacity and spot electricity to derive the pricing of reserves under equilibrium conditions. Starting with the indifference condition between offering in both markets, the reservation price is derived from the opportunity cost consideration and the unit commitment conditions in a fundamental interrelated market framework. The reserve market examined compares widely to the German market for secondary reserves, but the general approach may also be used to investigate other reserve markets. The approach explores and formalizes the influence of reserve capacity on the spot market supply function. A numerical solution procedure is provided to this non-trivial case of market interaction. The model is used to estimate the expected reservation price development over the last years in Germany. (author)

  17. Improving communication when seeking informed consent: a randomised controlled study of a computer-based method for providing information to prospective clinical trial participants.

    Science.gov (United States)

    Karunaratne, Asuntha S; Korenman, Stanley G; Thomas, Samantha L; Myles, Paul S; Komesaroff, Paul A

    2010-04-05

    To assess the efficacy, with respect to participant understanding of information, of a computer-based approach to communication about complex, technical issues that commonly arise when seeking informed consent for clinical research trials. An open, randomised controlled study of 60 patients with diabetes mellitus, aged 27-70 years, recruited between August 2006 and October 2007 from the Department of Diabetes and Endocrinology at the Alfred Hospital and Baker IDI Heart and Diabetes Institute, Melbourne. Participants were asked to read information about a mock study via a computer-based presentation (n = 30) or a conventional paper-based information statement (n = 30). The computer-based presentation contained visual aids, including diagrams, video, hyperlinks and quiz pages. Understanding of information as assessed by quantitative and qualitative means. Assessment scores used to measure level of understanding were significantly higher in the group that completed the computer-based task than the group that completed the paper-based task (82% v 73%; P = 0.005). More participants in the group that completed the computer-based task expressed interest in taking part in the mock study (23 v 17 participants; P = 0.01). Most participants from both groups preferred the idea of a computer-based presentation to the paper-based statement (21 in the computer-based task group, 18 in the paper-based task group). A computer-based method of providing information may help overcome existing deficiencies in communication about clinical research, and may reduce costs and improve efficiency in recruiting participants for clinical trials.

  18. 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.

  19. Effects of the DRG-based prospective payment system operated by the voluntarily participating providers on the cesarean section rates in Korea.

    Science.gov (United States)

    Lee, Kwangsoo; Lee, Sangil

    2007-05-01

    This study explored the effects of the diagnosis-related group (DRG)-based prospective payment system (PPS) operated by voluntarily participating organizations on the cesarean section (CS) rates, and analyzed whether the participating health care organizations had similar CS rates despite the varied participation periods. The study sample included delivery claims data from the Korean national health insurance program for the year 2003. Risk factors were identified and used in the adjustment model to distinguish the main reason for CS. Their risk-adjusted CS rates were compared by the reimbursement methods, and the organizations' internal and external environments were controlled. The final risk-adjustment model for the CS rates meets the criteria for an effective model. There were no significant differences of CS rates between providers in the DRG and fee-for-service system after controlling for organizational variables. The CS rates did not vary significantly depending on the providers' DRG participation periods. The results provide evidence that the DRG payment system operated by volunteering health care organizations had no impact on the CS rates, which can lower the quality of care. Although the providers joined the DRG system in different years, there were no differences in the CS rates among the DRG providers. These results support the future expansion of the DRG-based PPS plan to all health care services in Korea.

  20. Role of informal care providers in home based long term care in diabetes mellitus at Kaiwara Primary Health Center area, Karnataka, India

    Directory of Open Access Journals (Sweden)

    Arjunan Isaac

    2011-06-01

    Full Text Available Objective: To find the prevalence of diabetics, identify informal care providers for them in Kaiwara Primary Health Center (PHC area, assess the level of knowledge and skills of an informal care provider in home based long term care and improve the level of knowledge and skill of the informal care provider through a structured training capsule. Methods: A cross sectional and an interventional study was conducted on diabetics and their informal care providers in Kaiwara PHC area. Data were collected using pre-tested, structured questionnaire by an interview method. A structured training capsule was developed and implemented. Evaluation of the knowledge and skills was assessed at the beginning and at the end of the training. Student ’s paired/unpaired ‘t ’ tests and correlation analysis were done. Results: Improvement scores were calculated by subtracting the pre-evaluation scores from the post-evaluation scores. The mean improvement scores was (2.66暲0.32 and was statistically significant (P<0.001. No significant difference in mean values was found in the knowledge and skills scores in relation to the socio-demographic variables in the study. Conclusions: Knowledge and skills component of the informal care provider in home based care of diabetes could be perceived as a “felt need ”.

  1. 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.

  2. 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

  3. 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.

  4. 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.

  5. 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

  6. 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.

  7. 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.

  8. Comparison between exclusively school teacher-based and mixed school teacher and healthcare provider-based programme on basic cardiopulmonary resuscitation for secondary schools.

    Science.gov (United States)

    Jiménez-Fábrega, X; Escalada-Roig, X; Miró, O; Sanclemente, G; Díaz, N; Gómez, X; Villena, O; Rodríguez, E; Gaspar, A; Molina, J E; Salvador, J; Sánchez, M

    2009-09-01

    To compare two teaching methodologies for PROCES (a basic cardiopulmonary resuscitation (b-CPR) programme for secondary school students): one exclusively performed by school teachers (study group) and another by a mixed team of school teachers and healthcare providers (control group). According to their preferences, teachers chose either method and students were consequently assigned to the control or study group. All participants took a 10 multiple-choice question exam regarding b-CPR skills twice: immediately after PROCES and one year later. Eight or more correct answers was considered satisfactory learning. Results between groups were compared. Associations between satisfactory learning and some student characteristics were analysed. Immediately after PROCES, 442 students (219 in the study group and 223 in the control group) took the exam. The percentage of satisfactory learning was not different: 67.1% in the study group and 64.6% in the control group. Immediate satisfactory learning was related to the absence of pending subjects in the control (odds ratio (OR) 2.31, 95% CI 1.16 to 4.64) and study (OR 5.87, 95% CI 1.22 to 28.20) groups. One year later, a greater percentage of retention of b-CRP skills was detected in the study group (57.1% vs 40.6%; p = 0.01). The absence of any pending subject (OR 6.86, 95% CI 1.83 to 25.66) was independently associated with better retention in the study group, but not the control group. Secondary school teachers, previously trained in b-CPR, can teach these skills effectively to 14-16-year-old students using PROCES. The retention of b-CPR skills is greater with this methodology compared with a more standardised programme.

  9. 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

  10. Characteristics of service users and provider organisations associated with experience of out of hours general practitioner care in England: population based cross sectional postal questionnaire survey

    OpenAIRE

    Warren, Fiona C; Abel, Gary; Lyratzopoulos, Georgios; Elliott, Marc N; Richards, Suzanne; Barry, Heather E; Roland, Martin; Campbell, John L

    2015-01-01

    Objective: To investigate the experience of users of out of hours general practitioner services in England, UK. Design: Population based cross sectional postal questionnaire survey. Setting: General Practice Patient Survey 2012-13. Main outcome measures: Potential associations between sociodemographic factors (including ethnicity and ability to take time away from work during working hours to attend a healthcare consultation) and provider organisation type (not for profit, NHS, or commercial)...

  11. 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

  12. 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

  13. Reservation wages and starting wages

    NARCIS (Netherlands)

    van Ophem, H.; Hartog, J.; Berkhout, P.

    2011-01-01

    We analyse a unique data set that combines reservation wage and actually paid wage for a large sample of Dutch recent higher education graduates. On average, accepted wages are almost 8% higher than reservation wages, but there is no fixed proportionality. We find that the difference between

  14. 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…

  15. Shadowing emergency medicine residents by medical education specialists to provide feedback on non-medical knowledge-based ACGME sub-competencies.

    Science.gov (United States)

    Waterbrook, Anna L; Spear Ellinwood, Karen C; Pritchard, T Gail; Bertels, Karen; Johnson, Ariel C; Min, Alice; Stoneking, Lisa R

    2018-01-01

    Non-medical knowledge-based sub-competencies (multitasking, professionalism, accountability, patient-centered communication, and team management) are challenging for a supervising emergency medicine (EM) physician to evaluate in real-time on shift while also managing a busy emergency department (ED). This study examines residents' perceptions of having a medical education specialist shadow and evaluate their nonmedical knowledge skills. Medical education specialists shadowed postgraduate year 1 and postgraduate year 2 EM residents during an ED shift once per academic year. In an attempt to increase meaningful feedback to the residents, these specialists evaluated resident performance in selected non-medical knowledge-based Accreditation Council of Graduate Medical Education (ACGME) sub-competencies and provided residents with direct, real-time feedback, followed by a written evaluation sent via email. Evaluations provided specific references to examples of behaviors observed during the shift and connected these back to ACGME competencies and milestones. Twelve residents participated in this shadow experience (six post graduate year 1 and six postgraduate year 2). Two residents emailed the medical education specialists ahead of the scheduled shadow shift requesting specific feedback. When queried, five residents voluntarily requested their feedback to be included in their formal biannual review. Residents received milestone scores and narrative feedback on the non-medical knowledge-based ACGME sub-competencies and indicated the shadow experience and subsequent feedback were valuable. Medical education specialists who observe residents over the course of an entire shift and evaluate non-medical knowledge-based skills are perceived by EM residents to provide meaningful feedback and add valuable information for the biannual review process.

  16. 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.

  17. 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

  18. 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.

  19. An evidence synthesis of the international knowledge base for new care models to inform and mobilise knowledge for multispecialty community providers (MCPs).

    Science.gov (United States)

    Turner, Alison; Mulla, Abeda; Booth, Andrew; Aldridge, Shiona; Stevens, Sharon; Battye, Fraser; Spilsbury, Peter

    2016-10-01

    NHS England's Five Year Forward View (NHS England, Five Year Forward View, 2014) formally introduced a strategy for new models of care driven by simultaneous pressures to contain costs, improve care and deliver services closer to home through integrated models. This synthesis focuses on a multispecialty community provider (MCP) model. This new model of care seeks to overcome the limitations in current models of care, often based around single condition-focused pathways, in contrast to patient-focused delivery (Royal College of General Practitioners, The 2022 GP: compendium of evidence, 2012) which offers greater continuity of care in recognition of complex needs and multimorbidity. The synthesis, an innovative combination of best fit framework synthesis and realist synthesis, will develop a "blueprint" which articulates how and why MCP models work, to inform design of future iterations of the MCP model. A systematic search will be conducted to identify research and practice-derived evidence to achieve a balance that captures the historical legacy of MCP models but focuses on contemporary evidence. Sources will include bibliographic databases including MEDLINE, PreMEDLINE, CINAHL, Embase, HMIC and Cochrane Library; and grey literature sources. The Best Fit synthesis methodology will be combined with a synthesis following realist principles which are particularly suited to exploring what works, when, for whom and in what circumstances. The aim of this synthesis is to provide decision makers in health and social care with a practical evidence base relating to the multispecialty community provider (MCP) model of care. PROSPERO CRD42016039552 .

  20. Principles of classification of NIS reserves ampersand resources

    International Nuclear Information System (INIS)

    Anon.

    1993-01-01

    The newly independent states of the former Soviet Union (NIS) control large resources of uranium. These resources have been the subject of substantial debate within several forums of the Western uranium industry because of confusion surrounding the degree of correlation between the Soviet and various Western classification systems. As illustrated in this article, although developed independently of Western systems, the classification system used by the NIS is very definitive and provides a sound basis for resource reporting. In 1981 a new open-quotes System of Classification of Reserves and Resources of Mineral Depositsclose quotes was adopted. This classification system, which is still used today in the newly independent states of the former Soviet Union (NIS), subdivides mineral deposits into seven categories in three major groups, based on the level of exploration performed: (1) Explored Reserves (A, B, C 1 ); (2) Evaluated Reserves (C 2 ); and (3) Predicted Resources (P 1 , P 2 , P 3 )

  1. 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.

  2. The business case for pediatric asthma quality improvement in low-income populations: examining a provider-based pay-for-reporting intervention.

    Science.gov (United States)

    Reiter, Kristin L; Lemos, Kristin Andrews; Williams, Charlotte E; Esposito, Dominick; Greene, Sandra B

    2015-06-01

    To measure the return on investment (ROI) for a pediatric asthma pay-for-reporting intervention initiated by a Medicaid managed care plan in New York State. Practice-level, randomized prospective evaluation. Twenty-five primary care practices providing care to children enrolled in the Monroe Plan for Medical Care (the Monroe Plan). Practices were randomized to either treatment (13 practices, 11 participated) or control (12 practices). For each of its eligible members assigned to a treatment group practice, the Monroe plan paid a low monthly incentive fee to the practice. To receive the incentive, treatment group practices were required to conduct, and report to the Monroe Plan, the results of chart audits on eligible members. Chart audits were conducted by practices every 6 months. After each chart audit, the Monroe Plan provided performance feedback to each practice comparing its adherence to asthma care guidelines with averages from all other treatment group practices. Control practices continued with usual care. Intervention implementation and operating costs and per member, per month claims costs. ROI was measured by net present value (discounted cash flow analysis). The ROI to the Monroe Plan was negative, primarily due to high intervention costs and lack of reductions in spending on emergency department and hospital utilization for children in treatment relative to control practices. A pay-for-reporting, chart audit intervention is unlikely to achieve the meaningful reductions in utilization of high-cost services that would be necessary to produce a financial ROI in 2.5 years. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

  3. HIV Care Providers' Attitudes regarding Mobile Phone Applications and Web-Based Dashboards to support Patient Self-Management and Care Coordination: Results from a Qualitative Feasibility Study.

    Science.gov (United States)

    Swendeman, Dallas; Farmer, Shu; Mindry, Deborah; Lee, Sung-Jae; Medich, Melissa

    2016-10-01

    In-depth qualitative interviews were conducted with healthcare providers (HCPs) from five HIV medical care coordination teams in a large Los Angeles County HIV clinic, including physicians, nurses, and psychosocial services providers. HCPs reported on the potential utility, acceptability, and barriers for patient self-monitoring and notifications via mobile phones, and web-based dashboards for HCPs. Potential benefits included: 1) enhancing patient engagement, motivation, adherence, and self-management; and 2) improving provider-patient relationships and HCP care coordination. Newly diagnosed and patients with co-morbidities were highest priorities for mobile application support. Facilitators included universal mobile phone ownership and use of smartphones or text messaging. Patient-level barriers included concerns about low motivation and financial instability for consistent use by some patients. Organizational barriers, cited primarily by physicians, included concerns about privacy protections, easy dashboard access, non-integrated electronic records, and competing burdens in limited appointment times. Psychosocial services providers were most supportive of the proposed mobile tools.

  4. Use of provider-based complementary and alternative medicine by adult smokers in the United States: Comparison from the 2002 and 2007 NHIS survey.

    Science.gov (United States)

    Hamm, Eric; Muramoto, Myra L; Howerter, Amy; Floden, Lysbeth; Govindarajan, Lubna

    2014-01-01

    To provide a snapshot of provider-based complementary and alternative medicine (pbCAM) use among adult smokers and assess the opportunity for these providers to deliver tobacco cessation interventions. Cross-sectional analysis of data from the 2002 and 2007 National Health Interview Surveys. Nationally representative sample. A total of 54,437 (31,044 from 2002; 23,393 from 2007) adults 18 years and older. The analysis focuses on 10 types of pbCAM, including acupuncture, Ayurveda, biofeedback, chelation therapy, chiropractic care, energy therapy, folk medicine, hypnosis, massage, and naturopathy. The proportions of current smokers using any pbCAM as well as specific types of pbCAM in 2002 and 2007 are compared using SAS SURVEYLOGISTIC. Between 2002 and 2007, the percentage of recent users of any pbCAM therapy increased from 12.5% to 15.4% (p = .001). The largest increases occurred in massage, chiropractic, and acupuncture. Despite a decrease in the national average of current smokers (22.0% to 19.4%; p = .001), proportions of smokers within specific pbCAM disciplines remained consistent. Complementary and alternative medicine (CAM) practitioners, particularly those in chiropractic, acupuncture, and massage, represent new cohorts in the health care community to promote tobacco cessation. There is an opportunity to provide brief tobacco intervention training to CAM practitioners and engage them in public health efforts to reduce the burden of tobacco use in the United States.

  5. Providing Culturally Competent Care for LGBTQ Youth in School-Based Health Centers: A Needs Assessment to Guide Quality of Care Improvements.

    Science.gov (United States)

    Garbers, Samantha; Heck, Craig J; Gold, Melanie A; Santelli, John S; Bersamin, Melina

    2017-01-01

    School-based health centers (SBHCs) can take specific steps to provide culturally competent care for lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth, potentially impacting well-being. A needs assessment survey was conducted among a convenience sample of SBHC administrators and medical directors to assess climates and actions supportive of LGBTQ quality medical care. Half (53%) of the SBHCs surveyed ( N = 66) reviewed print materials for negative LGBTQ stereotypes, and 27.3% conducted exhaustive materials review. Regional differences were detected: 46.2% of Southern SBHCs conducted any materials review compared to 91.3% in the West and all in the East and Midwest (χ 2 , p LGBTQ youth. On intake forms, 85.4% included preferred names, but only 23.5% included preferred pronoun. There are significant gaps in the extent to which SBHCs provide culturally competent care. These findings can guide future training and advocacy.

  6. 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

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

    DEFF Research Database (Denmark)

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

    2011-01-01

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

  8. 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.

  9. Securities issues in reserves reporting

    International Nuclear Information System (INIS)

    Legg, M.B.

    1997-01-01

    Securities issues in oil and gas reserves reporting were discussed. Alberta requires specific information regarding important oil and gas properties, plants, facilities and installations. When preparing the reserves report, the following elements are important to consider: (1) the author of the report must be a registered professional engineer or registered professional geologist, (2) the report itself must be an engineering document, (3) the content of the report must be extensive, (4) it should be prepared in accordance with petroleum engineering and evaluation practices, and must include a summary of estimated net reserves

  10. Use of gadolinium-based magnetic resonance imaging contrast agents and awareness of brain gadolinium deposition among pediatric providers in North America

    International Nuclear Information System (INIS)

    Mithal, Leena B.; Patel, Payal S.; Mithal, Divakar; Palac, Hannah L.; Rozenfeld, Michael N.

    2017-01-01

    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

  11. 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.

  12. 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

  13. 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

  14. 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.

  15. 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

  16. 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

  17. 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.

  18. Provider-Induced Demand in the Treatment of Carotid Artery Stenosis: Variation in Treatment Decisions Between Private Sector Fee-for-Service vs Salary-Based Military Physicians.

    Science.gov (United States)

    Nguyen, Louis L; Smith, Ann D; Scully, Rebecca E; Jiang, Wei; Learn, Peter A; Lipsitz, Stuart R; Weissman, Joel S; Helmchen, Lorens A; Koehlmoos, Tracey; Hoburg, Andrew; Kimsey, Linda G

    2017-06-01

    Although many factors influence the management of carotid artery stenosis, it is not well understood whether a preference toward procedural management exists when procedural volume and physician compensation are linked in the fee-for-service environment. To explore evidence for provider-induced demand in the management of carotid artery stenosis. The Department of Defense Military Health System Data Repository was queried for individuals diagnosed with carotid artery stenosis between October 1, 2006, and September 30, 2010. A hierarchical multivariable model evaluated the association of the treatment system (fee-for-service physicians in the private sector vs salary-based military physicians) with the odds of procedural intervention (carotid endarterectomy or carotid artery stenting) compared with medical management. Subanalysis was performed by symptom status at the time of presentation. The association of treatment system and of management strategy with clinical outcomes, including stroke and death, was also evaluated. Data analysis was conducted from August 15, 2015, to August 2, 2016. The odds of procedural intervention based on treatment system was the primary outcome used to indicate the presence and effect of provider-induced demand. Of 10 579 individuals with a diagnosis of carotid artery stenosis (4615 women and 5964 men; mean [SD] age, 65.6 [11.4] years), 1307 (12.4%) underwent at least 1 procedure. After adjusting for demographic and clinical factors, the odds of undergoing procedural management were significantly higher for patients in the fee-for-service system compared with those in the salary-based setting (odds ratio, 1.629; 95% CI, 1.285-2.063; P fee-for-service system were significantly more likely to undergo procedural management for carotid stenosis compared with those in the salary-based setting. These findings remained consistent for individuals with and without symptomatic disease.

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

    Scie