Sample records for understandable format consult

  1. Understanding the consultation processes

    International Nuclear Information System (INIS)

    Laing, A.C.


    This presentation focuses on the consultation processes between industry, government and First Nations communities regarding resource development. The expectations of the Crown are to facilitate capacity building within First Nations, to promote traditional use studies and to participate with industry proponents on certain consultation issues. The role of industry is to encourage partnerships between established contractors and First Nations contracting firms to allow First Nations firms to grow and experience success under the guidance of a mentor company. It is important to realize that solid First Nations relations are the key to shorter time lines and lower costs in developing projects. However, consultation and involvement must be 'real' with benefits and participation that fall within the First Nations Communities' definition of success

  2. Understanding Alliance Formation Patterns (United States)


    might take a different trend in different eras, in which it is either positive, leading to a bigger chance of alliance formation , or negative, leading...of war and peace with regard to systemic analysis. Therefore, it is reasonable that there is a deviation in the trends of alliance formation during...ALLIANCE FORMATION PATTERNS by Wael Abbas Zoltan Schneider December 2015 Thesis Advisor: William P. Fox Second Reader: Heather S. Gregg

  3. Consultation system for image diagnosis: Report formation support system

    International Nuclear Information System (INIS)

    Ikeda, M.; Sakuma, S.; Ishigaki, T.; Suzuki, K.; Oikawa, K.


    The authors developed a consultation system for image diagnosis, involving artificial intelligence ideas. In this system, the authors proposed a new report formation support system and implemented it in lymphangiography. This support system starts with the input of image interpretation. The input process is made mainly by selecting items. This system encodes the input findings into the semantic network, which is represented as a directed graph, and it reserves them into the knowledge database in the above structure. Finally, the output (report) is made in the near natural language, which corresponds to the input findings

  4. Impact of three alternative consultation training formats on self-efficacy and consultation skills of medical students. (United States)

    Aper, Leen; Reniers, Jan; Koole, Sebastiaan; Valcke, Martin; Derese, Anselme


    Conducting a consultation is a core competence of medical professionals. Consultation training of medical students centers on clinical, communication, reasoning and reflection skills. The training incorporates practice with a standardized simulated patient and supervising physician, to prepare for real patient encounters. To meet the request for more training, while dealing with an increasing student population and limited staff availability, alternative formats of consultation training were developed and evaluated. To investigate the impact of three consultation training formats on students' self-efficacy beliefs and their consultation skills acquisition. The three formats comprised (1) traditional training with supervising physician, (2) autonomous training with feedback from simulated patients and peers, without direct supervision and (3) online training based on video fragments and answering guiding questions. A quasi-experimental pre/posttest study was set up, with random assignment of students to a training condition. The differential impact was tested on two dependent measures: self-efficacy and consultation performance. Self-efficacy was tested with a nine-item scale and the cognitive component of consultation performance was tested on the base of responses to a standardized video case. The autonomous training has a significant positive effect on students' self-efficacy (p=0.016). The traditional training and the online training did only positively influence the cognitive component of the consultation competence (ptraining contributes to the learning process in a different way. In order to achieve optimum learning effects, medical educators should be aware of the particular impact of specific trainings on the cognitive and motivational side of skills and pursue a balanced mixture of instructional formats.

  5. Can audio recording of outpatient consultations improve patients recall and understanding?

    DEFF Research Database (Denmark)

    Wolderslund, Maiken

    clinicians, the communication is challenged by the fact that patients tend to forget or misunderstand parts of the information given. Thus we have designed a study which gives the patients a possibility to hear their consultation again. An Interactive Voice Response platform enables an audio recording...... of the dialogue between the patient and the clinician via the telephone in the consultation room. By dialing a dedicated number, patients can get access to an audio recording of their consultation by entering their social security number along with a PIN. The primary objective of this study is to determine...... whether providing patients with digital audio recording of the consultation affects the patients overall perception of their consultation and understanding of the information given. The study includes 5.460 patients from four different outpatient clinics: Pediatrics, Urology, Orthopedics and Internal...

  6. Communicating bodily changes: physicians' ways of enabling patient understanding in gastrointestinal cancer consultations. (United States)

    Friberg, Febe; Lidén, Eva; Håkanson, Cecilia; Öhlén, Joakim


    To explore how physicians communicatively enable patients' understanding of bodily changes in gastrointestinal cancer care consultations. Two datasets were used. The first consisted of transcribed video-recorded palliative care consultations with three oncologists and six patients diagnosed with advanced gastrointestinal cancer, in the context of outpatient palliative care. The second dataset was audio-recorded transcriptions from diagnostic consultations with six surgeons and seven patients diagnosed with colorectal cancer, in the context of cancer surgery. An inductively driven and iterative analysis of interaction was performed, guided by Wetherell et al. (2001). Two overarching communicative strategies were identified: (1) "visualizing strategies," with the dimensions: visible strategies (visualizing with what you actually or potentially can see), sensory strategies (visualizing with what is possible to feel), and imaginative strategies; and (2) "contrasting strategies," with the dimensions: contrasting subjective experiences and contrasting between the patient and other people. The visualizing and contrasting communicative strategies form parts of physicians' tacit and experience-based knowledge. The strategies employed by physicians reveal clear potentials to enable patients' understanding and sense making of bodily changes. However, these strategies need to be explicated and problematized as parts of both consultation practice and basic medical education. By means of increased awareness, physicians can more easily identify turning points in patients' levels of understanding, thereby enriching ordinary medical consultations with reflected pedagogical strategies and skills in how to dialogue in a person-centered manner.

  7. College Students' Understanding of Atmospheric Ozone Formation (United States)

    Howard, Kristen E.; Brown, Shane A.; Chung, Serena H.; Jobson, B. Thomas; VanReken, Timothy M.


    Research has shown that high school and college students have a lack of conceptual understanding of global warming, ozone, and the greenhouse effect. Most research in this area used survey methodologies and did not include concepts of atmospheric chemistry and ozone formation. This study investigates college students' understandings of atmospheric…


    Directory of Open Access Journals (Sweden)

    G. A. Ignatieva


    Full Text Available Introduction. Today the main social and economic advantage of Russia in global economy (we do not take natural wealth into account is the human capital which development has to become a priority for all levels of an education system. The relevance of the article determined by the need to modernize the educational programs, technology and content of the educational process in the institutional space of postgraduate teacher education. It is one of the key factors in the development of the intellectual capital of a society, providing a transition to continuous, socially oriented, associated with global and domestic fundamental science education for all people and aimed at the formation of the creative socially responsible personality. The new mission of post-degree training «through all life», consisting in the advancing formation of intellectual potential of the country, demands search of new forms and methods of additional professional education.Aim. The aim of the article is to disclosure the essence of scientific-project consulting as an innovative format of teachers and scientific-pedagogical staff.Methods. The institutional approach is the basis of the study. In accordance with this approach, the development strategy and the areas of work of traditional and new institutions of post-degree education – Department of Pedagogy and Andragogy and the Center of Scientific and Design Consulting are designated. As methodological base of this type of consulting, it is offered to use provisions of the genetic-substantial theory of the developing education, in particular the principle of development regulating processes of continuous improvement of professionalism of experts of education and development of new functions by them in post-industrial society.Results. The conceptual model of a reflexive outline of management of process of formation of new professional positions of the teacher is constructed; its components are

  9. The Formation of the Model of Diagnosing the Results Implementation of of Consulting Projects for Enterprises

    Directory of Open Access Journals (Sweden)

    Kuzmin Oleh Ye.


    Full Text Available In the article the graphic-analytical model of diagnostics of results of implementation of consulting projects is formed, which allows to: take into consideration interests of participants to the project on choice of methods and methodologies of diagnosing; allocate alternative sets of business indicators for each object of impact in terms of consulting project; establish economic and non-economic criteria for evaluating the effectiveness of consulting, as well as monitoring of indicators and automated processing of diagnostic results to control deviations from the optimal values of the diagnosed project results. A structural-logical model of formation of alternative sets of indicators and choice of indicators for diagnostics of results of consulting projects has been developed. The elements of the enterprise management system have been codified to harmonize the corresponding indicators with their subsequent combination within the proposed sets. The control system objects and their elements have been allocated. The groups of indicators according to the technology of Balanced Score Card (BSC have been presented. The prospect of further research is the economic assessment of implementation of the diagnosed consulting projects, which will reveal the links between the parameters of production-economic activity and the assessment of projects, and allows choose the most significant ones.

  10. Virtualized healthcare delivery: understanding users and their usage patterns of online medical consultations. (United States)

    Jung, Changmi; Padman, Rema


    Virtualization of healthcare delivery via patient portals has facilitated the increasing interest in online medical consultations due to its benefits such as improved convenience and flexibility, lower cost, and time savings. Despite this growing interest, adoption by both consumers and providers has been slow, and little is known about users and their usage and adoption patterns. To learn characteristics of online healthcare consumers and understand their patterns of adoption and usage of online clinical consultation services (or eVisits delivered via the portal) such as adoption time for portal users, whether adoption hazard changes over time, and what factors influence patients to become early/late adopters. Using online medical consultation records between April 1, 2009 and May 31, 2010 from four ambulatory practices affiliated with a major healthcare provider, we conduct simple descriptive analysis to understand the users of online clinical consults and their usage patterns. Multilevel Logit regression is employed to measure the effect of patient and primary care provider characteristics on the likelihood of eVisit adoption by the patient, and survival analysis and Ordered Logit regression are applied to study eVisit adoption patterns that delineate elements describing early or late adopters. On average, eVisit adopters are younger and predominantly female. Their primary care providers participate in the eVisit service, highlighting the importance of physician's role in encouraging patients to utilize the service. Patients who are familiar with the patient portal are more likely to use the service, as are patients with more complex health issues. Younger and female patients have higher adoption hazard, but gender does not affect the decision of adopting early vs. late. These adopters also access the patient portal more frequently before adoption, indicating that they are potentially more involved in managing their health. The majority of eVisits are submitted

  11. Consultation on dengue vaccines: progress in understanding protection, 26-28 June 2013, Rockville, Maryland. (United States)

    Cassetti, M Cristina; Halstead, Scott B


    There is an unmet need for a dengue vaccine to further prevent the spread of this disease and contain the growing pandemic. To this end several vaccine companies and academic groups are actively pursuing the development of a tetravalent vaccine to prevent dengue. In the last few years progress has been made in this area, including the first results of a vaccine efficacy trial and improved understanding of the immune responses to the infection. Despite this progress, development of dengue vaccines faces important challenges including the need for a vaccine that induces balanced immune responses against all dengue strains and an incomplete understanding of the mechanism(s) of protection against infection and disease. This is a summary of a Consultation on dengue vaccines held in June 26-28, 2013 by the National Institute of Allergy and Infectious Diseases (part of the US National Institutes of Health) and the Dengue Vaccine Initiative (part of the International Vaccine Institute). The primary goal of this consultation was to review the progress in dengue vaccine development, evaluate the known mechanism of protection of dengue vaccines and discuss avenues for future research. Copyright © 2014. Published by Elsevier Ltd.. All rights reserved.

  12. Understanding reasons for asthma outpatient (non)-attendance and exploring the role of telephone and e-consulting in facilitating access to care: exploratory qualitative study.

    NARCIS (Netherlands)

    Baar, J.D. van; Joosten, H.; Car, J.; Freeman, G.; Partridge, M.R.; Weel, C. van; Sheikh, A.


    OBJECTIVE: To understand factors influencing patients' decisions to attend for outpatient follow up consultations for asthma and to explore patients' attitudes to telephone and email consultations in facilitating access to asthma care. DESIGN: Exploratory qualitative study using in depth interviews.

  13. Understanding Vaccine Hesitancy in Canada: Results of a Consultation Study by the Canadian Immunization Research Network (United States)

    Dubé, Eve; Gagnon, Dominique; Ouakki, Manale; Bettinger, Julie A.; Guay, Maryse; Halperin, Scott; Wilson, Kumanan; Graham, Janice; Witteman, Holly O.; MacDonald, Shannon; Fisher, William; Monnais, Laurence; Tran, Dat; Gagneur, Arnaud; Guichon, Juliet; Saini, Vineet; Heffernan, Jane M.; Meyer, Samantha; Driedger, S. Michelle; Greenberg, Joshua; MacDougall, Heather


    “Vaccine hesitancy” is a concept now frequently used in vaccination discourse. The increased popularity of this concept in both academic and public health circles is challenging previously held perspectives that individual vaccination attitudes and behaviours are a simple dichotomy of accept or reject. A consultation study was designed to assess the opinions of experts and health professionals concerning the definition, scope, and causes of vaccine hesitancy in Canada. We sent online surveys to two panels (1- vaccination experts and 2- front-line vaccine providers). Two questionnaires were completed by each panel, with data from the first questionnaire informing the development of questions for the second. Our participants defined vaccine hesitancy as an attitude (doubts, concerns) as well as a behaviour (refusing some / many vaccines, delaying vaccination). Our findings also indicate that both vaccine experts and front-line vaccine providers have the perception that vaccine rates have been declining and consider vaccine hesitancy an important issue to address in Canada. Diffusion of negative information online and lack of knowledge about vaccines were identified as the key causes of vaccine hesitancy by the participants. A common understanding of vaccine hesitancy among researchers, public health experts, policymakers and health care providers will better guide interventions that can more effectively address vaccine hesitancy within Canada. PMID:27257809

  14. Understanding coupling between bone resorption and formation

    DEFF Research Database (Denmark)

    Andersen, Thomas Levin; Abdelgawad, Mohamed Essameldim; Kristensen, Helene Bjørg


    Bone remodeling requires bone resorption by osteoclasts, bone formation by osteoblasts, and a poorly investigated reversal phase coupling resorption to formation. Likely players of the reversal phase are the cells recruited into the lacunae vacated by the osteoclasts and presumably preparing...... these lacunae for bone formation. These cells, called herein reversal cells, cover >80% of the eroded surfaces, but their nature is not identified, and it is not known whether malfunction of these cells may contribute to bone loss in diseases such as postmenopausal osteoporosis. Herein, we combined...... physiological status. Their prevalence correlated with decreased trabecular bone volume and osteoid and osteoblast surfaces in postmenopausal osteoporosis. They were, however, virtually absent in primary hyperparathyroidism, in which the transition between bone resorption and formation occurs optimally...

  15. Social Power and Influence: Understanding Its Relevance in Early Childhood Consultation (United States)

    Spino, Margie A.; Dinnebeil, Laurie A.; McInerney, William F.


    The purpose of this article is to introduce and describe a model of social power and influence developed by Erchul and Raven (1997). This model describes the decision-making process a consultant would engage in to choose, implement, evaluate as well as the use of strategies that they might use to influence another person to act in a particular…

  16. Understanding the use of email consultation in primary care using a retrospective observational study with data of Dutch electronic health records. (United States)

    Huygens, Martine W J; Swinkels, Ilse C S; Verheij, Robert A; Friele, Roland D; van Schayck, Onno C P; de Witte, Luc P


    It is unclear why the use of email consultation is not more widespread in Dutch general practice, particularly because, since 2006, its costs can be reimbursed. To encourage further implementation, it is needed to understand the current use of email consultations. This study aims to understand the use of email consultation by different patient groups, compared with other general practice (GP) consultations. For this retrospective observational study, we used Dutch routine electronic health record data obtained from NIVEL Primary Care Database for the years 2010 and 2014. 200 general practices were included in 2010 (734 122 registered patients) and 434 in 2014 (1 630 386 registered patients). The number and percentage of email consultations and patient characteristics (age, gender, neighbourhood socioeconomic status and diagnoses) of email consultation users were investigated and compared with those who had a telephone or face-to-face consultation. General practice characteristics were also taken into account. 32.0% of the Dutch general practices had at least one email consultation in 2010, rising to 52.8% in 2014. In 2014, only 0.7% of the GP consultations were by email (the others comprised home visits, telephone and face-to-face consultations). Its use highly varied among general practices. Most email consultations were done for psychological (14.7%); endocrine, metabolic and nutritional (10.9%); and circulatory (10.7%) problems. These diagnosis categories appeared less frequently in telephone and face-to-face consultations. Patients who had an email consultation were older than patients who had a telephone or face-to-face consultation. In contrast, patients with diabetes who had an email consultation were younger. Even though email consultation was done in half the general practices in the Netherlands in 2014, the actual use of it is extremely low. Patients who had an email consultation differ from those who had a telephone or face-to-face consultation. In

  17. Understanding the Potential for Patient Engagement in Electronic Consultation and Referral Systems: Lessons From One Safety Net System. (United States)

    Olayiwola, Jacqueline Nwando; Knox, Margae; Dubé, Kate; Lu, Emily Chen-Yuan; Woldeyesus, Tem; James, Iguehi E; Willard-Grace, Rachel; Tuot, Delphine


    To understand patient, primary care clinician (PCC), and subspecialist perspectives on potential, unexplored roles for patients in electronic consultation and referral (eCR) systems. Primary focus group and survey data collected April-November 2015. Zuckerberg San Francisco General Hospital (ZSFG) is part of an integrated public health delivery system. Its mature eCR system was first implemented in 2005. This mixed-methods study synthesizes patient, subspecialist, and PCC perspectives through two patient focus groups in English, Spanish, and Cantonese (n = 6); subspecialist focus groups (n = 2); and an electronic survey of all PCCs (n = 222/634, 35 percent response). Focus groups were audio-recorded and transcribed. Two researchers coded the transcripts to identify recurrent themes. Survey data were analyzed using summary and bivariate statistics. Patients expressed minimal desire to directly engage in eCR, instead of emphasizing their PCC's role in advocating, informing, and finding health solutions. Subspecialists requested more consistent communication to patients about the electronic consultation process. Most PCCs (52 percent) supported patient engagement in the eCR process, particularly patient ability to track consult status and securely message with subspecialists. Results suggest a continuum of opportunities for patients and their caregivers to engage in eCR systems. © Health Research and Educational Trust.

  18. Understanding the star formation modes in the distant universe

    International Nuclear Information System (INIS)

    Salmi, Fadia


    The goal of my PhD study consists at attempt to understand what are the main processes at the origin of the star formation in the galaxies over the last 10 billion years. While it was proposed in the past that merging of galaxies has a dominant role to explain the triggering of the star formation in the distant galaxies having high star formation rates, in the opposite, more recent studies revealed scaling laws linking the star formation rate in the galaxies to their stellar mass or their gas mass. The small dispersion of these laws seems to be in contradiction with the idea of powerful stochastic events due to interactions, but rather in agreement with the new vision of galaxy history where the latter are continuously fed by intergalactic gas. We were especially interested in one of this scaling law, the relation between the star formation (SFR) and the stellar mass (M*) of galaxies, commonly called the main sequence of star forming galaxies. We studied this main sequence, SFR-M * , in function of the morphology and other physical parameters like the radius, the colour, the clumpiness. The goal was to understand the origin of the sequence's dispersion related to the physical processes underlying this sequence in order to identify the main mode of star formation controlling this sequence. This work needed a multi-wavelength approach as well as the use of galaxies profile simulation to distinguish between the different galaxy morphological types implied in the main sequence. (author) [fr

  19. Improving Community Understanding of Medical Research: Audience Response Technology for Community Consultation for Exception to Informed Consent

    Directory of Open Access Journals (Sweden)

    Taher Vohra


    Full Text Available Introduction: The Department of Health and Human Services and Food and Drug Administration described guidelines for exception from informed consent (EFIC research. These guidelines require community consultation (CC events, which allow members of the community to understand the study, provide feedback and give advice. A real-time gauge of audience understanding would allow the speaker to modify the discussion. The objective of the study is to describe the use of audience response survey (ARS technology in EFIC CCs. Methods: As part of the Rapid Anticonvulsant Medication Prior to Arrival Trial (RAMPART, 13 CC events were conducted. We prepared a PowerPoint™ presentation with 4 embedded ARS questions,according to specific IRB guidelines to ensure that the pertinent information would reach our targeted audience. During 6 CCs, an ARS was used to gauge audience comprehension. Participants completed paper surveys regarding their opinion of the study following each CC. Results: The ARS was used with minimal explanation and only one ARS was lost. Greater than 80% of the participants correctly answered 3 of the 4 ARS questions with 61% correctly answering the question regarding EFIC. A total of 105 participants answered the paper survey; 80-90% of the responses to the paper survey were either strongly agree or agree. The average scores on the paper survey in the ARS sites compared to the non-ARS sites were significantly more positive. Conclusion: The use of an audience response system during the community consultation aspects of EFIC is feasible and provides a real-time assessment of audience comprehension of the study and EFIC process. It may improve the community’s opinion and support of the study.

  20. Understanding the mechanism of nanoparticle formation in wire explosion process

    International Nuclear Information System (INIS)

    Bora, B.; Wong, C.S.; Bhuyan, H.; Lee, Y.S.; Yap, S.L.; Favre, M.


    The mechanism of nanoparticle formation by wire explosion process has been investigated by optical emission spectroscopy in Antony et al. 2010 [2] [J Quant Spectrosc Radiat Transfer 2010; 111:2509]. It was reported that the size of the nanoparticles formed in Ar ambience increases with increasing pressure, while an opposite trend was observed for the nanoparticles produced in N 2 and He ambiences. However, the physics behind this opposite trend seems unclear. In this work, we have investigated the probable mechanism behind the opposite trend in particle size with pressure of different gases and understand the mechanism of nanoparticle formation in wire explosion process. The experiment was carried out to investigate the effect of ambient gas species (Ar and N 2 ) and pressure on arc plasma formation and its corresponding effects on the characteristics of the produced nanoparticles in wire explosion process. Our results show that the arc plasma formation is probably the mechanism that may account for the opposite trend of particle size with pressure of different gases. -- Highlights: ► Cu nanoparticles have been synthesized by wire explosion technique. ► Investigate the effect of the ambient gas species and pressure. ► Arc plasma formation in wire explosion process is investigated. ► Arc plasma formation plays a crucial role in characteristic of the nanoparticles

  1. The Contemporary Consultant

    DEFF Research Database (Denmark)

    Olson, Thomas; Poulfelt, Flemming; Greiner, Larry

    This book complements The handbook of Management Consulting: The Contemporary Consultant: Insights from Leading Experts, 1e but can also be studied separately. The book consists of 20 cases including Harvard and Stanford cases. The cases present the broad range of topics that are pertinent...... to current management consulting. Each of the four parts of the text presents a cogent introduction by the editors, delineating topics that are critical for today's consultants to understand. The cases represent major practice areas of consulting and afford new insights into change processes and other...... current management issues facing consulting firms. These cases, together with the handbook, will prepare consultants and other business managers for a successful future in a highly competitive consulting environment....

  2. The current opinions and use of MTA for apical barrier formation of non-vital immature permanent incisors by consultants in paediatric dentistry in the UK. (United States)

    Mooney, Gillian Catherine; North, Sarah


    The purpose of the study was to assess the current opinions and usage of mineral trioxide aggregate (MTA) for apical barrier formation of non-vital immature permanent teeth by consultants in paediatric dentistry in the UK. A semi-structured postal questionnaire was sent to all known consultants in paediatric dentistry in the UK. The response rate was 78.6% (44 of 56). Thity-eight consultants (86.3%) agreed that the use of this material was a good idea with 68.2% having used or arranged for its use in apical barrier formation. Forty-two consultants (95.5%) agreed that reduced number of visits was an advantage to the technique, with only 34.1% agreeing that this procedure was less likely to weaken the tooth and 63.6% agreed that material and equipment costs were a drawback and 50% agreed that lack of available evidence was a disadvantage to its use. The results from this study give an indication of the extent of MTA use by consultant-led services in paediatric dentistry in the UK and highlights the need for a multi-centre randomised controlled clinical trial.

  3. Consultant survival guide. (United States)

    Haque, Sahena


    Taking up a new consultant post can be both exciting and daunting. Once the elation of completing years of training and successfully securing a valued position has subsided, the reality of the task ahead becomes apparent. A new consultant needs to develop a number of skills to develop as a clinical leader and understand the processes within the National Health Service (NHS) that enable service development and innovation. In a programme packed with esteemed speakers, the Royal College of Physicians' one-day conference, Consultants' survival guide: how to succeed as a new consultant provided practical tips and advice for senior trainees and new consultants.

  4. Towards Understanding the Star Formation-Feedback Loop in Galaxy Formation and Evolution (United States)

    Kravtsov, Andrey

    We propose to carry out a comprehensive study of how star formation and feedback loop influences evolution of galaxies using a suite of ultra-high resolution cosmological simulations of galaxy formation using the Adaptive Mesh Refinement (AMR) approach implemented in the Adaptive Refinement Tree (ART) code. The simulations will result in the numerical models of galaxy evolution of unprecedented resolution and sophistication of the processes included. Our code includes treatment of a wide spectrum of processes critical for realistic modeling of galaxy formation from the primordial chemistry of hydrogen and helium species, radiative transfer of ionizing radiation, to the metallicity- dependent cooling, chemistry of molecular hydrogen on dust and treatment of radiative transfer of dissociating far ultraviolet radiation. The latter allows us to tie star formation with dense, molecular regions capable of self-shielding from heating radiation and avoid adopting arbitrary density and temperature thresholds for star formation. Simulations will also employ a new model for momentum injection due to radiation pressure exerted by young massive stars onto surrounding dust and gas. This early, pre-supernova feedback is critical to prompt dispersal of natal molecular clouds and regulating star formation efficiency and increasing efficiency of energy release by supernovae. The simulations proposed in this project will therefore treat the most important process to understanding the efficiency of baryon conversion to stars - the star formation - in the way most closely resembling the actual star formation observed in galaxies and stellar feedback model that is firmly rooted in observational evidence on how feedback operates in real molecular clouds. The simulations we propose will provide models of galaxy evolution during three important epochs in the history of the universe: (1) early evolution prior to and during the reionization of the universe (the first billion years of

  5. Understanding The Impact of Formative Assessment Strategies on First Year University Students’ Conceptual Understanding of Chemical Concepts


    Mehmet Aydeniz; Aybuke Pabuccu


    This study investigated the effects of formative assessment strategies on students’ conceptual understanding in a freshmen college chemistry course in Turkey. Our sample consists of 96 students; 27 males, 69 females. The formative assessment strategies such as reflection on exams, and collective problem solving sessions were used throughout the course. Data were collected through pre and post-test methodology. The findings reveal that the formative assessment strategies used in this study led...

  6. Consulting Overseas. (United States)

    Rosensweig, Fred; And Others

    Consultants experience difficulty in being effective in a foreign country, particularly in developing countries. Difficulties include definite cross-cultural differences that consultants lack the skills to overcome or adjust to, language and communication differences, consultants' inability to adjust to a new situation quickly, and inability of…

  7. Contribution of natural tracers for understanding transfers through argillaceous formations

    International Nuclear Information System (INIS)

    Bensenouci, F.


    This study is part of a research programme conducted by IRSN on the safety of deep geological disposal of high level and intermediate long-lived radioactive wastes. It more especially concerns the geological medium considered as a full component of the multi-barrier concept proposed by Andra for a deep repository. Indeed, the Callovo-Oxfordian argillite of the Paris Basin, in the east of France, is being investigated by Andra as a potential host rock for this repository. Performance assessment of this natural barrier is based on the knowledge of its confinement properties and therefore on phenomena possibly involved in the mass transport of radionuclides. In this context, this work aimed at studying the distribution of tracers naturally present in pore waters obtained from boreholes having crossed Mesozoic sedimentary series involving impervious and compacted clay rocks in the East (Andra borehole, EST433) and south of France (IRSN boreholes). Radial diffusion and vapour exchange methods were used to calculate the concentrations and diffusion parameters of the studied tracers. In Tournemire formations, the different profiles describe a curved shapes attributed to a diffusive exchange between the argillite pore water and the surrounding aquifers. Concerning the Mesozoic formations crossed by EST433, the study of the different profiles confirms the diffusion as the dominant transport mechanism in the Callovo-Oxfordian formation, and permits identifying the transport processes in the whole studied column from the Oxfordian formations down to the Liassic one. This study also helps to identify the Liassic formations as a major source of salinity of the Dogger aquifer

  8. Les facteurs de la performance commerciale en formation professionnelle : le cas du néo formateur consultant (NFC)


    Machuret, Jean-Jacques


    The purpose of this research is to establish factors for commercial performance in the professional training sector, the case of the N.T.C. (Neo Trainer Consultant). Empirical observation: The author has trained job seekers (more than 450) for over 10 years. Through this experience providing lessons, a suspicion arose regarding the origin of the difficulties (N.T.C.) concerning the factors for commercial performance in professional training.Research work plan: The start point is a group of fi...

  9. Accompanied consultations in occupational health. (United States)

    Hobson, J; Hobson, H; Sharp, R


    Accompanied consultations are often reported as difficult by occupational physicians but have not been studied in the occupational health setting. To collect information about accompanied consultations and the impact of the companion on the consultation. We collected data on all accompanied consultations by two occupational physicians working in a private sector occupational health service over the course of 16 months. Accompanied consultations were matched to non-accompanied consultations for comparison. We collected data on 108 accompanied consultations. Accompanied consultations were more likely to be connected with ill health retirement (P Occupational health practitioners may benefit from better understanding of accompanied consultations and guidance on their management. © The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email:

  10. Understanding carbon nanotube channel formation in the lipid membrane (United States)

    Choi, Moon-ki; Kim, Hyunki; Lee, Byung Ho; Kim, Teayeop; Rho, Junsuk; Kim, Moon Ki; Kim, Kyunghoon


    Carbon nanotubes (CNTs) have been considered a prominent nano-channel in cell membranes because of their prominent ion-conductance and ion-selectivity, offering agents for a biomimetic channel platform. Using a coarse-grained molecular dynamics simulation, we clarify a construction mechanism of vertical CNT nano-channels in a lipid membrane for a long period, which has been difficult to observe in previous CNT-lipid interaction simulations. The result shows that both the lipid coating density and length of CNT affect the suitable fabrication condition for a vertical and stable CNT channel. Also, simulation elucidated that a lipid coating on the surface of the CNT prevents the CNT from burrowing into the lipid membrane and the vertical channel is stabilized by the repulsion force between the lipids in the coating and membrane. Our study provides an essential understanding of how CNTs can form stable and vertical channels in the membrane, which is important for designing new types of artificial channels as biosensors for bio-fluidic studies.

  11. Understanding the kinetic mechanism of RNA single base pair formation. (United States)

    Xu, Xiaojun; Yu, Tao; Chen, Shi-Jie


    RNA functions are intrinsically tied to folding kinetics. The most elementary step in RNA folding is the closing and opening of a base pair. Understanding this elementary rate process is the basis for RNA folding kinetics studies. Previous studies mostly focused on the unfolding of base pairs. Here, based on a hybrid approach, we investigate the folding process at level of single base pairing/stacking. The study, which integrates molecular dynamics simulation, kinetic Monte Carlo simulation, and master equation methods, uncovers two alternative dominant pathways: Starting from the unfolded state, the nucleotide backbone first folds to the native conformation, followed by subsequent adjustment of the base conformation. During the base conformational rearrangement, the backbone either retains the native conformation or switches to nonnative conformations in order to lower the kinetic barrier for base rearrangement. The method enables quantification of kinetic partitioning among the different pathways. Moreover, the simulation reveals several intriguing ion binding/dissociation signatures for the conformational changes. Our approach may be useful for developing a base pair opening/closing rate model.

  12. The autophagosome: current understanding of formation and maturation

    Directory of Open Access Journals (Sweden)

    Mannack LVJC


    Full Text Available Lilith VJC Mannack, Jon D Lane Cell Biology Laboratories, School of Biochemistry, University of Bristol, Bristol, UK Abstract: Autophagy is an important and highly conserved catabolic process with roles in development, homeostasis, and cellular stress responses. It describes various distinct pathways for the delivery of cytoplasmic materials (including misfolded protein aggregates and some organelles to the lysosome for degradation and component recycling. The best understood form of autophagy (macroautophagy describes the de novo assembly, maturation, and trafficking of a unique double membrane-bound organelle – the autophagosomes – that sequesters cytoplasmic materials and ultimately merges with the lysosomal compartment to form a degradative autolysosome. To rapidly assemble such a structure in response to stimuli, cells express a family of dedicated autophagy-related (ATG gene products that act sequentially to control membrane events leading first to the nucleation of an isolation membrane or phagophore, followed by phagophore expansion, and sealing to form an autophagosome that traffics to – and ultimately fuses with – the lysosome. These molecules are activated in response to upstream signaling pathways (notably, the mechanistic target of rapamycin [mTOR] pathway, and comprise protein and lipid kinases, putative membrane coats, and unique ubiquitin-like conjugation systems. In concert, a barrage of accessory proteins involved in various membrane trafficking pathways focused on the endosomal compartment are co-opted at the assembly site to facilitate autophagosome biogenesis. Understanding the integrated pathways that coordinate autophagosome assembly at the molecular level will be crucial if we are to realize the potential for autophagy manipulation in future disease therapies. Keywords: autophagy, ATG proteins, lysosome, phagophore, omegasome, autolysosome, membrane trafficking, ULK1, mTOR, PI(3 kinase, PI3P, LIR motif

  13. An Investigation of Teachers' Growing Understandings of the Picture Book Format (United States)

    Martinez, Miriam G.; Harmon, Janis M.


    This study investigated the impact of a graduate course that focused on picture books on teachers' understandings of the picture book format and the ways in which these understandings influenced their self-reports of picture book use in the classroom. Findings of this qualitative investigation revealed that immersion in and analysis of the picture…

  14. Current Understanding of the Formation and Adaptation of Metabolic Systems Based on Network Theory

    Directory of Open Access Journals (Sweden)

    Kazuhiro Takemoto


    Full Text Available Formation and adaptation of metabolic networks has been a long-standing question in biology. With recent developments in biotechnology and bioinformatics, the understanding of metabolism is progressively becoming clearer from a network perspective. This review introduces the comprehensive metabolic world that has been revealed by a wide range of data analyses and theoretical studies; in particular, it illustrates the role of evolutionary events, such as gene duplication and horizontal gene transfer, and environmental factors, such as nutrient availability and growth conditions, in evolution of the metabolic network. Furthermore, the mathematical models for the formation and adaptation of metabolic networks have also been described, according to the current understanding from a perspective of metabolic networks. These recent findings are helpful in not only understanding the formation of metabolic networks and their adaptation, but also metabolic engineering.

  15. Embedded formative assessment and classroom process quality. How do they interact in promoting students' science understanding


    Decristan, Jasmin; Klieme, Eckhard; Kunter, Mareike; Hochweber, Jan; Büttner, Gerhard; Fauth, Benjamin; Hondrich, Anna Lena; Rieser, Svenja; Hertel, Silke; Hardy, Ilonca


    In this study we examine the interplay between curriculum-embedded formative assessment-a well-known teaching practice-and general features of classroom process quality (i.e., cognitive activation, supportive climate, classroom management) and their combined effect on elementary school students' understanding of the scientific concepts of floating and sinking. We used data from a cluster-randomized controlled trial and compared curriculum-embedded formative assessment (17 classes) with a cont...

  16. Effect of Sulfur Concentration and PH Conditions on Akaganeite Formation: Understanding Akaganeite Formation Conditions in Yellowknife Bay, Gale Crater, Mars (United States)

    Fox, A.; Peretyazhko, T.; Sutter, B.; Niles, P.; Ming, D. W.; Morris, R. V.


    The Chemistry and Mineralogy Instrument (CHEMIN) on board the Mars Science Laboratory (MSL) Curiosity Rover identified minor amounts of akaganeite (beta-FeOOH) at Yellowknife Bay, Mars. There is also evidence for akaganeite at other localities on Mars from the Compact Reconnaissance Imaging Spectrometer for Mars (CRISM). Akaganeite is an iron(III) hydroxide with a hollandite- like structure and Cl in its tunnels. Terrestrial akaganeite usually forms in Cl-rich environments under acidic, oxidizing conditions. Previous studies of akaganeite have revealed that akaganeite formation is affected by the presence of sulfate (hereafter denoted as S. The prediction of circumneutral pH coupled with the detection of S at Yellowknife Bay dictate that work is needed to determine how S and pH together affect akaganeite formation. The goal of this work is to study how changes in both S concentration and pH influence akaganeite precipitation. Akaganeite formation was investigated at S/Cl molar ratios of 0, 0.017, 0.083, 0.17 and 0.33 at pH 1.5, 2, and 4. Results are anticipated to provide combined S concentration and pH constraints on akaganeite formation in Yellowknife Bay and elsewhere on Mars. Knowledge of solution pH and S concentrations can be utilized in understanding microbial habitability potential on the Martian surface.

  17. Embedded Formative Assessment and Classroom Process Quality: How Do They Interact in Promoting Science Understanding? (United States)

    Decristan, Jasmin; Klieme, Eckhard; Kunter, Mareike; Hochweber, Jan; Büttner, Gerhard; Fauth, Benjamin; Hondrich, A. Lena; Rieser, Svenja; Hertel, Silke; Hardy, Ilonca


    In this study we examine the interplay between curriculum-embedded formative assessment--a well-known teaching practice--and general features of classroom process quality (i.e., cognitive activation, supportive climate, classroom management) and their combined effect on elementary school students' understanding of the scientific concepts of…

  18. Model Building to Facilitate Understanding of Holliday Junction and Heteroduplex Formation, and Holliday Junction Resolution (United States)

    Selvarajah, Geeta; Selvarajah, Susila


    Students frequently expressed difficulty in understanding the molecular mechanisms involved in chromosomal recombination. Therefore, we explored alternative methods for presenting the two concepts of the double-strand break model: Holliday junction and heteroduplex formation, and Holliday junction resolution. In addition to a lecture and…

  19. Control and understanding of kink formation in InAs-InP heterostructure nanowires. (United States)

    Fahlvik Svensson, S; Jeppesen, S; Thelander, C; Samuelson, L; Linke, H; Dick, K A


    Nanowire heterostructures are of special interest for band structure engineering due to an expanded range of defect-free material combinations. However, the higher degree of freedom in nanowire heterostructure growth comes at the expense of challenges related to nanowire-seed particle interactions, such as undesired composition, grading and kink formation. To better understand the mechanisms of kink formation in nanowires, we here present a detailed study of the dependence of heterostructure nanowire morphology on indium pressure, nanowire diameter, and nanowire density. We investigate InAs-InP-InAs heterostructure nanowires grown with chemical beam epitaxy, which is a material system that allows for very abrupt heterointerfaces. Our observations indicate that the critical parameter for kink formation is the availability of indium, and that the resulting morphology is also highly dependent on the length of the InP segment. It is shown that kinking is associated with the formation of an inclined facet at the interface between InP and InAs, which destabilizes the growth and leads to a change in growth direction. By careful tuning of the growth parameters, it is possible to entirely suppress the formation of this inclined facet and thereby kinking at the heterointerface. Our results also indicate the possibility of producing controllably kinked nanowires with a high yield.

  20. Just a Collection of Recollections: Clinical Ethics Consultation and the Interplay of Evaluating Voices. (United States)

    Bartlett, Virginia L; Bliton, Mark J; Finder, Stuart G


    Despite increased attention to the question of how best to evaluate clinical ethics consultations and emphasis on external evaluation (Hastings Center Report, ASBH Quality Attestation Process), there has been little sustained focus on how we, as clinicians, make sense of and learn from our own experiences in the midst of any one consultation. Questions of how we evaluate the request for, unfolding of, and conclusion of any specific ethics consultation are often overlooked, along with the underlying question of whether it is possible to give an accurate account of clinical ethics consultants' experience as experienced by ethics consultants. Before the challenge of submitting one's accounts or case reports for review and evaluation from others (at one's local institution or in the broader field), there is an underlying challenge of understanding and evaluating our own accounts. To highlight this crucial and deeply challenging dimension of actual clinical ethics practice, we present an account of a complex consultation, explicitly constructed to engage the reader in the unfolding experience of the consultant by emphasizing the multiple perspectives unfolding within the consultant's experience. Written in script format, the three perspectives presented-prototypical clinically descriptive account; didactically reflective and self-evidentiary account often seen in journal presentations; highly self-critical reflective account emphasizing uncertainties inherent to clinical ethics practice-reflect different manners for responding to the ways actual clinical involvement in ethics consultation practice accentuates and refocuses the question of how to understand and evaluate our own work, as well as that of our colleagues.


    Directory of Open Access Journals (Sweden)

    Scott M. Sporer


    , MD. and his collaborators designing the "Curbside Consultation in Hip Arthroplasty" try to widen the reader insight for a better outcome in hip arthroplasty by the expert opinions and current concepts for various treatment options in difficult or controversial cases. The carefully chosen scenarios forming the sections and brief answers containing clinically relevant information and practical solutions to frequently encountered problems are making the book almost a comprehensive and current reference of difficult clinical situations in total hip replacement surgery. The questions and the answers format and casual style of articles resembling the advices in a dialog of colleagues on a curbside consult provides a quicker access to a subject and makes the text easier to read and understand. Various image and diagrams enhances the knowledge in the text

  2. Towards an understanding of the role of clay minerals in crude oil formation, migration and accumulation (United States)

    Wu, Lin Mei; Zhou, Chun Hui; Keeling, John; Tong, Dong Shen; Yu, Wei Hua


    This article reviews progress in the understanding of the role of clay minerals in crude oil formation, migration and accumulation. Clay minerals are involved in the formation of kerogen, catalytic cracking of kerogen into petroleum hydrocarbon, the migration of crude oil, and the continued change to hydrocarbon composition in underground petroleum reservoirs. In kerogen formation, clay minerals act as catalysts and sorbents to immobilize organic matter through ligand exchange, hydrophobic interactions and cation bridges by the mechanisms of Maillard reactions, polyphenol theory, selective preservation and sorptive protection. Clay minerals also serve as catalysts in acid-catalyzed cracking of kerogen into petroleum hydrocarbon through Lewis and Brønsted acid sites on the clay surface. The amount and type of clay mineral affect the composition of the petroleum. Brønsted acidity of clay minerals is affected by the presence and state of interlayer water, and displacement of this water is a probable driver in crude oil migration from source rocks. During crude oil migration and accumulation in reservoirs, the composition of petroleum is continually modified by interaction with clay minerals. The clays continue to function as sorbents and catalysts even while they are being transformed by diagenetic processes. The detail of chemical interactions and reaction mechanisms between clay minerals and crude oil formation remains to be fully explained but promises to provide insights with broader application, including catalytic conversion of biomass as a source of sustainable energy into the future.

  3. Benzene solubility in ionic liquids: working toward an understanding of liquid clathrate formation. (United States)

    Pereira, Jorge F B; Flores, Luis A; Wang, Hui; Rogers, Robin D


    The solubility of benzene in 15 imidazolium, pyrrolidinium, pyridinium, and piperidinium ionic liquids has been determined; the resulting, benzene-saturated ionic liquid solutions, also known as liquid clathrates, were examined with (1) H and (19) F nuclear magnetic resonance spectroscopy to try and understand the molecular interactions that control liquid clathrate formation. The results suggest that benzene interacts primarily with the cation of the ionic liquid, and that liquid clathrate formation (and benzene solubility) is controlled by the strength of the cation-anion interactions, that is, the stronger the cation-anion interaction, the lower the benzene solubility. Other factors that were determined to be important in the final amount of benzene in any given liquid clathrate phase included attractive interactions between the anion and benzene (when significant), and larger steric or free volume demands of the ions, both of which lead to greater benzene solubility. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  4. Skills for Effective Consultation. (United States)

    Dustin, Dick; Ehly, Stewart


    Discusses counselor skills that promote effective consultation. Reviews research on effective school consultation and presents a five-stage model which involves phasing in, problem identification, implementation, evaluation, and termination. Provides recommendations for the process and products of consultation. (JAC)

  5. Consultant management estimating tool. (United States)


    The New York State Department of Transportation (NYSDOT) Consultant Management Bureaus primary responsibilities are to negotiate staffing hours/resources with : engineering design consultants, and to monitor the consultant's costs. Currently the C...

  6. Consulting in Collection Development. (United States)

    Ash, Lee


    Considers the role of the consultant in the areas of library collection development and weeding, and offers suggestions on determining the need for a consultant, obtaining one, and what to do when the consultant arrives. (FM)

  7. Understanding the process of social network evolution: Online-offline integrated analysis of social tie formation. (United States)

    Kwak, Doyeon; Kim, Wonjoon


    It is important to consider the interweaving nature of online and offline social networks when we examine social network evolution. However, it is difficult to find any research that examines the process of social tie formation from an integrated perspective. In our study, we quantitatively measure offline interactions and examine the corresponding evolution of online social network in order to understand the significance of interrelationship between online and offline social factors in generating social ties. We analyze the radio signal strength indicator sensor data from a series of social events to understand offline interactions among the participants and measure the structural attributes of their existing online Facebook social networks. By monitoring the changes in their online social networks before and after offline interactions in a series of social events, we verify that the ability to develop an offline interaction into an online friendship is tied to the number of social connections that participants previously had, while the presence of shared mutual friends between a pair of participants disrupts potential new connections within the pre-designed offline social events. Thus, while our integrative approach enables us to confirm the theory of preferential attachment in the process of network formation, the common neighbor theory is not supported. Our dual-dimensional network analysis allows us to observe the actual process of social network evolution rather than to make predictions based on the assumption of self-organizing networks.

  8. Understanding Nanoemulsion Formation and Developing a Procedure for Porous Material Growth using Assembled Nanoemulsions (United States)

    Yeranossian, Vahagn Frounzig

    Nanoemulsions as an emerging technology have found many applications in consumer products, drug delivery, and even particle formation. However, knowledge gaps exist in how some of these emulsions are formed, specifically what pathways are traversed to reach the final state. Moreover, how these pathways affect the final properties of the nanoemulsions would affect the applications that these droplets possess. Some nanoemulsions possess unique properties, including the assembly of droplets. While the assembly of droplets is being studied in the Helgeson lab, work must be done to understand how the assembly itself could be used to control the growth of porous materials, such a hydrogels. Thus, this thesis aims to address two factors of nanoemulsions: the formation of water-in-oil nanoemulsions and the use of assemblying droplets in oil-in-water nanoemulsions to form macroporous hydrogels. To elucidate the formation mechanism of water-in-oil nanoemulsions, a combination of dynamic light scattering and small angle neutron scattering were used to study the intermediate and final states of the nanoemulsion during its formation. These nanoemulsions were prepared by slowly adding water to an oil and surfactant mixture and were diluted to effectively measure using scattering techniques without multiple scattering events. To develop a procedure to use assembled nanoemulsions for the growth of porous materials, a combination of optical microscopy and diffusional studies were employed. Optical microscopy images taken at various stages of the procedure help elucidate how the pore sizes of the final porous material is related to the droplet-rich domains of the assembled nanoemulsion. Meanwhile, diffusional measurements help confirm the size and interconnectedness of the macropores. From the work done in the completion of my thesis, the formation mechanism of the water-in-oil nanoemulsion studied has been elucidated. The neutron scattering measurements show that during the

  9. Understanding adult neurogenesis beyond its role in learning and memory formation

    Directory of Open Access Journals (Sweden)

    Ab Latif Wani


    Full Text Available There has been a shift in the understanding of brain, neurons, and their functional role over the last two decades. Earlier it was believed that the brain was a static organ and was not subject to any change throughout life. An understanding was developed later that brain reorganizes its structure by a specific property called neuroplasticity. Recent research shows that the brain generates new neurons even in the adult stage, and this process is called adult neurogenesis. Although researchers still not have all the answers about the newborn neurons, and why and how they are generated, and what is their role, some have highlighted the importance of these in learning and memory formation, and even in memories of fear and spatial navigation. A wide range of environmental experience influences the generation of newborn neurons and their functional variability. There are questions about how different environmental experiences cause the differences in the generation of new neurons. Recently the field of optogenetics attempted to answer the questions on adult neurogenesis. However there are still questions about adult neurogenesis which needs a more naturalistic approach, for their better understanding.

  10. Defense mechanisms in ethics consultation. (United States)

    Agich, George J


    While there is no denying the relevance of ethical knowledge and analytical and cognitive skills in ethics consultation, such knowledge and skills can be overemphasized. They can be effectively put into practice only by an ethics consultant, who has a broad range of other skills, including interpretive and communicative capacities as well as the capacity effectively to address the psychosocial needs of patients, family members, and healthcare professionals in the context of an ethics consultation case. In this paper, I discuss how emotion can play an important interpretive role in clinical ethics consultation and why attention to the role of defense mechanisms can be helpful. I concentrate on defense mechanisms, arguing first, that the presence of these mechanisms is understandable given the emotional stresses and communicative occlusions that occur between the families of patients and critical care professionals in the circumstances of critical care; second, that identifying these mechanisms is essential for interpreting and managing how these factors influence the way that the "facts" of the case are understood by family members; and, third, that effectively addressing these mechanisms is an important component for effectively doing ethics consultation. Recognizing defense mechanisms, understanding how and why they operate, and knowing how to deal with these defense mechanisms when they pose problems for communication or decision making are thus essential prerequisites for effective ethics consultation, especially in critical care.

  11. Using Spin to Understand the Formation of LIGO and Virgo’s Black Holes (United States)

    Farr, Ben; Holz, Daniel E.; Farr, Will M.


    With the growing number of binary black hole (BBH) mergers detected by the Advanced LIGO and Virgo detectors, it is becoming possible to constrain the properties of the underlying population and better understand the formation of these systems. Black hole (BH) spin orientations are one of the cleanest discriminators of formation history, with BHs in dynamically formed binaries in dense stellar environments expected to have spins distributed isotropically, in contrast to isolated populations where stellar evolution is expected to induce spins preferentially aligned with the orbital angular momentum. In this work, we propose a simple, model-agnostic approach to characterizing the spin properties of LIGO/Virgo’s BBH population. Using measurements of the effective spin of the binaries, we introduce a simple parameter to quantify the fraction of the population that is isotropically distributed, regardless of the spin magnitude distribution of the population. Once the orientation characteristics of the population have been determined, we show how measurements of effective spin can be used to directly constrain the BH spin magnitude distribution. We find that most effective spin measurements are too small to be informative, with the first four events showing a slight preference for a population with alignment, with an odds ratio of 1.2. We argue that it will be possible to distinguish symmetric and anti-symmetric populations at high confidence with tens of additional detections, although mixed populations may take significantly longer to disentangle. We also derive BH spin magnitude distributions from LIGO’s first four BBHs under the assumption of aligned or isotropic populations.

  12. Consultant en gestion configuration


    Lugones Altamirano, Maximiliano


    Ce mémoire présente une synthèse de mon Projet de Fin d’Etude (PFE) dans le cadre de ma formation ISAE ENSICA. J’ai choisi la société de service Capgemini Aerospace & Defense à Toulouse pour ce dernier stage de 6 mois. Et plus précisément dans le Skill Group Business Application Consulting (BAC) parce que je voulais faire un stage mélangeant de la gestion de projet avec de l’ingénierie. Mon sujet de stage n’a pas été figé à l’avance car les choses vont très vite dans le conseil et précisém...

  13. Tribal Consultation Tracking System (United States)

    U.S. Environmental Protection Agency — The consultation-related information the AIEO Consultation Team working with our Tribal Portal contractors has developed a Lotus Notes Database that is capable of...

  14. Applying Chemical Imaging Analysis to Improve Our Understanding of Cold Cloud Formation (United States)

    Laskin, A.; Knopf, D. A.; Wang, B.; Alpert, P. A.; Roedel, T.; Gilles, M. K.; Moffet, R.; Tivanski, A.


    The impact that atmospheric ice nucleation has on the global radiation budget is one of the least understood problems in atmospheric sciences. This is in part due to the incomplete understanding of various ice nucleation pathways that lead to ice crystal formation from pre-existing aerosol particles. Studies investigating the ice nucleation propensity of laboratory generated particles indicate that individual particle types are highly selective in their ice nucleating efficiency. This description of heterogeneous ice nucleation would present a challenge when applying to the atmosphere which contains a complex mixture of particles. Here, we employ a combination of micro-spectroscopic and optical single particle analytical methods to relate particle physical and chemical properties with observed water uptake and ice nucleation. Field-collected particles from urban environments impacted by anthropogenic and marine emissions and aging processes are investigated. Single particle characterization is provided by computer controlled scanning electron microscopy with energy dispersive analysis of X-rays (CCSEM/EDX) and scanning transmission X-ray microscopy with near edge X-ray absorption fine structure spectroscopy (STXM/NEXAFS). A particle-on-substrate approach coupled to a vapor controlled cooling-stage and a microscope system is applied to determine the onsets of water uptake and ice nucleation including immersion freezing and deposition ice nucleation as a function of temperature (T) as low as 200 K and relative humidity (RH) up to water saturation. We observe for urban aerosol particles that for T > 230 K the oxidation level affects initial water uptake and that subsequent immersion freezing depends on particle mixing state, e.g. by the presence of insoluble particles. For T cloud formation. Initial results applying single particle IN analysis using CCSEM/EDX and STXM/NEXAFS reveal that a significant amount of IN are coated by organics and, thus, are similar to the

  15. 265 Statistical Consulting and the African Universities

    African Journals Online (AJOL)



    Jul 21, 2011 ... supervisor's understanding of statistics, self presentation of analysis, etc. Each part gives rise to specific issues and requires that the consultant have various non-statistical skills to deal with these issues. Statistical consulting as been part of the curriculum of advanced countries' universities for more than ...

  16. 3 CFR - Tribal Consultation (United States)


    .... Recommendations for improving the plans and making the tribal consultation process more effective, if any, should... 3 The President 1 2010-01-01 2010-01-01 false Tribal Consultation Presidential Documents Other Presidential Documents Memorandum of November 5, 2009 Tribal Consultation Memorandum for the Heads of Executive...

  17. Bioethics Consultations and Resources


    Thomas, Jennie


    Making difficult healthcare decisions is often helped by consultation with a bioethics committee. This article reviews the main bioethics principles, when it is appropriate and how to call a bioethics consult, ethical concerns, and members of the consult team. Bioethics resources are included.

  18. Understanding the role of contextual cues in supporting the formation of medication-taking habits

    Directory of Open Access Journals (Sweden)

    Katarzyna Stawarz


    in the presence of stable cues, with time they start to guide the behaviour and provide triggers to action (Lally & Gardner, 2011. However, adherence technologies tend to disregard contextual cues and the habitual nature of many medication regimens, and instead alert users when it is time to take the pill (Stawarz et al., 2014. Similarly, behaviour change technologies designed specifically to support habit formation also neglect contextual cues and instead focus on behaviour tracking and reminders (Stawarz et al, 2015. By supporting the identification and reinforcement of contextual cues, technology could aid both prospective memory and habit formation: it could help patients remember the new regimen and turn it into a reliable medication habit. Aims: Previous research by Stawarz et al. (2015 suggests that contextual cues support habit formation, but because habits take time to develop, people can still forget; conversely, reminders support remembering, but they can inhibit habit development. However, their study measured the development of an artificial habit (texting the researchers, lasted only for 4 weeks, and did not account for the role of location as a contextual cue. Therefore, the aim of this study was to explore the impact of contextual cues and reminders on the development of automaticity of behaviour (representing habit strength and frequency of repetition (representing adherence to the regimen over a longer period and with behaviours participants wanted to turn into habit. The understanding of how these factors influence the process of habit formation would enable us to design more effective adherence technologies that assist patients when they start a new regimen (prospective memory support as well as over the long term (habit support. Method: 209 participants were recruited on social networks, and among students and university staff. They were 18-58 years old (mean age = 27, SD = 7.6 years; 68% were women, 74% were students. They were asked to repeat a

  19. Toward an understanding of surface layer formation, growth, and transformation at the glass-fluid interface (United States)

    Hopf, J.; Eskelsen, J. R.; Chiu, M.; Ievlev, A. V.; Ovchinnikova, O. S.; Leonard, D.; Pierce, E. M.


    Silicate glass is a metastable and durable solid that has application to a number of energy and environmental challenges (e.g., microelectronics, fiber optics, and nuclear waste storage). If allowed to react with water over time silicate glass develops an altered layer at the solid-fluid interface. In this study, we used borosilicate glass (LAWB45) as a model material to develop a robust understanding of altered layer formation (i.e., amorphous hydrated surface layer and crystalline reaction products). Experiments were conducted at high surface area-to-volume ratio (∼200,000 m-1) and 90 °C in the pressurized unsaturated flow (PUF) apparatus for 1.5-years to facilitate the formation of thick altered layers and allow for the effluent solution chemistry to be monitored continuously. A variety of microscopy techniques were used to characterize reacted grains and suggest the average altered layer thickness is 13.2 ± 8.3 μm with the hydrated and clay layer representing 74.8% and 25.2% of the total altered layer, respectively. The estimate of hydrated layer thickness is within the experimental error of the value estimated from the B release rate data (∼10 ± 1 μm/yr) over the 1.5-year duration. PeakForce® quantitative nanomechanical mapping results suggest the hydrated layer has a modulus that ranges between ∼20 and 40 GPa, which is in the range of porous silica that contains from ∼20 to ∼50% porosity, yet significantly lower than dense silica (∼70-80 GPa). Scanning transmission electron microscopy (STEM) images confirm the presence of pores and an analysis of a higher resolution image provides a qualitative estimate of ≥22% porosity in the hydrated layer with variations in void volume with increasing distance from the unaltered glass. Chemical composition analyses, based on a combination of time-of-flight secondary-ion mass spectrometry (ToF-SIMS), scanning electron microscopy with X-ray energy dispersive spectroscopy (EDS), and STEM-EDS, clearly show

  20. A force sensor using nanowire arrays to understand biofilm formation (Conference Presentation) (United States)

    Sahoo, Prasana K.; Cavalli, Alessandro; Pelegati, Vitor B.; Murillo, Duber M.; Souza, Alessandra A.; Cesar, Carlos L.; Bakkers, Erik P. A. M.; Cotta, Monica A.


    Understanding the cellular signaling and function at the nano-bio interface can pave the way towards developing next-generation smart diagnostic tools. From this perspective, limited reports detail so far the cellular and subcellular forces exerted by bacterial cells during the interaction with abiotic materials. Nanowire arrays with high aspect ratio have been used to detect such small forces. In this regard, live force measurements were performed ex-vivo during the interaction of Xylella fastidiosa bacterial cells with InP nanowire arrays. The influence of nanowire array topography and surface chemistry on the response and motion of bacterial cells was studied in detail. The nanowire arrays were also functionalized with different cell adhesive promoters, such as amines and XadA1, an afimbrial protein of X.fastidiosa. By employing the well-defined InP nanowire arrays platform, and single cell confocal imaging system, we were able to trace the bacterial growth pattern, and show that their initial attachment locations are strongly influenced by the surface chemistry and nanoscale surface topography. In addition, we measure the cellular forces down to few nanonewton range using these nanowire arrays. In case of nanowire functionalized with XadA1, the force exerted by vertically and horizontally attached single bacteria on the nanowire is in average 14% and 26% higher than for the pristine array, respectively. These results provide an excellent basis for live-cell force measurements as well as unravel the range of forces involved during the early stages of bacterial adhesion and biofilm formation.

  1. Understanding Educational Policy Formation: The Case of School Violence Policies in Israel (United States)

    Fast, Idit


    This study explores mechanisms underlying processes of educational policy formation. Previous studies have given much attention to processes of diffusion when accounting for educational policy formation. Less account has been given to the day-to-day institutional dynamics through which educational policies develop and change. Building on extensive…

  2. Quantification of Release of Critical Elements, Formation of Fly Ash and Aerosols: Status on Current Understanding and Research Needs

    DEFF Research Database (Denmark)

    Jappe Frandsen, Flemming


    is that there are still in 2017, a number of big gaps in our current understanding of these phenomena, and that we need focus on these points, in order to be able to describe, understand, and, quantify the processes of ash and deposit formation completely [Frandsen, 2009].This paper provide a brief outline of the current......) shedding of deposits. Some of the steps may be repetitive, as the process is partly cyclic [Frandsen, 2011]. The inorganic fraction of solid fuels, may cause several problems during combustion, most importantly formation of particulate matter (aerosols and fly ashes). These may subsequently induce deposit...... of combustion units.Through several years, high quality research has been conducted on characterization of fuels, ashes and deposit formation in utility boilers fired with coal, biomass and waste fractions. Huge amounts of experimental data have been reported, from such work, but the fact...

  3. Understanding visual map formation through vortex dynamics of spin Hamiltonian models. (United States)

    Cho, Myoung Won; Kim, Seunghwan


    The pattern formation in orientation and ocular dominance columns is one of the most investigated problems in the brain. From a known cortical structure, we build spinlike Hamiltonian models with long-range interactions of the Mexican hat type. These Hamiltonian models allow a coherent interpretation of the diverse phenomena in the visual map formation with the help of relaxation dynamics of spin systems. In particular, we explain various phenomena of self-organization in orientation and ocular dominance map formation including the pinwheel annihilation and its dependency on the columnar wave vector and boundary conditions.

  4. The art of consultation. (United States)

    Bhangoo, Kulwant S


    Sophisticated marketing and practice-enhancing strategies can help bring patients to a surgeon's practice. However, the ability to retain these patients and also convert the consultations into surgical procedures depends on the art of consultation. This very important aspect of clinical practice is seldom taught in the medical school. In this paper, the author discusses many aspects of the art of consultation, which he has learned in his practice over the years.

  5. Ethics in Management Consulting


    Vallini, Carlo


    Ethics is a relevant value in business and management consulting. The presence of recognized ethics tends to reduce the need for informative or legal-contractual precautions in the formalization of relationships, for both of the parts involved in a negotiation. Management Consulting on ethics will develop more and more. Law will consider more and more ethics in business and management consulting. The ethics of corporations influences their workers and behaviour with the customers. It is an e...

  6. Consultation Models Revisited

    International Nuclear Information System (INIS)

    Fawaz, S.; Khan, Zulfiquar A.; Mossa, Samir Y.


    A new definition is proposed for analyzing the consultation in the primary health care, integrating other models of consultation and provides a framework by which general practitioners can apply the principles of consultation using communication skills to reconcile the respective agenda and autonomy of both doctor and patient into a negotiated agreed plan, which includes both management of health problems and health promotion. Achieving success of consultations depends on time and mutual cooperation between patient and doctor showed by doctor-patient relationship. (author)

  7. Inpatient Consultative Dermatology. (United States)

    Biesbroeck, Lauren K; Shinohara, Michi M


    Dermatology consultation can improve diagnostic accuracy in the hospitalized patient with cutaneous disease. Dermatology consultation can streamline and improve treatment plans, and potentially lead to cost savings. Dermatology consultants can be a valuable resource for education for trainees, patients, and families. Inpatient consultative dermatology spans a breadth of conditions, including inflammatory dermatoses,infectious processes, adverse medication reactions, and neoplastic disorders, many of which can be diagnosed based on dermatologic examination alone, but when necessary, bedside skin biopsies can contribute important diagnostic information. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Understanding the effect of substitution on the formation of S... F ...

    Indian Academy of Sciences (India) ... The formation of S. . .F chalcogen bonds was observed in all the cases, except for X = −H. The binding energy of the S. . .F non-covalent interactions is strongly dependent on the nature of the ...

  9. Towards the understanding of structure formation and dynamics in bio-nano systems

    DEFF Research Database (Denmark)

    Yakubovich, Alexander V.; Solov'yov, Ilia; Solov'yov, Andrey V.


    This paper gives an overview of a number of key structure formation processes involving the well known biomolecular and nano objects such as fullerenes, nanotubes, polypeptides, proteins and DNA molecules. We formulate the problems, describe the main experimental observations and theoretical...

  10. Pregnancy Resolution and Family Formation: Understanding Gender Differences in Adolescents' Preferences and Beliefs. (United States)

    Marsiglio, William; Menaghan, Elizabeth G.


    Examined gender differences in adolescents' personal views about pregnancy resolution and family formation. Surveyed adolescents (n=577) using vignette involving unplanned pregnancy. Findings showed similar percentages of males and females preferred abortion and adoption as strategies for handling pregnancy, but females were more likely to select…

  11. Molecular understanding of atmospheric particle formation from sulfuric acid and large oxidized organic molecules. (United States)

    Schobesberger, Siegfried; Junninen, Heikki; Bianchi, Federico; Lönn, Gustaf; Ehn, Mikael; Lehtipalo, Katrianne; Dommen, Josef; Ehrhart, Sebastian; Ortega, Ismael K; Franchin, Alessandro; Nieminen, Tuomo; Riccobono, Francesco; Hutterli, Manuel; Duplissy, Jonathan; Almeida, João; Amorim, Antonio; Breitenlechner, Martin; Downard, Andrew J; Dunne, Eimear M; Flagan, Richard C; Kajos, Maija; Keskinen, Helmi; Kirkby, Jasper; Kupc, Agnieszka; Kürten, Andreas; Kurtén, Theo; Laaksonen, Ari; Mathot, Serge; Onnela, Antti; Praplan, Arnaud P; Rondo, Linda; Santos, Filipe D; Schallhart, Simon; Schnitzhofer, Ralf; Sipilä, Mikko; Tomé, António; Tsagkogeorgas, Georgios; Vehkamäki, Hanna; Wimmer, Daniela; Baltensperger, Urs; Carslaw, Kenneth S; Curtius, Joachim; Hansel, Armin; Petäjä, Tuukka; Kulmala, Markku; Donahue, Neil M; Worsnop, Douglas R


    Atmospheric aerosols formed by nucleation of vapors affect radiative forcing and therefore climate. However, the underlying mechanisms of nucleation remain unclear, particularly the involvement of organic compounds. Here, we present high-resolution mass spectra of ion clusters observed during new particle formation experiments performed at the Cosmics Leaving Outdoor Droplets chamber at the European Organization for Nuclear Research. The experiments involved sulfuric acid vapor and different stabilizing species, including ammonia and dimethylamine, as well as oxidation products of pinanediol, a surrogate for organic vapors formed from monoterpenes. A striking resemblance is revealed between the mass spectra from the chamber experiments with oxidized organics and ambient data obtained during new particle formation events at the Hyytiälä boreal forest research station. We observe that large oxidized organic compounds, arising from the oxidation of monoterpenes, cluster directly with single sulfuric acid molecules and then form growing clusters of one to three sulfuric acid molecules plus one to four oxidized organics. Most of these organic compounds retain 10 carbon atoms, and some of them are remarkably highly oxidized (oxygen-to-carbon ratios up to 1.2). The average degree of oxygenation of the organic compounds decreases while the clusters are growing. Our measurements therefore connect oxidized organics directly, and in detail, with the very first steps of new particle formation and their growth between 1 and 2 nm in a controlled environment. Thus, they confirm that oxidized organics are involved in both the formation and growth of particles under ambient conditions.

  12. N-body simulations of planet formation: understanding exoplanet system architectures (United States)

    Coleman, Gavin; Nelson, Richard


    Observations have demonstrated the existence of a significant population of compact systems comprised of super-Earths and Neptune-mass planets, and a population of gas giants that appear to occur primarily in either short-period (100 days) orbits. The broad diversity of system architectures raises the question of whether or not the same formation processes operating in standard disc models can explain these planets, or if different scenarios are required instead to explain the widely differing architectures. To explore this issue, we present the results from a comprehensive suite of N-body simulations of planetary system formation that include the following physical processes: gravitational interactions and collisions between planetary embryos and planetesimals; type I and II migration; gas accretion onto planetary cores; self-consistent viscous disc evolution and disc removal through photo-evaporation. Our results indicate that the formation and survival of compact systems of super-Earths and Neptune-mass planets occur commonly in disc models where a simple prescription for the disc viscosity is assumed, but such models never lead to the formation and survival of gas giant planets due to migration into the star. Inspired in part by the ALMA observations of HL Tau, and by MHD simulations that display the formation of long-lived zonal flows, we have explored the consequences of assuming that the disc viscosity varies in both time and space. We find that the radial structuring of the disc leads to conditions in which systems of giant planets are able to form and survive. Furthermore, these giants generally occupy those regions of the mass-period diagram that are densely populated by the observed gas giants, suggesting that the planet traps generated by radial structuring of protoplanetary discs may be a necessary ingredient for forming giant planets.

  13. Global Consultation Processes: Lessons Learned from Refugee Teacher Consultation Research in Malaysia (United States)

    O'Neal, Colleen R.; Gosnell, Nicole M.; Ng, Wai Sheng; Clement, Jennifer; Ong, Edward


    The process of global consultation has received little attention despite its potential for promoting international mutual understanding with marginalized communities. This article details theory, entry, implementation, and evaluation processes for global consultation research, including lessons learned from our refugee teacher intervention. The…

  14. The Contemporary Consultant

    DEFF Research Database (Denmark)

    Olson, Thomas; Poulfelt, Flemming; Greiner, Larry

    This book complements The handbook of Management Consulting: The Contemporary Consultant: Insights from Leading Experts, 1e but can also be studied separately. The book consists of 20 cases including Harvard and Stanford cases. The cases present the broad range of topics that are pertinent...

  15. The Dream Consultant

    DEFF Research Database (Denmark)

    Muhr, Sara Louise; Kirkegaard, Line


    Consultants are known to work extreme hours. We show empirically how consultants fantasize about off-work activities, which are impossible to realize with their work schedule. These fantasies are, however, not obstructing their work, but important to justify the extreme hours and sustain desire...

  16. Applied DMP Consultation Workshop


    Zilinski, Lisa


    This workshop allowed participants to work through a data management plan consultation, using a real world example. The workshop covered data management plans (DMPs), described in detail the areas that are typically included in a DMP, and utilized tools and resources to help support a DMP consultation with disciplinary faculty.

  17. Molecular understanding of atmospheric particle formation from sulfuric acid and large oxidized organic molecules

    CERN Document Server

    Schobesberger, Siegfried; Bianchi, Federico; Lönn, Gustaf; Ehn, Mikael; Lehtipalo, Katrianne; Dommen, Josef; Ehrhart, Sebastian; Ortega, Ismael K; Franchin, Alessandro; Nieminen, Tuomo; Riccobono, Francesco; Hutterli, Manuel; Duplissy, Jonathan; Almeida, João; Amorim, Antonio; Breitenlechner, Martin; Downard, Andrew J; Dunne, Eimear M; Flagan, Richard C; Kajos, Maija; Keskinen, Helmi; Kirkby, Jasper; Kupc, Agnieszka; Kürten, Andreas; Kurtén, Theo; Laaksonen, Ari; Mathot, Serge; Onnela, Antti; Praplan, Arnaud P; Rondo, Linda; Santos, Filipe D; Schallhart, Simon; Schnitzhofer, Ralf; Sipilä, Mikko; Tomé, António; Tsagkogeorgas, Georgios; Vehkamäki, Hanna; Wimmer, Daniela; Baltensperger, Urs; Carslaw, Kenneth S; Curtius, Joachim; Hansel, Armin; Petäjä, Tuukka; Kulmala, Markku; Donahue, Neil M; Worsnop, Douglas R


    Atmospheric aerosols formed by nucleation of vapors affect radiative forcing and therefore climate. However, the underlying mechanisms of nucleation remain unclear, particularly the involvement of organic compounds. Here, we present high-resolution mass spectra of ion clusters observed during new particle formation experiments performed at the Cosmics Leaving Outdoor Droplets chamber at the European Organization for Nuclear Research. The experiments involved sulfuric acid vapor and different stabilizing species, including ammonia and dimethylamine, as well as oxidation products of pinanediol, a surrogate for organic vapors formed from monoterpenes. A striking resemblance is revealed between the mass spectra from the chamber experiments with oxidized organics and ambient data obtained during new particle formation events at the Hyytiälä boreal forest research station. We observe that large oxidized organic compounds, arising from the oxidation of monoterpenes, cluster directly with single sulfuric acid molec...

  18. Control analysis as a tool to understand the formation of the las operon in Lactococcus lactis

    DEFF Research Database (Denmark)

    Købmann, Brian Jensen; Solem, Christian; Jensen, Peter Ruhdal


    In Lactococcus lactis the enzymes phosphofructokinase (PFK), pyruvate kinase (PK) and lactate dehydrogenase (LDH) are uniquely encoded in the las operon and we here apply Metabolic Control Analysis to study the role of this organisation. Earlier work showed that LDH at wildtype level has zero...... control on formate and acetate production, whereas PFK has no control on these fluxes. Decreased expression of the entire las operon resulted in a strong decrease in growth rate and the glycolytic flux; at 53% expression of the las operon the glycolytic flux was reduced to 44% and the flux control...... coefficient found for the entire operon; the strong positive control by PK almost cancels out the negative control by LDH on formate production. The analysis suggests that co-regulation of PFK and PK provides a very efficient way to regulate glycolysis, and co-regulating PK and LDH allows the cells...

  19. Control of Listeria monocytogenes in the processing environment by understanding biofilm formation and resistance to sanitizers. (United States)

    Manios, Stavros G; Skandamis, Panagiotis N


    Listeria monocytogenes can colonize in the food processing environment and thus pose a greater risk of cross-contamination to food. One of the proposed mechanisms that facilitates such colonization is biofilm formation. As part of a biofilm, it is hypothesized that L. monocytogenes can survive sanitization procedures. In addition, biofilms are difficult to remove and may require additional physical and chemical mechanisms to reduce their presence and occurrence. The initial stage of biofilm formation is attachment to surfaces, and therefore it is important to be able to determine the ability of L. monocytogenes strains to attach to various inert surfaces. In this chapter, methods to study bacterial attachment to surfaces are described. Attachment is commonly induced by bringing planktonic cells into contact with plastic, glass, or stainless steel surfaces with or without food residues ("soil") in batch or continuous (e.g., with constant flow of nutrients) culture. Measurement of biofilm formed is carried out by detaching cells (with various mechanical methods) and measuring the viable counts or by measuring the total attached biomass. Resistance of biofilms to sanitizers is commonly carried out by exposure of the whole model surface bearing the attached cells to a solution of sanitizer, followed by measuring the survivors as described above.

  20. Making consultations run smoothly

    DEFF Research Database (Denmark)

    Jespersen, Astrid Pernille; Jensen, Torben Elgaard


    the field of science and technology studies (STS), including notions of relationality, multiplicity and otherness. Through this lens, and based on extensive fieldwork, it describes the daily work of arranging time before, during and after consultations. In conclusion, it suggests that a STS......This article investigates the skilful use of time in general practice consultations. It argues that consultation work involves social and material interactions, which are only partially conceptualized in existing medical practice literatures. As an alternative, this article employs ideas from...

  1. The contribution of tracers in understanding transportation processes in indurated argillaceous formations

    International Nuclear Information System (INIS)

    Savoye, Sebastien


    In a first part, the author recalls briefly the properties of the two argillaceous formations studied in this HDR report: the Toarcian/Domerian argillite and the Opalinus clay of Mont Terri. At first, have been described the two undamaged argillite materials and then the damaged Tournemire argillite. The second part gives the results obtained from the researches on the undamaged rock with natural tracers and with approaches using artificial tracers. The third part deals with the study of the damaged rock in separating natural perturbations of those of anthropogenic origin. At last, the conclusion gives the guiding thema of this research work and the main long-term future prospects that may result. (O.M.)

  2. Understanding Passive Layer Formation for Further Corrosion Management in Gas Production Pipes (United States)

    Santoso, R. K.; Rahmawati, S. D.; Gadesa, A.; Wahyuningrum, D.


    Corrosion is a critical issue during the development of a gas field, especially wet gas or retrograde gas field. Corrosion affects the management system of a field and further impacts the amount of investment. Therefore, accurate prediction of corrosion rate is needed to plan an effective preventive action before going further to the development phase. One of the important parameters that should be noticed to create an accurate prediction is the formation of the passive layer. In CO2-H2S environment, there will be three possibilities of passive layer: FeS, FeCO3 or no passive layer. In this study, we create mathematical models to determine the formed passive layer in each segment of the gas production tubing and pipeline. The model is built using Faraday’s Law and Thermodynamic approach to account the passive layer formation at different temperature, pH, corrosion rate and partial pressure of CO2 and H2S. From the simulation, it was found that there were three boundary conditions: no scale-FeS boundary, no scale-FeCO3 boundary and FeS-FeCO3 boundary. The first two boundaries evolved over a time as the concentration of Fe2+ ions was increasing. However, FeS-FeCO3 boundary remained steady as it was not affected by the addition of Fe2+ ions. Using sample case study, few variations were noticed at production pipeline and tubing. It was caused by the gas composition, which contained high CO2 and very low H2S. Boundary conditions only changed slightly over two days period.

  3. Simulated consultations: a sociolinguistic perspective. (United States)

    Atkins, Sarah; Roberts, Celia; Hawthorne, Kamila; Greenhalgh, Trisha


    consultation both expect and reward a particular interactional style. Whilst simulation undoubtedly has a place in formative learning for professional communication, the simulated consultation may distort assessment of professional communication These sociolinguistic findings contribute to the on-going critique of simulations in high-stakes assessments and indicate that further research, which steps outside psychometric approaches, is necessary.

  4. Negotiating exceptions to clients' problem discourse in consultative dialogue. (United States)

    Strong, Tom; Pyle, Nathan R


    The purpose of this qualitative study was to examine how consultants negotiated exceptions to clients problem or aspiration discourse in lifestyle consultations held for research purposes. Participants from a university campus (students and employees) were recruited for 1-hr lifestyle consultations with therapist consultants having graduate training and supervision in narrative and solution-focused therapy. The consultations were held with the expectation that consultants would, at least once, invite discussions of exceptions in client's problem or aspiration discourse. We wanted to understand how such discussions were initiated and brought to conclusion by examining client and consultants use of conversational practices. Twelve volunteer 'clients' participated in consultations with our six volunteering consultants. These consultations were videotaped then passages were selected where consultants initiated exception discussions with the clients involved. The 18 selected passages were discursively analyzed for general rhetorical features evident in those passages, and three passages were transcribed and analyzed using conversation analysis to make evident more specific rhetorical features of exception discussions, as they were engaged in by consultants and clients. Ten general features of exception discussions were highlighted and the more specific conversational analyses revealed a 'messiness' that was related to how exception discussions were introduced and negotiated as a novel discourse in the consultations. We discuss our findings in the context of therapists' use of exception questions and discussions in therapy and highlight particular conversational practices and sensitivities relevant to engaging clients in such exception discussions. ©2011 The British Psychological Society.

  5. Communication between primary care physicians and consultants. (United States)

    Epstein, R M


    Optimal communication between primary care physicians and consultants includes transfer of relevant clinical information, including the patient's perspectives and values, and provides a means of collaboration to provide meaningful and health-promoting interventions. Communication difficulties arise because of lack of time, lack of clarity about the reason for referral, patient self-referral, and unclear follow-up plans. Also, primary care physicians and consultants may have different core values and may have little day-to-day contact with each other. Poor communication leads to disruptions in continuity of care, delayed diagnoses, unnecessary testing, and iatrogenic complications. Changes in the health care system offer the opportunity for improved collaboration between physicians by creating smaller administrative units within large health care systems that facilitate contact between primary care physicians and consultants; incorporation of discussions of uncertainty, patient preferences, and values into referral letters; adoption of a friendlier consultant letter format; and the improvement of the transfer of clinical data.

  6. Understanding the physics of gas stripping and star-formation quenching of the satellite dwarf galaxies in the Local Group (United States)

    Wetzel, Andrew


    The Milky Way (MW) and M31 are among the best systems to study the physics of the halo environment on galaxy evolution. Nearly all of the satellite dwarf galaxies of the MW and M31 are gas-poor and have quenched star formation. Over 1200 orbits of HST observations of these satellites now provide detailed star-formation histories and proper-motion velocities for full 6-D orbital phase-space, informing both when and where each satellite quenched. However, the lack of sufficiently realistic theoretical models of gas stripping represents a severe limitation to leveraging the astrophysical returns of these HST observations.We propose to use the new Latte cosmological zoom-in hydrodynamic simulations of MW- and M31-mass systems to understand the environmental processes that strip gas from satellite dwarf galaxies and quench their star formation. Our initial Latte simulations form realistic satellite populations, with star-formation histories that agree well HST measurements. These simulations use the state-of-the-art FIRE model for star formation and feedback: this feedback drives strong gas outflows within dwarf galaxies that can enhance the efficiency of ram-pressure stripping within the halo. We will run a new suite of simulations carefully targeted to the Local Group, and we will investigate how the combination of internal feedback and external stripping leads to rapid quenching, as observed by HST. Finally, we will publicly release our satellite galaxy/subhalo catalogs, including their full orbital and star-formation histories, to compare with existing/upcoming HST observations, providing detailed insight into the physics of environmental quenching.

  7. Efficiency principles of consulting entrepreneurship


    Moroz Yustina S.; Drozdov Igor N.


    The article reviews the primary goals and problems of consulting entrepreneurship. The principles defining efficiency of entrepreneurship in the field of consulting are generalized. The special attention is given to the importance of ethical principles of conducting consulting entrepreneurship activity.

  8. Understanding non-enzymatic aminophospholipid glycation and its inhibition. Polar head features affect the kinetics of Schiff base formation. (United States)

    Caldés, Catalina; Vilanova, Bartolomé; Adrover, Miquel; Muñoz, Francisco; Donoso, Josefa


    Non-enzymatic aminophospholipid glycation is an especially important process because it alters the stability of lipid bilayers and interferes with cell function and integrity as a result. However, the kinetic mechanism behind this process has scarcely been studied. As in protein glycation, the process has been suggested to involve the formation of a Schiff base as the initial, rate-determining step. In this work, we conducted a comparative kinetic study of Schiff base formation under physiological conditions in three low-molecular weight analogues of polar heads in the naturally occurring aminophospholipids O-phosphorylethanolamine (PEA), O-phospho-DL-serine (PSer) and 2-aminoethylphenethylphosphate (APP) with various glycating carbonyl compounds (glucose, arabinose and acetol) and the lipid glycation inhibitor pyridoxal 5'-phosphate (PLP). Based on the results, the presence of a phosphate group and a carboxyl group in α position respect to the amino group decrease the formation constant for the Schiff base relative to amino acids. On the other hand, esterifying the phosphate group with a non-polar substituent in APP increases the stability of its Schiff base. The observed kinetic formation constants of aminophosphates with carbonyl groups were smaller than those for PLP. Our results constitute an important contribution to understanding the competitive inhibition effect of PLP on aminophospholipid glycation. Copyright © 2011 Elsevier Ltd. All rights reserved.

  9. ACF Tribal Consultation Policy (United States)

    U.S. Department of Health & Human Services — The purpose of the ACF Tribal Consultation Policy is to build meaningful relationships with federally recognized tribes by engaging in open, continuous, and...

  10. A contribution to the understanding of the high burn-up structure formation in nuclear fuels

    International Nuclear Information System (INIS)

    Jonnet, J.


    An increase of the discharge burn-up of UO 2 nuclear fuels in the light water reactors results in the appearance of a change of microscopic structure, called HBS. Although well characterised experimentally, important points on the mechanisms of its formation remain to be cleared up. In order to answer these questions, a study of the contribution of the dislocation-type defects was conducted. In a first part, a calculation method of the stress field associated with periodic configurations of dislocations was developed. The method was applied to the cases of edge dislocation pile-up and wall, for which an explicit expression of the internal stress potential was obtained. Through the study of other examples of dislocation configurations, it was highlighted that this method also allows the calculation of any periodic dislocation configuration. In a second part, the evolution of interstitial-type dislocation loops was studied in UO 2 fuel samples doped with 10% in mass of alpha emitters. The experimental loop size distributions were obtained for these samples stored during 4 and 7 years at room temperature. Kinetic equations are proposed in order to study the influence of the resolution process of interstitials from a loop back to the matrix due to an impact with the recoil atom 234 U, as well as the coalescence of two interstitial loops that can diffuse by a volume mechanism. The application of the model shows that the two processes must be considered in the study of the evolution of radiation damage. (author)

  11. Formation, function, and exhaustion of notochordal cytoplasmic vacuoles within intervertebral disc: current understanding and speculation. (United States)

    Wang, Feng; Gao, Zeng-Xin; Cai, Feng; Sinkemani, Arjun; Xie, Zhi-Yang; Shi, Rui; Wei, Ji-Nan; Wu, Xiao-Tao


    Notochord nucleus pulposus cells are characteristic of containing abundant and giant cytoplasmic vacuoles. This review explores the embryonic formation, biological function, and postnatal exhaustion of notochord vacuoles, aiming to characterize the signal network transforming the vacuolated nucleus pulposus cells into the vacuole-less chondrocytic cells. Embryonically, the cytoplasmic vacuoles within vertebrate notochord originate from an evolutionarily conserved vacuolation process during neurulation, which may continue to provide mechanical and signal support in constructing a mammalian intervertebral disc. For full vacuolation, a vacuolating specification from dorsal organizer cells, synchronized convergent extension, well-structured notochord sheath, and sufficient post-Golgi trafficking in notochord cells are required. Postnatally, age-related and species-specific exhaustion of vacuolated nucleus pulposus cells could be potentiated by Fas- and Fas ligand-induced apoptosis, intolerance to mechanical stress and nutrient deficiency, vacuole-mediated proliferation check, and gradual de-vacuolation within the avascular and compression-loaded intervertebral disc. These results suggest that the notochord vacuoles are active and versatile organelles for both embryonic notochord and postnatal nucleus pulposus, and may provide novel information on intervertebral disc degeneration to guide cell-based regeneration.

  12. Caustic-based approach to understanding bunching dynamics and current spike formation in particle bunches

    Directory of Open Access Journals (Sweden)

    T. K. Charles


    Full Text Available Current modulations, current spikes, and current horns, are observed in a range of accelerator physics applications including strong bunch compression in Free Electron Lasers and linear colliders, trains of microbunching for terahertz radiation, microbunching instability and many others. This paper considers the fundamental mechanism that drives intense current modulations in dispersive regions, beyond the common explanation of nonlinear and higher-order effects. Under certain conditions, neighboring electron trajectories merge to form caustics, and often result in characteristic current spikes. Caustic lines and surfaces are regions of maximum electron density, and are witnessed in accelerator physics as folds in phase space of accelerated bunches. We identify the caustic phenomenon resulting in cusplike current profiles and derive an expression which describes the conditions needed for particle-bunch caustic formation in dispersive regions. The caustic expression not only reveals the conditions necessary for caustics to form but also where in longitudinal space the caustics will form. Particle-tracking simulations are used to verify these findings. We discuss the broader implications of this work including how to utilize the caustic expression for manipulation of the longitudinal phase space to achieve a desired current profile shape.

  13. Consulting in the Library Network Environment. (United States)

    Markuson, Barbara Evans


    Describes four elements of consulting in library networks: network client groups, potential sources of consultants, categories of network consulting, and difficulties in network-related consulting. (FM)

  14. Advances in the formation, use and understanding of multi-cellular spheroids. (United States)

    Achilli, Toni-Marie; Meyer, Julia; Morgan, Jeffrey R


    Developing in vitro models for studying cell biology and cell physiology is of great importance to the fields of biotechnology, cancer research, drug discovery, toxicity testing, as well as the emerging fields of tissue engineering and regenerative medicine. Traditional two-dimensional (2D) methods of mammalian cell culture have several limitations and it is increasingly recognized that cells grown in a three-dimensional (3D) environment more closely represent normal cellular function due to the increased cell-to-cell interactions, and by mimicking the in vivo architecture of natural organs and tissues. In this review, we discuss the methods to form 3D multi-cellular spheroids, the advantages and limitations of these methods, and assays used to characterize the function of spheroids. The use of spheroids has led to many advances in basic cell sciences, including understanding cancer cell interactions, creating models for drug discovery and cancer metastasis, and they are being investigated as basic units for engineering tissue constructs. As so, this review will focus on contributions made to each of these fields using spheroid models. Multi-cellular spheroids are rich in biological content and mimic better the in vivo environment than 2D cell culture. New technologies to form and analyze spheroids are rapidly increasing their adoption and expanding their applications.

  15. The role of mathematical models in understanding pattern formation in developmental biology. (United States)

    Umulis, David M; Othmer, Hans G


    In a Wall Street Journal article published on April 5, 2013, E. O. Wilson attempted to make the case that biologists do not really need to learn any mathematics-whenever they run into difficulty with numerical issues, they can find a technician (aka mathematician) to help them out of their difficulty. He formalizes this in Wilsons Principle No. 1: "It is far easier for scientists to acquire needed collaboration from mathematicians and statisticians than it is for mathematicians and statisticians to find scientists able to make use of their equations." This reflects a complete misunderstanding of the role of mathematics in all sciences throughout history. To Wilson, mathematics is mere number crunching, but as Galileo said long ago, "The laws of Nature are written in the language of mathematics[Formula: see text] the symbols are triangles, circles and other geometrical figures, without whose help it is impossible to comprehend a single word." Mathematics has moved beyond the geometry-based model of Galileo's time, and in a rebuttal to Wilson, E. Frenkel has pointed out the role of mathematics in synthesizing the general principles in science (Both point and counter-point are available in Wilson and Frenkel in Notices Am Math Soc 60(7):837-838, 2013). We will take this a step further and show how mathematics has been used to make new and experimentally verified discoveries in developmental biology and how mathematics is essential for understanding a problem that has puzzled experimentalists for decades-that of how organisms can scale in size. Mathematical analysis alone cannot "solve" these problems since the validation lies at the molecular level, but conversely, a growing number of questions in biology cannot be solved without mathematical analysis and modeling. Herein, we discuss a few examples of the productive intercourse between mathematics and biology.

  16. Postpartum consultation: Occurrence, requirements and expectations

    Directory of Open Access Journals (Sweden)

    Carlgren Ingrid


    Full Text Available Abstract Background As a matter of routine, midwives in Sweden have spoken with women about their experiences of labour in a so-called 'postpartum consultation'. However, the possibility of offering women this kind of consultation today is reduced due to shortage of both time and resources. The aim of this study was to explore the occurrence, women's requirements of, and experiences of a postpartum consultation, and to identify expectations from women who wanted but did not have a consultation with the midwife assisting during labour. Methods All Swedish speaking women who gave birth to a live born child at a University Hospital in western Sweden were consecutively included for a phone interview over a three-week period. An additional phone interview was conducted with the women who did not have a postpartum consultation, but who wanted to talk with the midwife assisting during labour. Data from the interviews were analysed using qualitative content analysis. Results Of the 150 interviewed women, 56% (n = 84 had a postpartum consultation of which 61.9% (n = 52 had this with the midwife assisting during labour. Twenty of the 28 women who did not have a consultation with anyone still desired to talk with the midwife assisting during labour. Of these, 19 were interviewed. The content the women wanted to talk about was summarized in four categories: to understand the course of events during labour; to put into words, feelings about undignified management; to describe own behaviour and feelings, and to describe own fear. Conclusion The survey shows that the frequency of postpartum consultation is decreasing, that the majority of women who give birth today still require it, but only about half of them receive it. It is crucial to develop a plan for these consultations that meets both the women's needs and the organization within current maternity care.

  17. Entropic effects in formation of chromosome territories: towards understanding of radiation-induced gene translocation frequency (United States)

    Gudowska-Nowak, Ewa; Ritter, Sylvia; Durante, Marco; Deperas-Standylo, Joanna; Ciesla, Michal


    A detailed understanding of structural organization of biological target, such as geometry of an inter-phase chromosome, is an essential prerequisite for gaining deeper insight into relationship between radiation track structure and radiation-induced biological damage [1]. In particular, coupling of biophysical models aimed to describe architecture of chromosomes and their positioning in a cell nucleus [2-4] with models of local distribution of ionizations caused by passing projectiles, are expected to result in more accurate estimates of aberration induction caused by radiation. There is abundant experimental evidence indicating that arrangements of chromosomes in eukaryotic cell nucleus is non-random and has been evolutionary conserved in specific cell types. Moreover, the radial position of a given chromosome territory (CT) within the cell nucleus has been shown to correlate with its size and gene density. Usually it is assumed that chromosomal geometry and positioning result from the action of specific forces acting locally, such as hydrogen bonds, electrostatic, Van der Waals or hydrophobic interactions operating between nucleosomes and within their interiors. However, it is both desirable and instructive to learn to what extend organization of inter-phase chromosomes is affected by nonspecific entropic forces. In this study we report results of a coarse-grained analysis of a chromatin structure modeled by two distinct approaches. In the first method, we adhere to purely statistical analysis of chromatin packing within a chromosome territory. On the basis of the polymer theory, the chromatin fiber of diameter 30nm is approximated by a chain of spheres, each corresponding to about 30 kbp. Random positioning of the center of the domain is repeated for 1000 spherical nuclei. Configuration of the domain is determined by a random packing of a polymer (a string of identical beads) in estimated fraction of space occupied by a chromosome of a given length and mass

  18. Shared consultant physician posts.

    LENUS (Irish Health Repository)

    Cooke, J


    Our aim was to assess the acceptability and cost-efficiency of shared consultancy posts. Two consultant physicians worked alternate fortnights for a period of twelve months. Questionnaires were distributed to general practitioners, nurses, consultants and junior doctors affected by the arrangement. Patients or their next of kin were contacted by telephone. 1\\/17 of consultants described the experience as negative. 14\\/19 junior doctors reported a positive experience. 11 felt that training had been improved while 2 felt that it had been adversely affected. 17\\/17 GPs were satisfied with the arrangement. 1\\/86 nurses surveyed reported a negative experience. 1\\/48 patients were unhappy with the arrangement. An extra 2.2 (p<0.001) patients were seen per clinic. Length of stay was shortened by 2.49 days (p<0.001). A saving of 69,212 was made due to decreased locum requirements. We present data suggesting structured shared consultancy posts can be broadly acceptable and cost efficient in Ireland.

  19. Nuclear planetology: understanding planetary mantle and crust formation in the light of nuclear and particle physics (United States)

    Roller, Goetz


    The Hertzsprung-Russell (HR) diagram is one of the most important diagrams in astronomy. In a HR diagram, the luminosity of stars and/or stellar remnants (white dwarf stars, WD's), relative to the luminosity of the sun, is plotted versus their surface temperatures (Teff). The Earth shows a striking similarity in size (radius ≈ 6.371 km) and Teff of its outer core surface (Teff ≈ 3800 K at the core-mantle-boundary) with old WD's (radius ≈ 6.300 km) like WD0346+246 (Teff ≈ 3820 K after ≈ 12.7 Ga [1]), which plot in the HR diagram close to the low-mass extension of the stellar population or main sequence. In the light of nuclear planetology [2], Earth-like planets are regarded as old, down-cooled and differentiated black dwarfs (Fe-C BLD's) after massive decompression, the most important nuclear reactions involved being 56Fe(γ,α)52Cr (etc.), possibly responsible for extreme terrestrial glaciations events ("snowball" Earth), together with (γ,n), (γ,p) and fusion reactions like 12C(α,γ)16O. The latter reaction might have caused oxidation of the planet from inside out. Nuclear planetology is a new research field, tightly constrained by a coupled 187Re-232Th-238U systematics [3-5]. By means of nuclear/quantum physics and taking the theory of relativity into account, it aims at understanding the thermal and chemical evolution of Fe-C BLD's after gravitational contraction (e.g. Mercury) or Fermi-pressure controlled collapse (e.g. Earth) events after massive decompression, leading possibly to an r-process event, towards the end of their cooling period [2]. So far and based upon 187Re-232Th-238U nuclear geochronometry, the Fe-C BLD hypothesis can successfully explain the global terrestrial MORB 232Th/238U signature [5]. Thus, it may help to elucidate the DM (depleted mantle), EMI (enriched mantle 1), EMII (enriched mantle 2) or HIMU (high U/Pb) reservoirs [6], and the 187Os/188Os isotopic dichotomy in Archean magmatic rocks and sediments [7]. Here I present a

  20. Natural formation and degradation of chloroacetic acids and volatile organochlorines in forest soil--challenges to understanding. (United States)

    Laturnus, Frank; Fahimi, Isabelle; Gryndler, Milan; Hartmann, Anton; Heal, Mathew R; Matucha, Miroslav; Schöler, Heinz Friedrich; Schroll, Reiner; Svensson, Teresia


    The anthropogenic environmental emissions of chloroacetic acids and volatile organochlorines have been under scrutiny in recent years because the two compound groups are suspected to contribute to forest dieback and stratospheric ozone destruction, respectively. The two organochlorine groups are linked because the atmospheric photochemical oxidation of some volatile organochlorine compounds is one source of phytotoxic chloroacetic acids in the environment. Moreover, both groups are produced in higher amounts by natural chlorination of organic matter, e.g. by soil microorganisms, marine macroalgae and salt lake bacteria, and show similar metabolism pathways. Elucidating the origin and fate of these organohalogens is necessary to implement actions to counteract environmental problems caused by these compounds. While the anthropogenic sources of chloroacetic acids and volatile organochlorines are relatively well-known and within human control, knowledge of relevant natural processes is scarce and fragmented. This article reviews current knowledge on natural formation and degradation processes of chloroacetic acids and volatile organochlorines in forest soils, with particular emphasis on processes in the rhizosphere, and discusses future studies necessary to understand the role of forest soils in the formation and degradation of these compounds. Reviewing the present knowledge of the natural formation and degradation processes of chloroacetic acids and volatile organochlorines in forest soil has revealed gaps in knowledge regarding the actual mechanisms behind these processes. In particular, there remains insufficient quantification of reliable budgets and rates of formation and degradation of chloroacetic acids and volatile organochlorines in forest soil (both biotic and abiotic processes) to evaluate the strength of forest ecosystems regarding the emission and uptake of chloroacetic acids and volatile organochlorines, both on a regional scale and on a global scale

  1. Understanding the primary emissions and secondary formation of gaseous organic acids in the oil sands region of Alberta, Canada

    Directory of Open Access Journals (Sweden)

    J. Liggio


    Full Text Available Organic acids are known to be emitted from combustion processes and are key photochemical products of biogenic and anthropogenic precursors. Despite their multiple environmental impacts, such as on acid deposition and human–ecosystem health, little is known regarding their emission magnitudes or detailed chemical formation mechanisms. In the current work, airborne measurements of 18 gas-phase low-molecular-weight organic acids were made in the summer of 2013 over the oil sands region of Alberta, Canada, an area of intense unconventional oil extraction. The data from these measurements were used in conjunction with emission retrieval algorithms to derive the total and speciated primary organic acid emission rates, as well as secondary formation rates downwind of oil sands operations. The results of the analysis indicate that approximately 12 t day−1 of low-molecular-weight organic acids, dominated by C1–C5 acids, were emitted directly from off-road diesel vehicles within open pit mines. Although there are no specific reporting requirements for primary organic acids, the measured emissions were similar in magnitude to primary oxygenated hydrocarbon emissions, for which there are reporting thresholds, measured previously ( ≈  20 t day−1. Conversely, photochemical production of gaseous organic acids significantly exceeded the primary sources, with formation rates of up to  ≈  184 t day−1 downwind of the oil sands facilities. The formation and evolution of organic acids from a Lagrangian flight were modelled with a box model, incorporating a detailed hydrocarbon reaction mechanism extracted from the Master Chemical Mechanism (v3.3. Despite evidence of significant secondary organic acid formation, the explicit chemical box model largely underestimated their formation in the oil sands plumes, accounting for 39, 46, 26, and 23 % of the measured formic, acetic, acrylic, and propionic acids respectively and with

  2. Understanding the primary emissions and secondary formation of gaseous organic acids in the oil sands region of Alberta, Canada (United States)

    Liggio, John; Moussa, Samar G.; Wentzell, Jeremy; Darlington, Andrea; Liu, Peter; Leithead, Amy; Hayden, Katherine; O'Brien, Jason; Mittermeier, Richard L.; Staebler, Ralf; Wolde, Mengistu; Li, Shao-Meng


    Organic acids are known to be emitted from combustion processes and are key photochemical products of biogenic and anthropogenic precursors. Despite their multiple environmental impacts, such as on acid deposition and human-ecosystem health, little is known regarding their emission magnitudes or detailed chemical formation mechanisms. In the current work, airborne measurements of 18 gas-phase low-molecular-weight organic acids were made in the summer of 2013 over the oil sands region of Alberta, Canada, an area of intense unconventional oil extraction. The data from these measurements were used in conjunction with emission retrieval algorithms to derive the total and speciated primary organic acid emission rates, as well as secondary formation rates downwind of oil sands operations. The results of the analysis indicate that approximately 12 t day-1 of low-molecular-weight organic acids, dominated by C1-C5 acids, were emitted directly from off-road diesel vehicles within open pit mines. Although there are no specific reporting requirements for primary organic acids, the measured emissions were similar in magnitude to primary oxygenated hydrocarbon emissions, for which there are reporting thresholds, measured previously ( ≈ 20 t day-1). Conversely, photochemical production of gaseous organic acids significantly exceeded the primary sources, with formation rates of up to ≈ 184 t day-1 downwind of the oil sands facilities. The formation and evolution of organic acids from a Lagrangian flight were modelled with a box model, incorporating a detailed hydrocarbon reaction mechanism extracted from the Master Chemical Mechanism (v3.3). Despite evidence of significant secondary organic acid formation, the explicit chemical box model largely underestimated their formation in the oil sands plumes, accounting for 39, 46, 26, and 23 % of the measured formic, acetic, acrylic, and propionic acids respectively and with little contributions from biogenic VOC precursors. The model

  3. Consultation Content not Consultation Length Improves Patient Satisfaction (United States)

    Lemon, Thomas I.; Smith, Rebecca H.


    The suggestion that increased consultation length leads to improved patient satisfaction has some evidence, albeit uncertain. Importantly there are other determinants within the doctor-patient consultation that themselves may be responsible for this improved satisfaction and it is these we investigate in this paper. A systematic review of PubMed and associated papers was carried out using search terms ‘family practice consultation length’, ‘general practice consultation length’, ‘local health authority consultation length’ and ‘primary care consultation length’. 590 papers were originally selected using these search terms, post scoring this number became 9. The results obtained support the idea that consultation length does not directly improve consultation outcome, but rather there are variables integrated within the consultation affecting this. Increased time purely allows a physician to implement management, particularly relating to psychosocial aspects. PMID:25657939

  4. Consultation content not consultation length improves patient satisfaction

    Directory of Open Access Journals (Sweden)

    Thomas I Lemon


    Full Text Available The suggestion that increased consultation length leads to improved patient satisfaction has some evidence, albeit uncertain. Importantly there are other determinants within the doctor-patient consultation that themselves may be responsible for this improved satisfaction and it is these we investigate in this paper. A systematic review of PubMed and associated papers was carried out using search terms ′family practice consultation length′, ′general practice consultation length′, ′local health authority consultation length′ and ′primary care consultation length′. 590 papers were originally selected using these search terms, post scoring this number became 9. The results obtained support the idea that consultation length does not directly improve consultation outcome, but rather there are variables integrated within the consultation affecting this. Increased time purely allows a physician to implement management, particularly relating to psychosocial aspects.

  5. Resistance, Reactance, and Consultation. (United States)

    Hughes, Jan N.; Falk, Robert S.


    Presents a review of techniques for dealing with consultee resistance. Suggests the social psychological theory of reactance is a useful conceptual framework for considering resistance in consultation. Discusses examples of its application, variables that predict the likely effectiveness of a reactance utilization intervention, and ethical issues.…

  6. Shifting Design Consultancy Identities

    DEFF Research Database (Denmark)

    Larsen, Henry; Huijboom, Nina; Holm Nielsen, Anne


    Knowledge-intensive business services, such as design consultancies are perceived as key drivers for innovation and competitiveness. However, many designers create their own companies, which often remain as one-man companies. By interviewing designers who own small design firms we found patterns...

  7. Ethical Issues in Consulting. (United States)

    Schwartz, Lois


    Identifies common ethical dilemmas that arise in performance technology consultant-client relationships and the difficulties both parties have in resolving them. Questions of integrity v ethics, legality v ethics, conflict of interest issues, contracts and fee issues, and ownership issues are addressed. (MER)

  8. Understanding ozone formation and the radical budget during oil sands plume transport in the Athabasca region of Alberta (United States)

    Moussa, S. G.; Leithead, A.; Li, S. M.; Wang, D. K.; O'brien, J.; Mittermeier, R. L.; Gordon, M.; Staebler, R. M.; Liu, P.; Liggio, J.


    The sources of ozone and hydroxyl radicals (OH) in the Alberta oil sands (OS) region have not previously been well characterized. In the summer of 2013, airborne measurements of various volatile organic compounds (VOCs), nitrogen oxides (NOx = NO2+NO) and ozone were made in the Athabasca OS region between August 13 and September 7, 2013. Proton Transfer Reaction-Time of Flight-Mass Spectrometry (PTR-ToF-MS) and whole air samples were used to measure VOCs. A box model incorporating the Master Chemical Mechanism (MCM v3.3), was constrained by measured chemical species and meteorological parameters and used to simulate the evolution of an OS plume. In doing so, an improved understanding of the chemical factors controlling the radical budget and the evolution of ozone in oil sands plumes is achieved. Our results indicate that approximately 20% of the in-plume generated OH radicals are derived from primary sources (HCHO, O3 and HONO photolysis). The remaining OH is derived from the recycling of hydroperoxyl radical (HO2). The HO2 and alkyl peroxyl radical (RO2) chemistry leads to 35% of the ozone formation in the plume, while the main sink for ozone in the plume was via reactions with alkenes (anthropogenic and biogenic). The results of this work will help to characterize ozone formation and the factors influencing its atmospheric fate in the oil sands region.

  9. Three models of child abuse consultations: A qualitative study of inpatient child abuse consultation notes. (United States)

    Keenan, Heather T; Campbell, Kristine A


    Child abuse pediatricians have multiple roles in caring for abused children, including prevention, diagnosis, treatment, and, when needed, expert legal opinion. The child physical abuse consultation differs from the traditional medical consultation in that it has medical, investigative and legal audiences, all of whom have different information needs. How child abuse pediatricians approach their cases and how they document their initial inpatient consultations that will be used by such a diverse audience is currently unexplored. We used content analysis to examine 37 child physical abuse consultation notes from a national sample of child abuse pediatricians in order to understand physicians' approaches to these consultations. Three commonly used models of child physical abuse consultation were identified in the data that we named the base model, the investigative model, and the family-dynamic model. While model types overlap, each is distinguished by key features including the approach used to gather information, the information recorded, and the language used in documentation. The base model most closely mirrors the traditional medical approach; the investigative model concentrates on triangulation of sources of information; and, the family-dynamic model concentrates on physician perceptions of family relationships. The three models of consultations for child physical abuse mirror the areas of child abuse pediatrics: diagnostic, forensic and therapeutic. These models are considered in relationship to best practice from other medical specialties with forensic components. Copyright © 2014 Elsevier Ltd. All rights reserved.

  10. Small Business & Consultancy: Exploration of an Experiment with Student Consultants

    NARCIS (Netherlands)

    I. Hollaender


    In this paper I’ll discuss the first outcomes of an explorative research concerning the consultancy projects of a consultancy-based learning programme (Minor Consultancy 2006 - 2007, half-year bachelor programme University of Applied Sciences, Hogeschool Utrecht, The Netherlands). In order to

  11. 78 FR 48342 - Consultation Agreements: Proposed Changes to Consultation Procedures (United States)


    .... OSHA-2010-0010] RIN 1218-AC32 Consultation Agreements: Proposed Changes to Consultation Procedures... federally-funded On-site Consultation Program to: Clarify, so it more directly reflects the wording of... proposed rule. DATES: This withdrawal becomes effective August 8, 2013. FOR FURTHER INFORMATION CONTACT...

  12. Mentoring for new consultants. (United States)

    Ackroyd, R; Adamson, K A


    There is increasing evidence of the benefits of having a mentor during the early years as a consultant. Mentoring encourages and provides support to an individual in their professional development. Although there are different forms of mentoring there is recognition that developing a formal mentoring scheme can provide a consistent approach and support within a framework. The Royal College of Physicians of Edinburgh has introduced a mentoring scheme for new consultants that provides a forum for supporting them in their ongoing professional wellbeing. There is potential that the process of mentoring can improve an individual's development, and motivate and encourage them to develop the skills needed to achieve their goals, thus having an impact on ultimately improving their ability to deliver an effective patient-centred service.

  13. Tutoring Mentoring Peer Consulting


    Szczyrba, Birgit; Wildt, Johannes


    Consulting, Coaching und Supervision, Tutoring, Mentoring und kollegiale Beratung: Beratungsangebote verschiedenster Art werden wie selbstverständlich in den Berufen nachgefragt, die mit Beziehung und Interaktion, mit komplexen sozialen Organisationen und Systemen, mit hoher Verantwortlichkeit, aber unsicheren Handlungsbedingungen zu tun haben. Mittlerweile beginnt diese Nachfrage auch in den Hochschulen zu steigen. Eine solche Steigerung wird ausgelöst durch den Wandel in den Lehr-Lernkultur...

  14. [Indoor environment consultant nurse]. (United States)

    Frain, Sophie


    Sustainable development combines a search for comfort with a reduction in energy consumption and these aspects can have a negative impact on health. In Brittany, a nurse trained in respiratory and environmental health as well as therapeutic education carries out, on medical prescription and as part of an association, environmental audits of patients' homes or their workplace. As an indoor environment medical consultant, she informs, orientates and promotes good healthcare practices.

  15. NICU consultants and support staff (United States)

    Newborn intensive care unit - consultants and support staff; Neonatal intensive care unit - consultants and support staff ... a baby's nipple-feeding readiness and oral-motor skills. Speech therapists will also help with feeding skills ...

  16. "Systematizing" ethics consultation services. (United States)

    Bruce, Courtenay R; Eves, Margot M; Allen, Nathan G; Smith, Martin L; Peña, Adam M; Cheney, John R; Majumder, Mary A


    While valuable work has been done addressing clinical ethics within established healthcare systems, we anticipate that the projected growth in acquisitions of community hospitals and facilities by large tertiary hospitals will impact the field of clinical ethics and the day-to-day responsibilities of clinical ethicists in ways that have yet to be explored. Toward the goal of providing clinical ethicists guidance on a range of issues that they may encounter in the systematization process, we discuss key considerations and potential challenges in implementing system-wide ethics consultation services. Specifically, we identify four models for organizing, developing, and enhancing ethics consultation activities within a system created through acquisitions: (1) train-the-trainer, (2) local capacity-building, (3) circuit-riding, and (4) consolidated accountability. We note each model's benefits and challenges. To our knowledge, this is the first paper to consider the broader landscape of issues affected by consolidation. We anticipate that clinical ethicists, volunteer consultants, and hospital administrators will benefit from our recommendations.

  17. Malpractice and the Communication Consultant: A Proactive Approach. (United States)

    Montgomery, Daniel J.; And Others


    Provides communication practitioners with an overview of legal and ethical issues facing individuals who market themselves as professional communication consultants. Discusses the tort of negligence. Outlines court-supported practices that professional consultants might use to help protect clients and themselves. Argues that an understanding of…

  18. Practice what you Preach: How Consultants Frame Management Concepts as Enacted Practice

    NARCIS (Netherlands)

    Heusinkveld, H.S.; Visscher, K.J.


    To contribute to the understanding of management knowledge commodification, this research explores how management consultants frame management concepts as enacted practice. Despite the recognition of consultants as important knowledge entrepreneurs, little academic research considers how they

  19. Practice what you preach: how consultants frame management concepts as enacted practice

    NARCIS (Netherlands)

    Heusinkveld, S.; Visscher, Klaasjan


    To contribute to the understanding of management knowledge commodification, this research explores how management consultants frame management concepts as enacted practice. Despite the recognition of consultants as important knowledge entrepreneurs, little academic research considers how they

  20. On the Magnitude and Orientation of Stress during Shock Metamorphism: Understanding Peak Ring Formation by Combining Observations and Models. (United States)

    Rae, A.; Poelchau, M.; Collins, G. S.; Timms, N.; Cavosie, A. J.; Lofi, J.; Salge, T.; Riller, U. P.; Ferrière, L.; Grieve, R. A. F.; Osinski, G.; Morgan, J. V.; Expedition 364 Science Party, I. I.


    Shock metamorphism occurs during the earliest moments after impact. The magnitude and orientation of shock leaves recordable signatures in rocks, which spatially vary across an impact structure. Consequently, observations of shock metamorphism can be used to understand deformation and its history within a shock wave, and to examine subsequent deformation during crater modification. IODP-ICDP Expedition 364 recovered nearly 600 m of shocked target rocks from the peak ring of the Chicxulub Crater. Samples from the expedition were used to measure the magnitude and orientation of shock in peak ring materials, and to determine the mechanism of peak-ring emplacement. Here, we present the results of petrographic analyses of the shocked granitic target rocks of the Chicxulub peak ring; using universal-stage optical microscopy, back-scattered electron images, and electron back-scatter diffraction. Deformation microstructures in quartz include planar deformation features (PDFs), feather features (FFs), which are unique to shock conditions, as well as planar fractures and crystal-plastic deformation bands. The assemblage of PDFs in quartz suggest that the peak-ring rocks experienced shock pressures of 15 GPa throughout the recovered drill core, and that the orientation of FFs are consistent with the present-day orientation of the maximum principal stress direction during shock is close to vertical. Numerical impact simulations of the impact event were run to determine the magnitude and orientation of principal stresses during shock and track those orientations throughout crater formation. Our results are remarkably consistent with the geological data, and accurately predict both the shock-pressure magnitudes, and the final near-vertical orientation of the direction of maximum principal stress in the shock wave. Furthermore, analysis of the state of stress throughout the impact event can be used to constrain the timing of fracture and fault orientations observed in the core

  1. Insights in understanding aggregate formation and dissociation in cation exchange chromatography for a structurally unstable Fc-fusion protein. (United States)

    Chen, Zhiqiang; Huang, Chao; Chennamsetty, Naresh; Xu, Xuankuo; Li, Zheng Jian


    surface properties and charged ligand type. Experimental data was correlated semi-quantitatively with theoretical protein charge and hydrophobicity calculations using homology modeling within the BIOVIA Discovery Studio software. Finally, an arginine-sulphopropyl (Arg-SP) agarose resin immobilized with multi-functional ligands was prepared to verify the proposed hypothesis and to eliminate the aggregate formation. The findings of this work provide general insights in understanding aggregate formation and dissociation for structurally unstable proteins in the CEX step. Copyright © 2016 Elsevier B.V. All rights reserved.

  2. Working with boundaries in systems psychodynamic consulting

    Directory of Open Access Journals (Sweden)

    Henk Struwig


    Research purpose: The purpose of the research was to produce a set of theoretical assumptions about organisational boundaries and boundary management in organisations and, from these, to develop a set of hypotheses as a thinking framework for practising consulting psychologists when they work with boundaries from a systems psychodynamic stance. Motivation for the study: The researcher used the belief that organisational boundaries reflect the essence of organisations. Consulting to boundary managers could facilitate a deep understanding of organisational dynamics. Research design, approach and method: The researcher followed a case study design. He used systems psychodynamic discourse analysis. It led to six working hypotheses. Main findings: The primary task of boundary management is to hold the polarities of integration and differentiation and not allow the system to become fragmented or overly integrated. Boundary management is a primary task and an ongoing activity of entire organisations. Practical/managerial implications: Organisations should work actively at effective boundary management and at balancing integration and differentiation. Leaders should become aware of how effective boundary management leads to good holding environments that, in turn, lead to containing difficult emotions in organisations. Contribution/value-add: The researcher provided a boundary-consulting framework in order to assist consultants to balance the conceptual with the practical when they consult.

  3. A short review of our current understanding of the development of ring faults during collapse caldera formation

    Directory of Open Access Journals (Sweden)

    Adelina eGeyer


    Full Text Available The term collapse caldera refers to those volcanic depressions resulting from the sinking of the chamber roof due to the rapid withdrawal of magma during the course of an eruption. During the last three decades, collapse caldera dynamics has been the focus of attention of numerous, theoretical, numerical and experimental studies. Nonetheless, even if there is a tendency to go for a general and comprehensive caldera dynamics model, some key aspects remain unclear, controversial or completely unsolved. This is the case of ring fault nucleation points and propagation and dip direction. Since direct information on calderas’ deeper structure comes mainly from partially eroded calderas or few witnessed collapses, ring faults layout at depth remains still uncertain. This has generated a strong debate over the detailed internal fault and fracture configuration of a caldera collapse and, in more detail, how ring faults initiate and propagate. We offer here a very short description of the main results obtained by those analogue and theoretical/mathematical models applied to the study of collapse caldera formation. We place special attention on those observations related to the nucleation and propagation of the collapse-controlling ring faults. This summary is relevant to understand the current state-of-the-art of this topic and it should be taken under consideration in future works dealing with collapse caldera dynamics.

  4. Understanding the Formation of the Self-Assembly of Colloidal Copper Nanoparticles by Surfactant: A Molecular Velcro

    Directory of Open Access Journals (Sweden)

    Raquel Kely Bortoleto-Bugs


    Full Text Available Self-assembly procedure is employed to synthesize colloidal copper nanoparticles (ccNPs with cationic surfactant in an environmentally friendly method. Scanning electron microscopy images provide a clear view of the ccNPs formed having an approximate size of 15 nm. The X-ray diffraction reveals that the ccNPs have the two types of copper oxide as well as the metallic copper. The new procedure shows that the cationic surfactant CTAB plays an important role in the understanding and development of self-assembly. There is a strong relationship between the ccNPs formation with the critical micelle concentration of the CTAB which influences both shape and size. The outcomes allowed the development of a molecular model for the ccNPs synthesis showing that the CTAB monomer on the surface has the function of a molecular velcro making the linkage of ccNPs to form an agglomerate with size around 600 nm. Finally, with the emerging new technologies, the synthesis of copper oxide takes a new perspective for their applicability in diverse integrated areas such as the flexible electronics and energy.

  5. A Case Study of Online Peer Coaching of Consultant Communication Skill Development (United States)

    Wizda, Lorraine L.


    The purpose of the this study was to explore how peer coaches support the development of collaborative communication skills in an online format for consultants in training (CITs). The program examined was Instructional Consultation which pairs a consultant with a teacher to work collaboratively to resolve the teacher's concern regarding a student.…

  6. Discovering What Matters: Interrogating Clinician Responses to Ethics Consultation. (United States)

    Finder, Stuart G; Bartlett, Virginia L


    Against the background assumptions that (a) knowing what clinical ethics consultation represents to those with whom ethics consultants work most closely is a necessary component for being responsible in the practice of ethics consultation, and (b) the complexities of soliciting and understanding colleague evaluations require another inherent responsibility for the methods by which ethics consultations are evaluated, in this article we report our experience soliciting, analyzing, and trying to understand retrospective evaluations of our Clinical Ethics Consultation Service. These evaluations were collected through a quality assessment effort at our institution. Drawing from the qualitative elements of our survey instrument, we describe unexpected variations among the requests for ethics consultation and the retrospective reports from those colleagues making the requests. Focusing on just one aspect - the reason for request - raised several core questions about how we should evaluate those retrospective reports, what could be learned from the differences that we were now encountering, and what we could learn about the process of evaluating our practices. Working through these questions, we suggest several issues to consider in ongoing efforts to describe and evaluate clinical ethics consultation: the role of time and memory in evaluating retrospective evaluations, the importance of attending to the language of moral shift or disruption with which our colleagues describe their experiences, and how to understand the role of ethics consultation in creating 'moral space' (a la Margaret Urban Walker's conception) for colleagues to process their moral experiences. © 2017 John Wiley & Sons Ltd.

  7. Consulting in Electronic Commerce

    Directory of Open Access Journals (Sweden)

    Florentina Loredana Tache


    Full Text Available Economic development of electronic services provide advice and many agents of existingreferral systems to recommend and provide products, information and customized views of thecommunity through a personalized interaction in real time. Distributed systems of autonomous agentsare becoming increasingly important in electronic comet because the basic decisions of agents adviceon trust and reputation are taken in a similar way human society. If these decisions will be as a realconsumer protection, when new aspects of online consumer legislation will become usefulinformation in advice and consulting of electronic commerce.

  8. Consulting Communities When Patients Cannot Consent: A Multi-Center Study of Community Consultation for Research in Emergency Settings (United States)

    Dickert, Neal W; Mah, Victoria A; Biros, Michelle H; Harney, Deneil M; Silbergleit, Robert; Sugarman, Jeremy; Veledar, Emir; Weinfurt, Kevin P; Wright, David W; Pentz, Rebecca D


    Objective To assess the range of responses to community consultation efforts conducted within a large network and the impact of different consultation methods on acceptance of exception from informed consent (EFIC) research and understanding of the proposed study. Design A cognitively pre-tested survey instrument was administered to 2,612 community consultation participants at 12 US centers participating in a multi-center trial of treatment for acute traumatic brain injury (TBI). Setting Survey nested within community consultation for a Phase III, randomized controlled trial of treatment for acute TBI conducted within a multi-center trial network and using EFIC. Subjects Adult participants in community consultation events. Interventions Community consultation efforts at participating sites. Measurements and Main Results Acceptance of EFIC in general, attitude toward personal EFIC enrollment, and understanding of the study content were assessed. 54% of participants agreed EFIC was acceptable in the proposed study; 71% were accepting of personal EFIC enrollment. Participants in interactive versus non-interactive community consultation events were more accepting of EFIC in general (63% vs. 49%) and personal EFIC inclusion (77% vs. 67%). Interactive community consultation participants had high-level recall of study content significantly more often than non-interactive consultation participants (77% vs. 67%). Participants of interactive consultation were more likely to recall possible study benefits (61% vs. 45%) but less likely to recall potential risks (56% vs. 69%). Conclusions Interactive community consultation methods were associated with increased acceptance of EFIC and greater overall recall of study information but lower recall of risks. There was also significant variability in EFIC acceptance among different interactive consultation events. These findings have important implications for IRBs and investigators conducting EFIC research and for community

  9. Exploring the research domain of consultant practice: Experiences of consultant radiographers

    International Nuclear Information System (INIS)

    Harris, R.; Paterson, A.


    Aim: This paper reports on one part of a larger study. The aim of the overall study was to explore what the core domain of research means to consultant radiographers in clinical practice and to identify the key factors that facilitate or hinder research activity by this staff group. Design and method: Grounded theory research methodology was employed. This second part of the study involved telephone interviews with twenty five consultant radiographers. Results: Results indicate there are variations across clinical specialties as to the amount and level of research undertaken by consultant radiographers. The principal barriers revealed were: lack of time; excessive clinical workload; lack of skills and confidence to undertake research; poor research culture; and lack of support. The main facilitators noted were: dedicated time, research training and up-skilling; mutually beneficial collaborations; managerial understanding of the research domain of the role; and research focussed on clinical demand. Conclusion: Fulfilling the clinical role is imperative and integral to the profession at consultant level; however, if it is undertaken to the detriment of the other domains then these practitioners may not be operating at ‘consultant’ level. Overall improvements must be made to ensure that the consultant radiographer role is delivering on current expectations and is safeguarded for the future of the next generation of radiographers. - Highlights: • Consultant radiographers undertake research but have concerns about their research skills. • Research aims to improve practice and patients' experiences. • Relatively few consultant radiographers publish their work regularly. • Consultant radiographers allocate little protected time for research due to clinical demands.

  10. Coupling an aerosol box model with one-dimensional flow: a tool for understanding observations of new particle formation events


    Kivekäs, N.; Carpman, J.; Roldin, P.; Leppä, J.; O'Connor, E. J.; Kristensson, A.; Asmi, E.


    Field observations of new particle formation and the subsequent particle growth are typically only possible at a fixed measurement location, and hence do not follow the temporal evolution of an air parcel in a Lagrangian sense. Standard analysis for determining formation and growth rates requires that the time-dependent formation rate and growth rate of the particles are spatially invariant; air parcel advection means that the observed temporal evolution of the particle size distribution at a...

  11. Communication with patients and the duration of family medicine consultations. (United States)

    Valverde Bolívar, Francisco Javier; Pedregal González, Miguel; Moreno Martos, Herminia; Cózar García, Inmaculada; Torío Durántez, Jesús


    To determine the distribution of consultation times, the factors that determine their length, and their relationship with a more participative, patient-centred consulting style. Cross-sectional multicentre study. Primary Healthcare Centres in Andalusia, Spain. A total of 119 tutors and family medicine physician residents. Consultation length and communication with the patient were analysed using the CICCAA scale (Connect, Identify, Understand, Consent, Help) during 436 interviews in Primary Care. The mean duration of consultations was 8.8min (sd: 3.6). The consultation tended to be longer when the physician had a patient-centred approach (10.37±4.19min vs 7.54±2.98min; p=0.001), and when there was joint decision-making (9.79±3.96min vs 7.73±3.42min: p=0.001). In the multivariable model, longer consultations were associated with obtaining higher scores on the CICAA scale, a wider range of reasons for consultation, whether they came accompanied, in urban centres, and a smaller number of daily visits (r 2 =0.32). There was no correlation between physician or patient gender, or problem type. A more patient centred medical profile, increased shared decision-making, a wider range of reasons for consultation, whether they came accompanied, in urban centres, and less professional pressure all seem to be associated with a longer consultation. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  12. Wind power projects and Aboriginal consultation

    Energy Technology Data Exchange (ETDEWEB)

    Isaac, T. [McCarthy Tetrault LLP, Vancouver, BC (Canada)


    This presentation outlined some of the legal aspects related to Aboriginal involvement in wind power development consultation processes and disputes. Aboriginal rights are rights held by Aboriginal people that are an element of a practice, custom, or tradition integral to the culture of groups claiming such rights. Wind power developers should understand that Aboriginal rights claims may include fishing; whaling; transportation; and cultural and spiritual activities. Aboriginal title is a subcategory of Aboriginal rights, and is a right to land itself, and an encumbrance on the Crown's underlying title to land. Weak Aboriginal claims where potential infringement by energy developers is minor may only require notice and information. Strong prima facie cases for Aboriginal rights and title where the potential for infringement is of high significance may result in more extensive consultation involving interim solutions; formal Aboriginal participation in decision-making processes; and written responses demonstrating how Aboriginal concerns have been considered. There are a number of circumstances requiring a case-by-case approach, and the Crown may make decisions in the face of Aboriginal disagreement. However, energy developers should ensure that consultation processes are fair and reasonable. Conflicting interests can often be successfully resolved through consultation, and accommodation to Aboriginal rights may include mitigation, avoiding interference, and agreeing to as little infringement as possible. Aboriginal title may attach to private land but only to the Crown's underlying title. The Crown has no duty to consult respecting Aboriginal title on private land because title has already been infringed. In these cases, duty to consult and accommodate may be discharged through other regulatory processes such as environmental impact assessments. It was concluded that wind power project proponents should build a relationship with the Crown, as avoiding

  13. Moral mediation in interpreted health care consultations. (United States)

    Seale, Clive; Rivas, Carol; Al-Sarraj, Hela; Webb, Sarah; Kelly, Moira


    This paper reports on the moral work done in routine diabetes review consultations in primary care with nurses. Consultations with fluent English speakers are compared with consultations where an interpreter was present, largely involving patients of Bangladeshi origin. The study setting was Tower Hamlets in London, where type 2 diabetes is particularly common. Existing research has shown some dissatisfaction with diabetes care amongst Bangladeshi patients, and studies of care providers in other locations suggest that they at times experience the care of this group as particularly challenging. Through analysis of video-recorded consultations recorded in 2010-2011 we shed light on possible reasons for these difficulties. The 12 non-English speakers often experienced difficulties in raising issues that concerned them, particularly if their interpreter did not translate their utterance because it was deemed to be unrelated to diabetes. These difficulties were not shared by the 24 fluent English speakers, who also found it easier to convey a positive moral reputation and to excuse behaviour that deviated from recommended self-management practices. Interpreters at times also acted as moral mediators. For example, where a participant in the consultation made statements that appeared to convey a negative moral judgement of an other participant, these would often go untranslated. Probably, neither health care providers nor patients are fully aware of the nature of their communication difficulties. Given this, interpreters possess considerable power to influence matters. Understanding the moral work of consultations is important in explaining the findings of other studies showing difficulties in the provision of diabetes care to people with limited English language skills. Copyright © 2013 Elsevier Ltd. All rights reserved.

  14. Coupling an aerosol box model with one-dimensional flow: a tool for understanding observations of new particle formation events

    Directory of Open Access Journals (Sweden)

    Niku Kivekäs


    Full Text Available Field observations of new particle formation and the subsequent particle growth are typically only possible at a fixed measurement location, and hence do not follow the temporal evolution of an air parcel in a Lagrangian sense. Standard analysis for determining formation and growth rates requires that the time-dependent formation rate and growth rate of the particles are spatially invariant; air parcel advection means that the observed temporal evolution of the particle size distribution at a fixed measurement location may not represent the true evolution if there are spatial variations in the formation and growth rates. Here we present a zero-dimensional aerosol box model coupled with one-dimensional atmospheric flow to describe the impact of advection on the evolution of simulated new particle formation events. Wind speed, particle formation rates and growth rates are input parameters that can vary as a function of time and location, using wind speed to connect location to time. The output simulates measurements at a fixed location; formation and growth rates of the particle mode can then be calculated from the simulated observations at a stationary point for different scenarios and be compared with the ‘true’ input parameters. Hence, we can investigate how spatial variations in the formation and growth rates of new particles would appear in observations of particle number size distributions at a fixed measurement site. We show that the particle size distribution and growth rate at a fixed location is dependent on the formation and growth parameters upwind, even if local conditions do not vary. We also show that different input parameters used may result in very similar simulated measurements. Erroneous interpretation of observations in terms of particle formation and growth rates, and the time span and areal extent of new particle formation, is possible if the spatial effects are not accounted for.

  15. From Research Assistant to Professional Research Assistance: Research Consulting as a Form of Research Practice

    Directory of Open Access Journals (Sweden)

    Dawn E. Pollon


    Full Text Available Research assistantships have long been viewed as an extension of the formal education process, a form of apprenticeship, and a pathway into the professional practice of research in institutional settings. However, there are other contexts in which researchers practice research. This self-study documents the formative role research assistantships played in the authors’ development as professional research consultants. Four professional research consultants who held research assistant positions during their master’s and doctoral studies describe the contributions of their research assistantship experiences to the advancement of their knowledge, skills, and passion for research and subsequently to their career decisions. Professional research consulting is identified as a natural extension of research assistant roles and a potential career path. The article enhances current understandings about the ways research assistantships contribute to the development of researchers, and specifically to the development of professional research consultants. The analysis will be of interest to students contemplating entering into research assistantships, current research assistants, current research assistant supervisors, academic staff looking to improve their research productivity, and department chairs.

  16. 75 FR 78709 - Public Comment on the Draft Tribal Consultation Policy (United States)


    ... understanding and comprehension. Consultation is integral to a deliberative process, which results in effective... the Draft Tribal Consultation Policy AGENCY: Administration for Children and Families, HHS. ACTION... Departments and Agencies on Tribal Consultation.'' The President stated that his Administration is committed...

  17. Mental Health Consultation Among Ontario's Immigrant Populations. (United States)

    Islam, Farah; Khanlou, Nazilla; Macpherson, Alison; Tamim, Hala


    To determine the prevalence rates and characteristics of past-year mental health consultation for Ontario's adult (18 + years old) immigrant populations. The Canadian Community Health Survey (CCHS) 2012 was used to calculate the prevalence rates of past-year mental health consultation by service provider type. Characteristics associated with mental health consultation were determined by carrying out multivariable logistic regression analysis on merged CCHS 2008-2012 data. Adult immigrant populations in Ontario (n = 3995) had lower estimated prevalence rates of past-year mental health consultation across all service provider types compared to Canadian-born populations (n = 14,644). Amongst those who reported past-year mental health consultation, 57.89% of Ontario immigrants contacted their primary care physician, which was significantly higher than the proportion who consulted their family doctor from Canadian-born populations (45.31%). The factors of gender, age, racial/ethnic background, education level, working status, food insecurity status, self-perceived health status, smoking status, alcohol drinking status, years since immigration, and age at time of immigration were significantly associated with past-year mental health consultation for immigrant populations. Ontario's adult immigrant populations most commonly consult their family doctor for mental health care. Potential exists for expanding the mental health care role of primary care physicians as well as efforts to increase accessibility of specialized mental health services. Integrated, coordinated care where primary care physicians, specialized mental health professionals, social workers, and community educators, etc. working together in a sort of "one-stop-shop" may be the most effective way to mitigate gaps in the mental health care system. In order to effectively tailor mental health policy, programming, and promotion to suit the needs of immigrant populations initiatives that focus on

  18. Using 238U/235U ratios to understand the formation and oxidation of reduced uranium solids in naturally reduced zones (United States)

    Jemison, N.; Johnson, T. M.; Druhan, J. L.; Davis, J. A.


    Uranium occurs in groundwater primarily as soluble and mobile U(VI), which can be reduced to immobile U(IV), often observed in sediments as uraninite. Numerous U(VI)-contaminated sites, such as the DOE field site in Rifle, CO, contain naturally reduced zones (NRZ's) that have relatively high concentrations of organic matter. Reduction of heavy metals occurs within NRZ's, producing elevated concentrations of iron sulfides and U(IV). Slow, natural oxidation of U(IV) from NRZ's may prolong U(VI) contamination of groundwater. The reduction of U(VI) produces U(IV) with a higher 238U/235U ratio. Samples from two NRZ sediment cores recovered from the Rifle site revealed that the outer fringes of the NRZ contain U(IV) with a high 238U/235U ratio, while lower values are observed in the center . We suggest that as aqueous U(VI) was reduced in the NRZ, it was driven to lower 238U/235U values, such that U(IV) formed in the core of the NRZ reflects a lower 238U/235U. Two oxidation experiments were conducted by injecting groundwater containing between 14.9 and 21.2 mg/L dissolved O2 as an oxidant into the NRZ. The oxidation of U(IV) from this NRZ increased aqueous U(VI) concentrations and caused a shift to higher 238U/235U in groundwater as U(IV) was oxidized primarily on the outer fringes of the NRZ. In total these observations suggest that the stability of solid phase uranium is governed by coupled reaction and transport processes. To better understand various reactive transport scenarios we developed a model for the formation and oxidation of NRZ's utilizing the reactive transport software CrunchTope. These simulations suggest that the development of isotopically heterogeneous U(IV) within NRZ's is largely controlled by permeability of the NRZ and the U(VI) reduction rate. Oxidation of U(IV) from the NRZ's is constrained by the oxidation rate of U(IV) as well as iron sulfides, which can prevent oxidation of U(IV) by scavenging dissolved oxygen.

  19. Managing professional knowledge boundaries during ECHO telementoring consultations in two Veterans Affairs specialty care liver clinics: A theme-oriented discourse analysis. (United States)

    Koenig, Christopher J; Wenger, Matthew; Graham, Glenn D; Asch, Steven; Rongey, Catherine


    Introduction Consultations are the traditional method of communication between generalist and specialist providers managing patients with specialty care needs. Traditional written consultations have limitations, including inadequate clinical information and inappropriate, or unclear consultation questions. Teleconsultations minimize these limitations through real-time communication between generalist and specialist providers to actively manage professional knowledge boundaries about specialty care problems. Methods We video-recorded 37 teleconsultation sessions, resulting in 115 consultations between generalist and specialty care providers participating in Veterans Affairs (VA) Extension for Community Healthcare Outcomes (ECHO) liver clinics. Data were collected at two US sites across nine months to observe consultation communication among 33 primary care generalists and three liver specialists. Video recordings were transcribed verbatim and analysed using theme-oriented discourse analysis to characterize consultation question content and format. Results Generalists' consultation question content addressed a range of topics, including treatment, diagnosis, interpreting results, patient communication, screening and surveillance, and care coordination. Some generalists relied on descriptive narratives rather than a specific question to convey complex patient cases. Consultation question format showed nearly even division between targeting general medical knowledge and specialty care knowledge domains, including specialty care, medical, organizational, and experiential knowledge. Discussion Timely access to specialists through teleconsultation has the potential to transform specialty care delivery. This article examines provider-to-provider interactions to understand how the communication process contributes to knowledge management during teleconsultations. Video studies of health information technology use provide a rich opportunity for analysing real

  20. The effectiveness of formative assessment with understanding by design (UbD) stages in forming habits of mind in prospective teachers (United States)

    Gloria, R. Y.; Sudarmin, S.; Wiyanto; Indriyanti, D. R.


    Habits of mind are intelligent thinking dispositions that every individual needs to have, and it needs an effort to form them as expected. A behavior can be formed by continuous practice; therefore the student's habits of mind can also be formed and trained. One effort that can be used to encourage the formation of habits of mind is a formative assessment strategy with the stages of UbD (Understanding by Design), and a study needs to be done to prove it. This study aims to determine the contribution of formative assessment to the value of habits of mind owned by prospective teachers. The method used is a quantitative method with a quasi-experimental design. To determine the effectiveness of formative assessment with Ubd stages on the formation of habits of mind, correlation test and regression analysis were conducted in the formative assessment questionnaire consisting of three components, i.e. feed back, peer assessment and self assessment, and habits of mind. The result of the research shows that from the three components of Formative Assessment, only Feedback component does not show correlation to students’ habits of mind (r = 0.323). While peer assessment component (r = 0. 732) and self assessment component (r = 0.625), both indicate correlation. From the regression test the overall component of the formative assessment contributed to the habits of mind at 57.1%. From the result of the research, it can be concluded that the formative assessment with Ubd stages is effective and contributes in forming the student's habits of mind; the formative assessment components that contributed the most are the peer assessment and self assessment. The greatest contribution goes to the Thinking interdependently category.

  1. Advanced training of tax consultants

    Directory of Open Access Journals (Sweden)

    Adigamova Farida F.


    Full Text Available The purpose of the research is to review and analyze the data on the necessity to provide an educational environment for training and advanced training of tax consultants in Russia. The article considers the types of tax consulting, the historical background of training financiers in Russia, as well as identifies conditions determining the significance of tax consulting. The research establishes the connection between the negative attitude to tax payment and tax evasion. The advanced training of tax consultants should be a continuous process as they need to take into account both external and internal taxpayers risks associated with the development of law and law-enforcement practice. Obviously, the training of tax consultants should take into account the experience of developed foreign countries, such as Germany, Austria, Czech Republic, Slovakia and other European countries as well. In Russia, it is necessary to open educational institutions, which will not only be involved in the certification of tax consultants, but also provide training courses. These courses should contribute to constant increase of tax consultants knowledge, consider the tax treatment of economic activities, as well changes in the legislation, economics, finance, accounting, manufacturing processes, which will improve the quality of services provided by tax consultants.

  2. The transition to hospital consultant

    DEFF Research Database (Denmark)

    Westerman, Michiel; Teunissen, Pim W.; Jorgensen, Rasmus Lundhus


    Danish and Dutch new consultants' perceptions regarding the transition to consultant were compared to gain insight into this period, particularly the influence of contextual factors concerning the organisation of specialty training and health care therein. Preparation for medical and generic comp...... competencies, perceived intensity and burnout were compared. Additionally, effects of differences in working conditions and cultural dimensions were explored....

  3. Understanding the formation process of the liquid slug in a hilly-terrain wet natural gas pipeline

    DEFF Research Database (Denmark)

    Yang, Yan; Li, Jingbo; Wang, Shuli


    condition on the liquid slug formation is discussed including pipe diameter, inclination angle, gas superficial velocity and liquid holdup. The results show that the pipe is blocked by the liquid slug at the moment of slug formed. The pipe pressure suddenly increases, and then decreases gradually...... in the process of liquid slug formation and motion. The pipe pressure drop and liquid holdup decrease along with the increasing inclination angle of ascending pipe. On the contrary, they rise with the increase of the inclination angle of descending pipe. Higher gas superficial velocity and liquid holdup result...

  4. How do family physicians communicate about cardiovascular risk? Frequencies and determinants of different communication formats

    Directory of Open Access Journals (Sweden)

    Rosemann Thomas


    Full Text Available Abstract Background Patients understand information about risk better if it is communicated in numerical or visual formats (e.g. graphs compared to verbal qualifiers only. How frequently different communication formats are used in clinical primary care settings is unknown. Methods We collected socioeconomic and patient understanding data using questionnaires and audio-recorded consultations about cardiovascular disease risk. The frequencies of the communication formats were calculated and multivariate regression analysis of associations between communication formats, patient and general practitioner characteristics, and patient subjective understanding was performed. Results In 73% of 70 consultations, verbal qualifiers were used exclusively to communicate cardiovascular risk, compared to numerical (11% and visual (16% formats. Female GPs and female patient's gender were significantly associated with a higher use of verbal formats compared to visual formats (p = 0.001 and p = 0.039, respectively. Patient subjective understanding was significantly higher in visual counseling compared to verbal counseling (p = 0.001. Conclusions Verbal qualifiers are the most often used communication format, though recommendations favor numerical and visual formats, with visual formats resulting in better understanding than others. Also, gender is associated with the choice of communication format. Barriers against numerical and visual communication formats among GPs and patients should be studied, including gender aspects. Adequate risk communication should be integrated into physicians' education.

  5. The effect of community consultation on perceptions of a proposed mine : a case study from southeast Australia

    NARCIS (Netherlands)

    Walsh, B.M.; Plank, van der S.; Behrens, P.A.


    Consultation is the predominant method of community engagement in infrastructure development. Therefore, understanding stakeholder interactions within consultation is critical to acquiring a social licence to operate. While previous research has focused on the factors which contribute to this social

  6. Impact of Diabetes E-Consults on Outpatient Clinic Workflow. (United States)

    Zoll, Brian; Parikh, Pratik J; Gallimore, Jennie; Harrell, Stephen; Burke, Brian


    An e-consult is an electronic communication system between clinicians, usually a primary care physician (PCP) and a medical or surgical specialist, regarding general or patient-specific, low complexity questions that would not need an in-person consultation. The objectives of this study were to understand and quantify the impact of the e-consult initiative on outpatient clinic workflow and outcomes. We collected data from 5 different Veterans Affairs (VA) outpatient clinics and interviewed several physicians and staff members. We then developed a simulation model for a primary care team at an outpatient clinic. A detailed experimental study was conducted to determine the effects of factors, such as e-consult demand, view-alert notification arrivals, walk-in patient arrivals, and PCP unavailability, on e-consult cycle time. Statistical tests indicated that 4 factors related to outpatient clinic workflow were significant, and levels within each of the 4 significant factors resulted in statistically different e-consult cycle times. The arrival rate of electronic notifications, along with patient walk-ins, had a considerable effect on cycle time. Splitting the workload of an unavailable PCP among the other PCPs, instead of the current practice of allocating it to a single PCP, increases the system's ability to handle a much larger e-consult demand. The full potential of e-consults can only be realized if the workflow at the outpatient clinics is designed or modified to support this initiative. This study furthers our understanding of how e-consult systems can be analyzed and alternative workflows tested using statistical and simulation modeling to improve care delivery and outcomes. © The Author(s) 2014.

  7. Family Practice Consultation.

    African Journals Online (AJOL)

    throughout. Feedback interviews facil- itated understanding and allowed respondents' final approval. All respondents said that they enjoyed participating. One feedback interview was concluded with a prayer, at the request of and, by the respondent. Data was collected by tape recording and written field notes. Each respon-.

  8. Consultant nurse-consultant physician: a new partnership for patient-centred care? (United States)

    Graham, Iain W


    The aim was to describe the process of role transition by an individual who has assumed the position of a consultant nurse in cardiovascular health care. The objective was to explain the 'gestalt' of being a consultant nurse and how the 'gestalt' has evolved. The development of the consultant nurse role is new, research has described the value and potential contribution of the role. The literature suggests that the role still requires further evaluation and description to be understood better. DESIGN. A free-association narrative interview method was chosen as the research design. An in depth interview, tape-recorded and analysed along with field note analysis was the method for eliciting the narrative. The analysis of the narrative reveals an emerging 'gestalt' for being a consultant nurse. Various concepts and phenomena attributable to the role are identified from the experience described. The gestalt explains the journey of the individual through an 'apprenticeship' to role attainment, whereby a new sense of professional self or 'Me' is realized. The significance of the paper lies in the analysis of the narrative and the insights it gives to help other aspirant consultant nurses. It is through the understanding of these insights that individuals could plan their own learning and development to be achieved in the role of consultant nurse. To be effective and provide effective patient care, one can argue that appropriate learning needs to take place. Those that have been appointed to the role have battled to find achievement and acceptance. These battles may be made easier to win if the role is better understood and appropriate preparation provided. Only then will the real potential of the role be realized in improved patient care outcomes.

  9. Formation of colloids from introduced materials in the post-emplacement environment: A report on the state of understanding

    International Nuclear Information System (INIS)

    Meike, A.; Wittwer, C.


    This literature review examines potential sources of colloids and enhanced adsorption that may stem from materials introduced into a repository setting, with a view towards prioritizing future studies. Three major sources of colloids are reviewed: metals, cements, and organics. Know chemical influences on colloid formation and mechanisms by which introduced materials may become involved are considered with respect to gradients, chemical species, pH, time, temperature, radiolysis, redox state, and microbial activity. Areas that have not been addressed but may have significant consequences in a repository setting are identified


    Directory of Open Access Journals (Sweden)

    A. Candeiro Carlos Roberto


    Full Text Available The Peirópolis paleontological site (Late Cretaceous, Maastrichtian in Minas Gerais State, Brazil yielded an important assemblage of fossil vertebrates. The typical occurrence of South American widespread taxa in Peirópolis is important for correlation between the Brazilian Bauru Basin and Argentinean Late Cretaceous basins. The fishes, turtles, anuran, crocodilians and dinosaurs known from Peirópolis (Marília Formation resemble the Patagonian latest Late Cretaceous vertebrate faunas but lacks ornithischian dinosaurs.

  11. Patients' assessments of consulting a nurse practitioner: the time factor. (United States)

    Williams, Anne; Jones, Melanie


    This paper reports a study exploring patients' views about consulting with a primary care nurse practitioner. United Kingdom based randomized controlled trials comparing the work of doctors and nurse practitioners add considerable weight to the view that patients tend to be more satisfied with primary care nurse practitioner consultations. However, there is a need for qualitative research to explore issues raised by the trials. A judgement sample of 10 patients consulting with a primary care nurse practitioner was drawn. In-depth interviews were conducted and analysed thematically. The data were collected in 2000-2001. The following themes were identified in the data: time spent in the consultation; and time as a commodity in patients' lives. Time matters to patients when they consult on their health, whether it is time to discuss problems or time saved as a result of having issues resolved, thus minimizing further visits. Factors associated with the style and emphasis of consultations are also important. Understanding the relationship between time, and style and emphasis of consultation may help to explain patients' satisfaction with primary care nurse practitioners.

  12. The effect of different cardiovascular risk presentation formats on intentions, understanding and emotional affect: a randomised controlled trial using a web-based risk formatter (protocol

    Directory of Open Access Journals (Sweden)

    Newcombe Robert


    Full Text Available Abstract Background The future risk of heart disease can be predicted with increasing precision. However, more research is needed into how this risk is conveyed and presented. The aim of this study is to compare the effects of presenting cardiovascular risk in different formats on individuals' intention to change behaviour to reduce risk, understanding of risk information and emotional affect. Methods/design A randomised controlled trial comprising four arms, with a between subjects design will be performed. There will be two intervention groups and two control groups. The first control comprises a pre-intervention questionnaire and presents risk in a bar graph format. The second control presents risk in a bar graph format without pre-intervention questionnaire. These two control groups are to account for the potential Hawthorne effect of thinking about cardiovascular risk before viewing actual risk. The two intervention groups comprise presenting risk in either a pictogram or metonym format (image depicting seriousness of having a myocardial infarction. 800 individuals' aged between 45 and 64 years, who have not been previously diagnosed with heart disease and have access to a computer with internet, will be given a link to a website comprising a risk calculator and electronic questionnaires. 10-year risk of having a coronary heart disease event will be assessed and presented in one of the three formats. A post-intervention questionnaire will be completed after viewing the risk format. Main outcome measures are (i intention to change behaviour, (ii understanding of risk information, (iii emotional affect and (iv worry about future heart disease. Secondary outcomes are the sub-components of the theory of planned behaviour: attitudes, perceived behavioural control and subjective norms. Discussion Having reviewed the literature, we are not aware of any other studies which have used the assessment of actual risk, in a trial to compare different

  13. Understanding the wetting properties of nanostructured selenium coatings: the role of nanostructured surface roughness and air-pocket formation

    Directory of Open Access Journals (Sweden)

    Tran PA


    Full Text Available Phong A Tran,1,2 Thomas J Webster31Department of Chemical and Biomolecular Engineering, University of Melbourne, Melbourne, VIC, Australia; 2The Particulate Fluid Processing Centre, University of Melbourne, Melbourne, VIC, Australia; 3Department of Chemical Engineering and Program in Bioengineering, Northeastern University, Boston, MA, USAAbstract: Wetting properties of biomaterials, in particular nanomaterials, play an important role, as these influence interactions with biological elements, such as proteins, bacteria, and cells. In this study, the wetting phenomenon of titanium substrates coated with selenium nanoparticles was studied using experimental and mathematical modeling tools. Importantly, these selenium-coated titanium substrates were previously reported to increase select protein adsorption (such as vitronectin and fibronectin, to decrease bacteria growth, and increase bone cell growth. Increased selenium nanoparticle coating density resulted in higher contact angles but remained within the hydrophilic regime. This trend was found in disagreement with the Wenzel model, which is widely used to understand the wetting properties of rough surfaces. The trend also did not fit well with the Cassie–Baxter model, which was developed to understand the wetting properties of composite surfaces. A modified wetting model was thus proposed in this study, to understand the contributing factors of material properties to the hydrophilicity/hydrophobicity of these nanostructured selenium-coated surfaces. The analysis and model created in this study can be useful in designing and/or understanding the wetting behavior of numerous biomedical materials and in turn, biological events (such as protein adsorption as well as bacteria and mammalian cell functions.Keywords: hydrophilicity, hydrophobicity, Wenzel model, Cassie–Baxter model, free energy, implant material, proteins, cells, bacteria

  14. Understanding the acquisition and regulation mechanisms of the water chemistry in a clay formation: the CEC/ANDRA Archimede-argile project

    International Nuclear Information System (INIS)

    Merceron, T.; Mossmann, J.R.; Neerdael, B.; Canniere, P. de; Beaucaire, C.; Toulhoat, P.; Daumas, S.; Bianchi, A.; Christen, R.


    Clay formations are candidate host environments to high level radioactive waste repository. The radioelements could be partially released from the waste into the host geological formation after a very long time. Understanding behaviour of the natural chemical species is considered as a fundamental prerequisite before the disturbed system will be studied. Additional laboratory studies are also essential in order to forecast, by analogy, the behaviour of radioelements released from the radioactive waste repository. The ARCHIMEDE-ARGILE project has two main goals. The first is to gain an understanding of the mechanisms of acquisition and regulation of the water chemistry in a clay environment. This step is essential to predict both the behaviour and the migration in solution of artificial elements which are initially absent in the clay formation. The second is to test and validate in clay the measured physico chemical parameters which are the basis for the geochemical modelling of the behaviour of the natural and artificial radioelements. The paper presents the main results previously obtained on granitic waters and the research strategy established for the ARCHIMEDE project. (authors). 2 figs., 2 refs

  15. HabEat: Understanding critical periods and critical factors of the formation and of the modification of food habits


    Nicklaus, Sophie; Issanchou, Sylvie


    Introduction: Diets of young children in many European countries are not ideal (too many lipids; not enough fruit and vegetables). Early nutrition may have an impact on health in later life (diabetes, obesity, heart problems) and the first two years of life are of crucial importance in the acquisition of food habits. The HabEat project aims at understanding better of how food habits are formed and can be changed, in infants and children (< 5 years). Methods: With 11 beneficiaries from 6 Euro...

  16. Choosing a Model for eConsult Specialist Remuneration: Factors to Consider

    Directory of Open Access Journals (Sweden)

    Clare Liddy


    Full Text Available Electronic consultation (eConsult is an innovative solution that allows specialists and primary care providers to communicate electronically, improving access to specialist care. Understanding the cost implications of different remuneration models available to pay specialists is of critical importance as adoption of these services continues to increase. We used data collected through the Champlain BASE (Building Access to Specialists through eConsultation eConsult service to simulate the cost implications of different remuneration models in Canada. The prorated hourly rate model averaged $45.72 CAD (Canadian Dollar per eConsult while the prorated hourly rate with incentive averaged $51.90 CAD per eConsult, and the fee for service cost $60.50 CAD per eConsult. Paying all specialty groups to block three hours per week for eConsults averaged $337.44 CAD per eConsult and paying for 1-h blocks averaged $133.41 CAD per eConsult. As the remuneration of specialists is the largest cost driver of an established eConsult service, our findings can inform policymakers considering the implementation of eConsult or wishing to further develop an existing service.

  17. Cationic amino acids specific biomimetic silicification in ionic liquid: a quest to understand the formation of 3-D structures in diatoms.

    Directory of Open Access Journals (Sweden)

    Rajesh Ramanathan

    Full Text Available The intricate, hierarchical, highly reproducible, and exquisite biosilica structures formed by diatoms have generated great interest to understand biosilicification processes in nature. This curiosity is driven by the quest of researchers to understand nature's complexity, which might enable reproducing these elegant natural diatomaceous structures in our laboratories via biomimetics, which is currently beyond the capabilities of material scientists. To this end, significant understanding of the biomolecules involved in biosilicification has been gained, wherein cationic peptides and proteins are found to play a key role in the formation of these exquisite structures. Although biochemical factors responsible for silica formation in diatoms have been studied for decades, the challenge to mimic biosilica structures similar to those synthesized by diatoms in their natural habitats has not hitherto been successful. This has led to an increasingly interesting debate that physico-chemical environment surrounding diatoms might play an additional critical role towards the control of diatom morphologies. The current study demonstrates this proof of concept by using cationic amino acids as catalyst/template/scaffold towards attaining diatom-like silica morphologies under biomimetic conditions in ionic liquids.

  18. Applying a new understanding of supergene REE deposit formation to global exploration initiatives for environmentally sustainable resources (United States)

    Hardy, Liam; Smith, Martin; Hood, Leo; Heller, Shaun; Faltyn, Rowan; Blum, Astrid; Bamberger, Axel


    Two new models have recently been proposed for the formation of REE ion-adsorption deposits and it is likely that they are both active in their related study profiles described in the Ambohimirahavavy Complex in Madagascar (Marquis et al, 2016) and the Serra de Monchique (SDM) complex in Portugal (Hardy et al, 2016). These are two separate environments presenting two different soil systems in terms of flora, protolith and structure. In the latosol profiles of SDM the natural sweating cycle of eucalyptus trees is proposed as the main geochemical cycling control for some 40% of Fe and 30% of Y, which have been observed migrating up and down profile seasonally between upper horizons and the rooting depths of these intensively farmed trees. If, through their natural cycle, eucalyptus trees in SDM are capable of concentrating depleted protolithic Y contents of 4-10ppm to some 140-160ppm in their enriched 150-200cm deep E horizons in only the 40 years since they were introduced to the region (Jenkins, 1979), then what potential deposits and concentrations may lay underneath older plantations across Brazil, Chile, China and most importantly, Australia, where these trees naturally cover some 16% of the entire continent. Eucalyptus is mostly farmed as pulp for paper mills and has lost its market value with the demand for paper decreasing, as the demand for REEs increases, ironically driven by the demand for the accessible technology to replace paper (EPA, 2012). Not only might there be great resources below these forests, but the removal of the aggressive intrusive species would be welcomed across Southern Europe and South America where they have limited market value and have destroyed local ecosystems and water supplies (Brito, 1999), where local people are actively seeking an alternative use of their lands. References: Brito, J. G. (1999). Management strategies for conservation of the lizard Lacerta schreiberi in Portugal. Biological conservation, 311-319. EPA. (2012

  19. Psychiatric consulting in primary care

    Directory of Open Access Journals (Sweden)

    Susana María Castro Pérez


    Full Text Available The psychiatric consultation is broadly defined as an educational relationship between a psychiatrist, a general practitioner and other professionals working in the area of Mental Health. Currently it is a fundamental tool to optimize the treatment of psychiatric patients in primary care, given the high prevalence of these conditions and limited access to hours of specialty. Psychiatric Consulting is centrally positioned because patients are generally reluctant to consult with specialists, either because of the stigma associated with psychiatric illness or the cost effectiveness of the specialty. This leads patients to consult in primary care. Therefore we were interested in reviewing the evidence supporting this activity and what are the benefits it delivers. After reviewing the literature we conclude that the Psychiatric Consultation helps to improve the diagnosis, treatment and monitoring of psychiatric disorders in primary care, particularly the management of depressive disorders and somatoform disorders, improving the resolution capabilities of general practitioners, thus lowering the associated healthcare costs of these conditions. There is no evidence to support the health benefits of training general practitioners.

  20. Nanoparticle Surface Specific Adsorption of Zein and Its Self-assembled Behavior of Nanocubes Formation in Relation to On-Off SERS: Understanding Morphology Control of Protein Aggregates. (United States)

    Navdeep; Banipal, Tarlok Singh; Kaur, Gurinder; Bakshi, Mandeep Singh


    Zein, an industrially important protein, is characterized in terms of its food and pharmaceutical coating applications by using surface enhanced Raman spectroscopy (SERS) on Au, Ag, and PbS nanoparticles (NPs). Its specific surface adsorption behavior on Ag NPs produced self-assembled zein nanocubes which demonstrated on and off SERS activity. Both SERS characterization as well as nanocube formation of zein helped us to understand the complex protein aggregation behavior in shape controlled morphologies, a process with significant ramifications in protein crystallization to achieve ordered morphologies. Interestingly, nanocube formation was promoted in the presence of Ag rather than Au or PbS NPs under in situ synthesis and discussed in terms of specific adsorption. Zein fingerprinting was much more clear and enhanced on Au surface in comparison to Ag while PbS did not demonstrate SERS due to its semiconducting nature.

  1. Patient assessment: effective consultation and history taking. (United States)

    Kaufman, Gerri

    This article explores patient consultation with specific reference to the Calgary-Cambridge consultation guide. It provides an overview of history taking and explores the patient's perspective during the consultation. The article also discusses the skills required to provide information effectively. In addition, the article addresses 'safety netting' and emphasises the interdependence of communication and consultation skills.

  2. Hands in medicine: understanding the impact of competency-based education on the formation of medical students’ identities in the United States

    Directory of Open Access Journals (Sweden)

    Catherine Gonsalves


    Full Text Available Purpose There have been critiques that competency training, which defines the roles of a physician by simple, discrete tasks or measurable competencies, can cause students to compartmentalize and focus mainly on being assessed without understanding how the interconnected competencies help shape their role as future physicians. Losing the meaning and interaction of competencies can result in a focus on ‘doing the work of a physician’ rather than identity formation and ‘being a physician.’ This study aims to understand how competency-based education impacts the development of a medical student’s identity. Methods Three ceramic models representing three core competencies ‘medical knowledge,’ ‘patient care,’ and ‘professionalism’ were used as sensitizing objects, while medical students reflected on the impact of competency-based education on identity formation. Qualitative analysis was used to identify common themes. Results Students across all four years of medical school related to the ‘professionalism’ competency domain (50%. They reflected that ‘being an empathetic physician’ was the most important competency. Overall, students agreed that competency-based education played a significant role in the formation of their identity. Some students reflected on having difficulty in visualizing the interconnectedness between competencies, while others did not. Students reported that the assessment structure deemphasized ‘professionalism’ as a competency. Conclusion Students perceive ‘professionalism’ as a competency that impacts their identity formation in the social role of ‘being a doctor,’ albeit a competency they are less likely to be assessed on. High-stakes exams, including the United States Medical Licensing Exam clinical skills exam, promote this perception.

  3. Methodological principles for establishment of consulting cooperation organizational and economic mechanism

    Directory of Open Access Journals (Sweden)

    Yevtushenko Natalya Аleksandrovna


    Full Text Available The article deals with conceptual principles of the consulting cooperation key concepts within organizational and economic mechanism: consulting, cooperation of the economic entities, organizational and economic mechanism of the consulting cooperation. Based on the analysis of the literary sources, synergetic approach essence to control subjects of the consulting cooperation as an open system is observed. Peculiarities to form synergetic effect of the consulting cooperation at different levels of the management system are studied within organizational and economic mechanism. Synergetic effect of the consulting cooperation is defined at the macro-, micro and nanolevel. Synergetic approach impact on formation of the practical constituent in the organizational and economic mechanism of the consulting cooperation is proved and interconnection between consulting company and enterprise-customer via communicative space is revealed. Main components of the consulting cooperation communicative space are established and their interconnection in consulting cooperation communicative process realization is justified. Recommendations to form qualitative and quantitative criteria in the process of the consulting cooperation organizational and economic mechanism realization are given.

  4. The understanding of the formation of valleys and its implication on site characterization: Moredalen and Pukedalen, south-eastern Sweden

    International Nuclear Information System (INIS)

    Tiren, Sven A.; Waenstedt, Stefan; Straeng, Thomas


    In south-eastern Sweden, there are a number of over-deepened narrow valleys, more than 20 m deep, formed in Precambrian bedrock located above the highest post-glacial shoreline. Canyon-like valleys, called 'kursu' or kursu valleys, are generally interpreted to be formed by glaciofluvial erosion. An example of such a valley is Moredalen, a canyon in the Fennoscandian Shield, which has an implication on site selection for radioactive waste disposal. There are also more open over-deepened valleys along which sub-glacial flow has occurred, e.g. Pukedalen. The main part of this paper discusses a combined geological and geophysical investigation of Moredalen, with the aim to investigate possible reasons for the formation of such an unusual feature formed in acid vulcanite and foliated tonalitic to granodioritic rocks. Moredalen is a marked, approximately 7 km long, E-W striking valley that cuts through a plateau (c. 140 m a.s.l.), and an elevated block of the sub-Cambrian peneplain. Glaciofluvial sediments can be found up-streams where the canyon widens to the west. Just east of the valley is a larger delta deposited at the highest post-glacial shoreline (c. 105 m a.s.l). Further east of, and in line with the Moredalen valley there is an esker. Rock debris in the valley is angular. Pukedalen is a northwest-southeast trending valley incised in massive granite. The valley is in its northern parts relatively open and becomes narrow in its south-eastern part having partly a vertical south-western wall. Rock surfaces are smooth along the valley and rock debris in the valley consists generally of rounded blocks. In line with Pukedalen, on both sides at great distances though, there are eskers. Geomorphological features of this kind indicate certain characteristics of the bedrock that need to be considered during safety analysis of repositories for nuclear waste. The distinct weakness zones along which the kursu-valleys are formed create prominent transport paths for

  5. BNFL Sellafield further public consultation

    International Nuclear Information System (INIS)


    The main issues raised during the further public consultation on the draft Sellafield authorisations for the discharge of radioactive wastes from the British Nuclear Fuel (BNFL) Sellafield site are outlined. An analysis of the categories and numbers of the 42,500 responses is made. The public consultation was based on five documents; a letter to consultees from the Department of the Environment and the Ministry of Agriculture, Fisheries and Food (MAFF); the report by Her Majesty's Inspectorate of Pollution and the Inspectorate of MAFF on their earlier consultation exercise; a paper by BNFL on the economic and commercial justification of the Thermal Oxide Reprocessing Plant (THORP); a statement of the Government's policy on reprocessing and THORP and a document prepared by BNFL on the environmental implication of THORP. (UK)

  6. Tectonomagmatic evolution of the terrestrial planets: importance for understanding of processes of their formation and subsequent development (United States)

    Sharkov, E.; Bogatikov, O.


    Our knowledge about formation and evolution of the terrestrial planets (the Earth, Venus, Mars, Mercury and, possibly, the Moon) based on different physical and geochemical speculations and models. The main disadvantage of such hypotheses is their abstract character and ignoring any data on tectonomagmatic evolution of those planets. At the same time, just this type of data provide an important information, which is necessary for elaborating of a present-day theory of their formation and evolution. The Earth has been much better studied compared to the other planets, therefore we will discuss the main questions of planetary tectonomagmatic evolution using the Earth as example plus involve other data on the Moon and the terrestrial planets. Two dominating hypotheses about composition of the primordial Earth's crust exist now: (1) traditional implies that the primordial crust had basic composition, whereas the sialic crust resulted from a geosyncline process or, in modern terms, from processes at convergent plate margins, and (2) primordial crust was sialic; the plate tectonic mechanisms started in the Middle Paleoproterozoic and resulted in oceanic spreading and formation of the secondary oceanic crust. Both models require a global melting of a primary chondritic material to form the primordial crust. The final result depends on the degree of melt differentiation during solidification of a magmatic ocean. Such a solidification, due to differences between adiabatic and melting-points gradients had to proceed in bottom-top direction (Jeffries, 1929) and resulted in accumulation of low-temperature derivates in the primordial crust. Geological data, namely granite-dominated Archean crust, and results of studying of detrital zircon from Australia supports the primordial-sialic crust hypothesis. The Moon which is four times smaller than Earth has a basic primordial crust. Such a difference can be explained by different depths of their magmatic oceans. The Early

  7. "Struggling Readers: What Consultants Need to Know." The Consultant's Corner. (United States)

    Margolis, Howard


    To help struggling readers' improve their reading, educational consultants must know a great deal about reading, reading assessment, and struggling readers. This article provides basic information about these topics by discussing Lipson and Wixson's (2003) Assessment-Instruction Process, making recommendations for working with struggling readers…

  8. Understanding the formation of the Ontong Java Plateau through joint ambient noise earthquake tomography and laboratory modeling (United States)

    Covellone, B. M.; Szwaja, S.; Savage, B. K.; Shen, Y.; Kincaid, C. R.


    Current knowledge of the Ontong Java Plateau (OJP) comes from a broad range of research disciplines. Despite decades of work, numerous hypotheses on the origin of the OJP do not fully address all of the geophysical and geochemical observations. A more complete image of the current lower crust and upper mantle seismic structure beneath the plateau will provide a link between the plateau's 120 Ma complex history and it's formation. We investigate the anomalous wave speed structure underlying the OJP using an iterative, full-waveform, joint ambient noise and earthquake tomography approach. A 3-dimensional wave speed model is determined from ambient noise data at periods between 25 and 200 seconds. Data from over 100 earthquakes, recorded between 1990 and 2012, are then added to the inversion to improve data coverage and model resolution. The combination of datasets allows us to best exploit the limited station distribution in the Pacific, resulting in resolution better than 5-degrees beneath the plateau and extending to depths greater than 350 km. To improve our sense of expected deformation patterns for sub-plateau mantle through geologic time, a set of laboratory models were run where OJP residuum viscosity is changed relative to the ambient fluid. Models focus on the interaction between OJP residuum and the rollback-driven flow associated with passage of the Tonga subduction system to the south. Model results show dramatic thinning and extraction of the southern portion of sub-OJP fluid due to subduction induced torroidal flows. Significant distortion of the sub-OJP material over roughly the last 40 Ma is predicted in cases where residuum is either stronger or weaker than ambient fluid. The results of this work confirm an anomalously slow mantle beneath the OJP extending to depths greater than 300 km and provide high-resolution images constraining the magnitude and dimensions of wave speed anomalies that can be used to determine thermal and compositional variations

  9. Formation of complexes between hematite nanoparticles and a non-conventional galactomannan gum. Toward a better understanding on interaction processes. (United States)

    Busch, Verónica M; Loosli, Fréderic; Santagapita, Patricio R; Buera, M Pilar; Stoll, Serge


    The physicochemical characteristics of hematite nanoparticles related to their size, surface area and reactivity make them useful for many applications, as well as suitable models to study aggregation kinetics. For several applications (such as remediation of contaminated groundwater) it is crucial to maintain the stability of hematite nanoparticle suspensions in order to assure their arrival to the target place. The use of biopolymers has been proposed as a suitable environmentally friendly option to avoid nanoparticle aggregation and assure their stability. The aim of the present work was to investigate the formation of complexes between hematite nanoparticles and a non-conventional galactomannan (vinal gum--VG) obtained from Prosopis ruscifolia in order to promote hematite nanoparticle coating with a green biopolymer. Zeta potential and size of hematite nanoparticles, VG dispersions and the stability of their mixtures were investigated, as well as the influence of the biopolymer concentration and preparation method. DLS and nanoparticle tracking analysis techniques were used for determining the size and the zeta-potential of the suspensions. VG showed a polydispersed size distribution (300-475 nm Z-average diameter, 0.65 Pdi) and a negative zeta potential (between -1 and -12 mV for pH2 and 12, respectively). The aggregation of hematite nanoparticles (3.3 mg/L) was induced by the addition of VG at lower concentrations than 2mg/L (pH5.5). On the other hand, hematite nanoparticles were stabilized at concentrations of VG higher than 2 mg/L. Several phenomena between hematite nanoparticles and VG were involved: steric effects, electrostatic interactions, charge neutralization, charge inversion and polymer bridging. The process of complexation between hematite nanoparticles and the biopolymer was strongly influenced by the preparation protocols. It was concluded that the aggregation, dispersion, and stability of hematite nanoparticles depended on biopolymer

  10. Inside the fitness for work consultation: a qualitative study. (United States)

    Cohen, D A; Aylward, M; Rollnick, S


    Evidence now suggests that work is generally good for physical and mental health and well-being. Worklessness for whatever reason can lead to poorer physical and mental health. The role of the general practitioner (GP) in the management of fitness for work is pivotal. To understand the interaction between GP and patient in the fitness for work consultation. This study forms part of a larger research project to develop a learning programme for GPs around the fitness for work consultation based on behaviour change methodology. A qualitative study set in South Wales. Structured discussion groups with seven GPs. Two sessions each lasting 3 h were conducted to explore the GP and patient interaction around the fitness for work consultation. Multiple methods were used to enhance engagement. Thematic analysis was used to analyse the data. Four major themes emerged from the meetings: role legitimacy, negotiation, managing the patient and managing the systems. Within these, subthemes emerged around role legitimacy. 'It's not my job', 'It's not what I trained for' and the 'shifting agenda' Negotiation was likened to 'A polite tug of war' and subthemes around decision making, managing the agenda and dealing with uncertainty emerged. This study starts to unravel the complexity of the fitness for work consultation. It illustrates how GPs struggle with the 'importance' of their role and 'confidence' in managing the fitness for work consultation. It addresses the skillful negotiation that is required to manage the consultation effectively.

  11. Development of a Remote Consultation System Using Avatar Technology (United States)

    Ohnishi, Tatsuya; Yajima, Hiroshi; Sawamoto, Jun

    The chance to use the Internet as a communications tool has been increasing, and the consultation businesses for customers at remote places are diversifying in their communication media and forms. In the remote consultation, the lack of non-verbal information is reported as one of the reasons for inefficiency and customer's dissatisfaction compared with the face-to-face consultation. The technique for supplementing non-verbal information with a TV telephone is proposed, and helps to confirm understanding degree or the utterance timing by watching the movement of the face. But the displayed face of the partner causes strong feeling of strain between strangers and the participants also care about background scene displayed on the monitor producing risks in the consultation tasks. In this paper, we propose a remote consultation method that uses avatar technology in the virtual space in order to provide non-verbal information and also avoiding the problem of TV telephone at the same time. The effectiveness of the proposed remote consultation method is confirmed by experiments.

  12. Consultative Instructor Supervision and Evaluation (United States)

    Lee, William W.


    Organizations vary greatly in how they monitor training instructors. The methods used in monitoring vary greatly. This article presents a systematic process for improving instructor skills that result in better teaching and better learning, which results in better-prepared employees for the workforce. The consultative supervision and evaluation…

  13. Narrative and Structure in Consultation (United States)

    Hadley, David


    This article explores the process of consultation to professional networks, teams, groups and individuals concerned with the mental health of children and young people in the care system, and those adopted. Frequently there are significant elements of early trauma suffered by the young people and disruption in the professional organisation. The…

  14. Gamification in a Consulting Company

    NARCIS (Netherlands)

    Blaauw, Frank; Bazylevska, L.; Aiello, M.


    Gamification refers to the use of game-design elements in a non-gaming context. The consulting company Capgemini has set up a rudimentary Gamification platform to help motivating the people to do extra work for the company in their spare time. In order to re- ward people for this effort, they can

  15. Faculty Consulting: Responsibility or Promiscuity? (United States)

    Boyer, Carol M; Lewis, Darrell R.


    The potential benefits--to the individual, the institution, and society--and the potential costs of faculty consulting are examined. A review of the relevant literature and data precedes a presentation of new findings and a taxonomy for developing institutional guidelines. (Author/MLW)

  16. School Mental Health Consultation Program. (United States)

    Lucero, John A.

    The goals of the School Mental Health Consultation Program, a cooperative effort of the Children and Youth Service at High Plains Mental Health Center and the Unified School District 489 in Hays, Kansas, are to evaluate students' behavioral problems, to assess how students' difficulties affect teachers, and to help the consultee assess the…


    Energy Technology Data Exchange (ETDEWEB)

    Ronald C. Surdam


    An anomalous velocity model was constructed for the Wind River Basin (WRB) based on {approx}2000 mi of 2-D seismic data and 175 sonic logs, for a total of 132,000 velocity/depth profiles. Ten cross sections were constructed through the model coincident with known gas fields. In each cross section, an intense, anomalously slow velocity domain coincided with the gas-productive rock/fluid interval. The anomalous velocity model: (1) Easily isolates gas-charged rock/fluid systems characterized by anomalously slow velocities and water-rich rock/fluid systems characterized by normal velocities; and (2) Delineates the regional velocity inversion surface, which is characterized by steepening of the Ro/depth gradient, a significant increase in capillary displacement pressure, a significant change in formation water composition, and acceleration of the reaction rate of smectite-to-illite diagenesis in mixed-layer clays. Gas chimneys are observed as topographic highs on the regional velocity inversion surface. Beneath the surface are significant fluid-flow compartments, which have a gas-charge in the fluid phase and are isolated from meteoric water recharge. Water-rich domains may occur within regional gas-charged compartments, but are not being recharged from the meteoric water system (i.e., trapped water). The WRB is divided into at least two regionally prominent fluid-flow compartments separated by the velocity inversion surface: a water-dominated upper compartment likely under strong meteoric water drive and a gas-charged, anomalously pressured lower compartment. Judging from cross sections, numerous gas-charged subcompartments occur within the regional compartment. Their geometries and boundaries are controlled by faults and low-permeability rocks. Commercial gas production results when a reservoir interval characterized by enhanced porosity/permeability intersects one of these gas-charged subcompartments. The rock/fluid characteristics of the Rocky Mountain Laramide

  18. Data-based psychiatric consultation: applying mainframe computer capability to consultation. (United States)

    Popkin, M K; Mackenzie, T B; Callies, A L


    Critical, intertwined objectives for consultation psychiatry include 1) the development of data-based clinical practices, and 2) heightening the effectiveness of consultation. Toward these ends, the Consultation Psychiatry Service at the University of Minnesota has previously conducted systematic studies of consultation and established an ongoing data collection system for consultations. Both steps have relied extensively upon mainframe computer capability. This primary application of computer capability to the field of psychiatric consultation is reviewed by the authors.

  19. Consultation Barriers between Teachers and External Consultants: A Grounded Theory of Change Resistance in School Consultation (United States)

    Thornberg, Robert


    The aim of this study, conducted in Sweden, was to investigate the cultural barriers between school personnel (teachers and principals) and nonschool personnel (a resource team), who were external to the school system, regarding consultation about challenging or difficult-to-teach students. Focus groups with teachers, principals, and the resource…

  20. Why Do Patients Choose to Consult Homeopaths? | McIntosh ...

    African Journals Online (AJOL)

    Background: Patients are using homeopathy in increasing numbers and not telling their doctors about it. It is important as family physicians that we understand the reasons why patients choose to consult homeopaths. It is important to know what our patients are looking for that they do not find in Western medicine.

  1. Consulting with Parents: Applying Family Systems Concepts and Techniques. (United States)

    Mullis, Fran; Edwards, Dana


    This article describes family systems concepts and techniques that school counselors, as consultants, can use to better understand the family system. The concepts are life cycle transitions and extrafamilial influences, extended family influences, boundaries, parental hierarchy and power, and triangulation. (Contains 39 references.) (GCP)

  2. Medical consultations and the sharing of medical images involving spinal injury over mobile phone networks. (United States)

    Filip, Michal; Linzer, Petr; Šámal, Filip; Tesař, Jiří; Herzig, Roman; Školoudík, David


    The transmission of medical images and other data over mobile phone networks may facilitate remote medical consultations between neurosurgeons and regional hospitals treating spinal injury patients. The aim of this study was to compare the efficacy of mobile phone consultations with standard hospital workstation consultations in spinal injury patients. The images were exported over the Internet from surrounding local hospitals through the Picture Archiving and Communication System, in DICOM III format, to the central hospital server. The xVision browser was used to view the acquired images on a standard workstation. The data were also exported to the secured hospital Web server IIS60 and converted to JPEG format to enable remote physician access and consultation. The remote consulting physician connected to this server by mobile phone using the phone's Internet browser. A second physician, blind to the mobile phone results, evaluated the same images at a workstation in the hospital. The results of the mobile phone consultations were compared with the results from standard workstation consultations. There was no difference in the quality of spinal computed tomographic/magnetic resonance images viewed on the phone screen compared with on the workstation. More importantly, the final diagnoses made by mobile phone did not differ from those made by workstation consultations. A transfer to the department of neurosurgery was required after consultation in 11 patients. Mobile phone consultations for patients with spinal injuries was as effective as workstation consultations. Mobile phone consultations can increase the expertise available to regional hospitals, which are often the first responders to medical emergencies. Copyright © 2012 Elsevier Inc. All rights reserved.

  3. Consultations

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


    Référence: Contrat CRDI N°: 123456. 1. Honoraires. 20 jours @ 400 CAD/jour. 8 000.00 CAD. 2. Dépenses autorisées (spécifiées au contrat). Forfait pour visas, etc. 150.00 CAD. Per diems à Dakar : 10 jrs @ 225 CAD/jr. 2 250.00 CAD. Photocopies (5 copies x 30 pages @ 0.10 CAD/page*). 15.00 CAD. Dépenses totales.

  4. Uruguay; 2011 Article IV Consultation


    International Monetary Fund


    This 2011 Article IV Consultation highlights that the growth momentum in Uruguay has continued into 2011 but a slowdown is under way, led by weaker exports and slower public investment. Uruguay’s economic and financial vulnerabilities are modest, and the government has reduced debt vulnerabilities significantly and built important financial buffers. Executive Directors have commended authorities’ skillful macroeconomic management that has underpinned Uruguay’s excellent economic performance, ...

  5. Ultrasound for the Pulmonary Consultant

    Directory of Open Access Journals (Sweden)

    Astha Chichra


    Full Text Available Bedside ultrasonographic assessment of the lung and pleura provides rapid, noninvasive, and essential information in diagnosis and management of various pulmonary conditions. Ultrasonography helps in diagnosing common conditions, including consolidation, interstitial syndrome, pleural effusions and masses, pneumothorax, and diaphragmatic dysfunction. It provides procedural guidance for various pulmonary procedures, including thoracentesis, chest tube insertion, transthoracic aspiration, and biopsies. This article describes major applications of ultrasonography for the pulmonary consultant along with illustrative figures and videos.

  6. Business Plan : Cultural consultant company


    Absiye, Mohamed


    The purpose of this research was to study the circumstances of immigrants in Finland with the intention of establishing a consultant company that would help the immigrants in their integration process in Finland. The primary data of this study were obtained from the results of the “survey on work and well-being among people of foreign origin” conducted between 2015 until 2016 by Statistic Finland. Additionally, the author did background research on the institutions of Finland and respect...

  7. ENDF/B Format

    International Nuclear Information System (INIS)

    Khalil, M.A.


    This document is a brief user's description of the format of ENDF/B, the evaluated neutron nuclear data library of the US National Nuclear Data Center. This summary is an aid to customers of the IAEA Nuclear Data Section when receiving data retrievals in ENDF/B format. For more detailed information the report BNL-50274 (ENDF-102) should be consulted. (author)

  8. Can Process Understanding Help Elucidate The Structure Of The Critical Zone? Comparing Process-Based Soil Formation Models With Digital Soil Mapping. (United States)

    Vanwalleghem, T.; Román, A.; Peña, A.; Laguna, A.; Giráldez, J. V.


    There is a need for better understanding the processes influencing soil formation and the resulting distribution of soil properties in the critical zone. Soil properties can exhibit strong spatial variation, even at the small catchment scale. Especially soil carbon pools in semi-arid, mountainous areas are highly uncertain because bulk density and stoniness are very heterogeneous and rarely measured explicitly. In this study, we explore the spatial variability in key soil properties (soil carbon stocks, stoniness, bulk density and soil depth) as a function of processes shaping the critical zone (weathering, erosion, soil water fluxes and vegetation patterns). We also compare the potential of traditional digital soil mapping versus a mechanistic soil formation model (MILESD) for predicting these key soil properties. Soil core samples were collected from 67 locations at 6 depths. Total soil organic carbon stocks were 4.38 kg m-2. Solar radiation proved to be the key variable controlling soil carbon distribution. Stone content was mostly controlled by slope, indicating the importance of erosion. Spatial distribution of bulk density was found to be highly random. Finally, total carbon stocks were predicted using a random forest model whose main covariates were solar radiation and NDVI. The model predicts carbon stocks that are double as high on north versus south-facing slopes. However, validation showed that these covariates only explained 25% of the variation in the dataset. Apparently, present-day landscape and vegetation properties are not sufficient to fully explain variability in the soil carbon stocks in this complex terrain under natural vegetation. This is attributed to a high spatial variability in bulk density and stoniness, key variables controlling carbon stocks. Similar results were obtained with the mechanistic soil formation model MILESD, suggesting that more complex models might be needed to further explore this high spatial variability.

  9. A method for the production of large volumes of WAF and CEWAF for dosing mesocosms to understand marine oil snow formation. (United States)

    Wade, Terry L; Morales-McDevitt, Maya; Bera, Gopal; Shi, Dawai; Sweet, Stephen; Wang, Binbin; Gold-Bouchot, Gerado; Quigg, Antonietta; Knap, Anthony H


    Marine oil snow (MOS) formation is a mechanism to transport oil from the ocean surface to sediments. We describe here the use of 110L mesocosms designed to mimic oceanic parameters during an oil spill including the use of chemical dispersants in order to understand the processes controlling MOS formation. These experiments were not designed to be toxicity tests but rather to illustrate mechanisms. This paper focuses on the development of protocols needed to conduct experiments under environmentally relevant conditions to examine marine snow and MOS. The experiments required the production of over 500 liters of water accommodated fraction (WAF), chemically enhanced water accommodated fraction of oil (CEWAF) as well as diluted CEWAF (DCEWAF). A redesigned baffled (170 L) recirculating tank (BRT) system was used. Two mesocosm experiments (M1 and M2) were run for several days each. In both M1 and M2, marine snow and MOS was formed in controls and all treatments respectively. Estimated oil equivalent (EOE) concentrations of CEWAF were in the high range of concentrations reported during spills and field tests, while WAF and DCEWAF concentrations were within the range of concentrations reported during oil spills. EOE decreased rapidly within days in agreement with historic data and experiments.

  10. Toward Full Participation in Management Consulting Practice: Experiences of Recent College Graduates (United States)

    Chao, Chia-an


    Purpose - This study seeks to understand the college-to-work transition process from the perspectives of a group of new management consultants. Design/methodology/approach - This study focuses on the experience of a group of management consultants, how they construct meaning in their work, and the workplace itself. Participants in this study…

  11. Core Competencies for Training Effective School Consultants (United States)

    Burkhouse, Katie Lynn Sutton


    The purpose of this research was to develop and validate a set of core competencies of effective school-based consultants for preservice school psychology consultation training. With recent changes in service delivery models, psychologists are challenged to engage in more indirect, preventative practices (Reschly, 2008). Consultation emerges as…

  12. 15 CFR 923.57 - Continuing consultation. (United States)


    ... § 923.57 Continuing consultation. (a) As required by subsection 306(d)(3)(B) of the Act, a State must establish an effective mechanism for continuing consultation and coordination between the management agency... 15 Commerce and Foreign Trade 3 2010-01-01 2010-01-01 false Continuing consultation. 923.57...

  13. 76 FR 55678 - Tribal Consultation Policy (United States)


    ... consultation is requested or required. DATES: The effective date of this policy is the date of signature by the... to conduct timely, respectful, meaningful, and effective two-way communication and consultation with... Consultation Policy AGENCY: Administration for Children and Families. ACTION: Final policy issuance. SUMMARY...

  14. Observed Consultation: Confidence and Accuracy of Assessors (United States)

    Tweed, Mike; Ingham, Christopher


    Judgments made by the assessors observing consultations are widely used in the assessment of medical students. The aim of this research was to study judgment accuracy and confidence and the relationship between these. Assessors watched recordings of consultations, scoring the students on: a checklist of items; attributes of consultation; a…

  15. 34 CFR 75.191 - Consultation costs. (United States)


    ... 34 Education 1 2010-07-01 2010-07-01 false Consultation costs. 75.191 Section 75.191 Education... Development of Curricula Or Instructional Materials § 75.191 Consultation costs. An applicant may budget reasonable consultation fees or planning costs in connection with the development of curricula or...

  16. Special Educator's Consultation Handbook. Second Edition. (United States)

    Idol, Lorna

    This book is written primarily for special educators who offer resource and consultation support for students with mild handicaps and students at risk for school failure. Examples of consultation projects implemented and evaluated in the field are used to illustrate principles of effective consultation. Suggestions and guidelines are provided for…

  17. Systematic review: frequency and reasons for consultation for gastro-oesophageal reflux disease and dyspepsia. (United States)

    Hungin, A P S; Hill, C; Raghunath, A


    Upper gastrointestinal symptoms impose a substantial illness burden and management costs. Understanding perceptions and reasons for seeking healthcare is a prerequisite for meeting patients' needs effectively. To review systematically findings on consultation frequencies for gastro-oesophageal reflux disease (GERD) and dyspepsia and patients' reasons for consultation. Systematic literature searches. Reported consultation rates ranged from 5.4% to 56% for GERD and from 26% to 70% for dyspepsia. Consultation for GERD was associated with increased symptom severity and frequency, interference with social activities, sleep disturbance, lack of timetabled work, higher levels of comorbidity, depression, anxiety, phobia, somatization and obsessionality. Some consulted because of fears that their symptoms represented serious disease; others avoided consultation because of this. Inconsistent associations were seen with medication use. Patients were less likely to consult if they felt that their doctor would trivialize their symptoms. Few factors were consistently associated with dyspepsia consultation. However, lower socio-economic status and Helicobacter pylori infection were associated with increased consultation. Patients' perceptions of their condition, comorbid factors and external reasons such as work and social factors are related to consultation rates for GERD. Awareness of these factors can guide the clinician towards a more effective strategy than one based on drug therapy alone.

  18. Understanding Litter Input Controls on Soil Organic Matter Turnover and Formation are Essential for Improving Carbon-Climate Feedback Predictions for Arctic, Tundra Ecosystems

    Energy Technology Data Exchange (ETDEWEB)

    Wallenstein, Matthew [Colorado State Univ., Fort Collins, CO (United States)


    The Arctic region stored vast amounts of carbon (C) in soils over thousands of years because decomposition has been limited by cold, wet conditions. Arctic soils now contain roughly as much C that is contained in all other soils across the globe combined. However, climate warming could unlock this oil C as decomposition accelerates and permafrost thaws. In addition to temperature-driven acceleration of decomposition, several additional processes could either counteract or augment warming-induced SOM losses. For example, increased plant growth under a warmer climate will increase organic matter inputs to soils, which could fuel further soil decomposition by microbes, but will also increase the production of new SOM. Whether Arctic ecosystems store or release carbon in the future depends in part on the balance between these two counteracting processes. By differentiating SOM decomposition and formation and understanding the drivers of these processes, we will better understand how these systems function. We did not find evidence of priming under current conditions, defined as an increase in the decomposition of native SOM stocks. This suggests that decomposition is unlikely to be further accelerated through this mechanism. We did find that decomposition of native SOM did occur when nitrogen was added to these soils, suggesting that nitrogen limits decomposition in these systems. Our results highlight the resilience and extraordinary C storage capacity of these soils, and suggest shrub expansion may partially mitigate C losses from decomposition of old SOM as Arctic soils warm.

  19. Biophysical and biochemical strategies to understand membrane binding and pore formation by sticholysins, pore-forming proteins from a sea anemone. (United States)

    Alvarez, Carlos; Ros, Uris; Valle, Aisel; Pedrera, Lohans; Soto, Carmen; Hervis, Yadira P; Cabezas, Sheila; Valiente, Pedro A; Pazos, Fabiola; Lanio, Maria E


    Actinoporins constitute a unique class of pore-forming toxins found in sea anemones that are able to bind and oligomerize in membranes, leading to cell swelling, impairment of ionic gradients and, eventually, to cell death. In this review we summarize the knowledge generated from the combination of biochemical and biophysical approaches to the study of sticholysins I and II (Sts, StI/II), two actinoporins largely characterized by the Center of Protein Studies at the University of Havana during the last 20 years. These approaches include strategies for understanding the toxin structure-function relationship, the protein-membrane association process leading to pore formation and the interaction of toxin with cells. The rational combination of experimental and theoretical tools have allowed unraveling, at least partially, of the complex mechanisms involved in toxin-membrane interaction and of the molecular pathways triggered upon this interaction. The study of actinoporins is important not only to gain an understanding of their biological roles in anemone venom but also to investigate basic molecular mechanisms of protein insertion into membranes, protein-lipid interactions and the modulation of protein conformation by lipid binding. A deeper knowledge of the basic molecular mechanisms involved in Sts-cell interaction, as described in this review, will support the current investigations conducted by our group which focus on the design of immunotoxins against tumor cells and antigen-releasing systems to cell cytosol as Sts-based vaccine platforms.

  20. Communicating Uncertain News in Cancer Consultations. (United States)

    Alby, Francesca; Zucchermaglio, Cristina; Fatigante, Marilena


    In cancer communication, most of the literature is in the realm of delivering bad news while much less attention has been given to the communication of uncertain news around the diagnosis and the possible outcomes of the illness. Drawing on video-recorded cancer consultations collected in two Italian hospitals, this article analyzes three communication practices used by oncologists to interactionally manage the uncertainty during the visit: alternating between uncertain bad news and certain good news, anticipating scenarios, and guessing test results. Both diagnostic and personal uncertainties are not hidden to the patient, yet they are reduced through these practices. Such communication practices are present in 32 % of the visits in the data set, indicating that the interactional management of uncertainty is a relevant phenomenon in oncological encounters. Further studies are needed to improve both its understanding and its teaching.

  1. Analyzing the Effect of Consultation Training on the Development of Consultation Competence (United States)

    Newell, Markeda L.; Newell, Terrance


    The purpose of this study was to examine the effectiveness of one consultation course on the development of pre-service school psychologists' consultation knowledge, confidence, and skills. Computer-simulation was used as a means to replicate the school environment and capture consultants' engagement throughout the consultation process without…

  2. Why and When do Patients Use e-Consultation Services? The Trust and Resource Supplementary Perspectives. (United States)

    Li, Jia; Liu, Minghui; Liu, Xuan; Ma, Ling


    e-Consultation provides a new way to deliver healthcare services online. With the help of e-Consultation services, patients can gain access to nationwide medical expertise that otherwise would not be available to them. As an online delivery approach, e-Consultation also provides a choice for patients to receive medical advice from online doctors immediately, no matter how far away from the hospital they may be or how late in the day it is. However, the adoption and usage of e-Consultation is still far from satisfactory. Therefore, understanding why and when patients use e-Consultation services are important research questions. Considering that the choice of a healthcare provider is a serious decision, this research uses the trust perspective to explain the e-Consultation service adoption phenomenon. Specifically, trust is conceptualized as a second-order construct consisting of two dimensions: competence and integrity. In addition, e-Consultation is viewed as a supplementary resource to traditional off-line consultation services, and disease type as a contextual factor is hypothesized to focus the context where e-Consultation services are more suitable. A scenario-based survey was conducted to test the proposed research model. We obtained a total of 190 valid questionnaires. Our results indicated that trust (p e-Consultation service. Meanwhile, our results also indicated that the higher the disease is in rarity (p e-Consultation service. Trust is the major driving force of an e-Consultation service adoption. When the disease is high in rarity, severity, or urgency, an off-line healthcare provider is less capable of providing meaningful, qualified, and immediate service. Therefore, there is a decreased positive effect of trust on the intention to use an e-Consultation service for those diseases.

  3. Strangers at the Benchside: Research Ethics Consultation (United States)

    Cho, Mildred K.; Tobin, Sara L.; Greely, Henry T.; McCormick, Jennifer; Boyce, Angie; Magnus, David


    Institutional ethics consultation services for biomedical scientists have begun to proliferate, especially for clinical researchers. We discuss several models of ethics consultation and describe a team-based approach used at Stanford University in the context of these models. As research ethics consultation services expand, there are many unresolved questions that need to be addressed, including what the scope, composition, and purpose of such services should be, whether core competencies for consultants can and should be defined, and how conflicts of interest should be mitigated. We make preliminary recommendations for the structure and process of research ethics consultation, based on our initial experiences in a pilot program. PMID:18570086

  4. Consultant breast radiographers: Where are we now?

    International Nuclear Information System (INIS)

    Rees, Zebby


    Introduction: The aim of this study is to: • Evaluate the current role of the consultant breast radiographer. • Compare current practice with the four key components for consultant practice. • Gauge the support of radiologist colleagues. • Determine the other professional commitments involved with the role. This study could be the precursor for a macro study of all consultant radiographer practice in other specialities. Methodology: Methodology used was a comparative ethnographic study. Questionnaires to the 24 consultant breast radiographers currently in post, and consultant breast radiologists, who work with them, were conducted. Data collection was a qualitative thematic approach. Conclusion: Consultant breast radiographers provide high quality care to patients through excellent clinical practice, leadership and good communication. However, this study shows hospital Trusts emphasis for non medical consultants is for clinical practice first. Some radiologists are still a barrier to progression for consultant breast radiographers, and radiologists have a big influence in recruitment decisions. Consultant breast radiographer posts are well established, their numbers are increasing through recognition of the role and of their abilities and performance. Consultant breast radiographers state that becoming a consultant is the major achievement of their career, proving the Society of Radiographers' vision of the four-tier career structure has been well received by the radiography profession

  5. Reflections on the role of consultant radiographers in the UK: what is a consultant radiographer?


    Booth, Lisa; Henwood, Suzanne; Miller, Paul K.


    Context: This paper is the second paper from a two year in depth case study, exploring the role of consultant radiographers in the UK.\\ud \\ud Methods: A longitudinal case study approach was used to determine the role of consultant radiographers. Interviews were used to explore experiences of being a consultant, which were analysed using thematic analysis. Eight consultant radiographers participated (Note, two of the consultants withdrew after the first interview due to workload). Therefore tw...

  6. [Teenagers' drawings in transcultural consultations]. (United States)

    Simon, Amalini; Titia Rizzi, Alice

    The place of teenagers' drawings has been studied as part of a transcultural consultation, based on the creativity of the children of migrants. When speaking is difficult, drawings enable teenagers to show another dimension of their internal world. Aravin, a young Tamil boy, who lacked the necessary words, was able to express all the complexity of his thoughts through his drawings, finally being able to formulate in the group the difficult situations which he was drawing. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  7. Revenue Potential for Inpatient IR Consultation Services: A Financial Model. (United States)

    Misono, Alexander S; Mueller, Peter R; Hirsch, Joshua A; Sheridan, Robert M; Siddiqi, Assad U; Liu, Raymond W


    Interventional radiology (IR) has historically failed to fully capture the value of evaluation and management services in the inpatient setting. Understanding financial benefits of a formally incorporated billing discipline may yield meaningful insights for interventional practices. A revenue modeling tool was created deploying standard financial modeling techniques, including sensitivity and scenario analyses. Sensitivity analysis calculates revenue fluctuation related to dynamic adjustment of discrete variables. In scenario analysis, possible future scenarios as well as revenue potential of different-size clinical practices are modeled. Assuming a hypothetical inpatient IR consultation service with a daily patient census of 35 patients and two new consults per day, the model estimates annual charges of $2.3 million and collected revenue of $390,000. Revenues are most sensitive to provider billing documentation rates and patient volume. A range of realistic scenarios-from cautious to optimistic-results in a range of annual charges of $1.8 million to $2.7 million and a collected revenue range of $241,000 to $601,000. Even a small practice with a daily patient census of 5 and 0.20 new consults per day may expect annual charges of $320,000 and collected revenue of $55,000. A financial revenue modeling tool is a powerful adjunct in understanding economics of an inpatient IR consultation service. Sensitivity and scenario analyses demonstrate a wide range of revenue potential and uncover levers for financial optimization. Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.

  8. Elderly Women's Perception About Nursing Gynecological Consultation: A Comprehensive Analysis

    Directory of Open Access Journals (Sweden)

    Aline Furtado Rosa


    Full Text Available The Brazilian elderly population, that is, the population aged 60 or older according to the Elderly Estatute, has increased in recent decades, a phenomenon observed in Brazil and worldwide. This rapid growth represents a major political and social impact, reflecting the consequent rise in cost of health services because this is the population that most need this service. Objective: To understand the meaning of Nursing Consultation for elderly women assisted at a School Clinic in Mountain Region-RJ-Brazil. Method: The is a qualitative study of descriptive and exploratory nature supported by the theoretical and methodological framework of Alfred Schutz through sociological phenomenology. The study was approved by the Ethics and Research Committee of the Arthur Sá Earp Neto Faculty on April 11, 2015 under Opinion number 1.019361. We used phenomenological interview. Results: We performed 19 interviews with elderly women aged 60-80 years. The responses provided the understanding of women's experiences during the nursing consultation. This study gave rise to three categories that revealed the intentionality of this social group when searching for the nursing consultation: "To be well assisted", "To have resolving power" and "To prevent health problems". Conclusions: The found that the nursing consultation promotes the approximation between women and the nursing professionals, establishing bonds, presenting efficient and effective results to treatment and prevention, besides providing mutual learning.

  9. How doctors move from generic goals to specific communicative behavior in real practice consultations

    NARCIS (Netherlands)

    Veldhuijzen, W.; Mogendorff, K.; Ram, P.; Weijden, T.T. van der; Elwyn, G.; Vleuten, C.P.M. van der


    OBJECTIVE: To understand how recommendations for communication can be brought into alignment with clinical communication routines, we explored how doctors select communicative actions during consultations. METHODS: We conducted stimulated recall interviews with 15 GPs (general practitioners), asking

  10. The effects of infographics and several quantitative versus qualitative formats for cardiovascular disease risk, including heart age, on people's risk understanding. (United States)

    Damman, Olga C; Vonk, Suzanne I; van den Haak, Maaike J; van Hooijdonk, Charlotte M J; Timmermans, Danielle R M


    To study how comprehension of cardiovascular disease (CVD) risk is influenced by: (1) infographics about qualitative risk information, with/without risk numbers; (2) which qualitative risk dimension is emphasized; (3) heart age vs. traditional risk format. For aim 1, a 2 (infographics versus text) x 2 (risk number versus no risk number) between-subjects design was used. For aim 2, three pieces of information were tested within-subjects. Aim 3 used a simple comparison group. Participants (45-65 yrs old) were recruited through an online access panel; low educated people were oversampled. They received hypothetical risk information (20%/61yrs). Primary outcomes: recall, risk appraisals, subjective/objective risk comprehension. behavioral intentions, information evaluations. Infographics of qualitative risk dimensions negatively affected recall, subjective risk comprehension and information evaluations. No effect of type of risk dimension was found on risk perception. Heart age influenced recall, comprehension, evaluations and affective risk appraisals. Infographics of hypothetical CVD risk information had detrimental effects on measures related to risk perception/comprehension, but effects were mainly seen in undereducated participants. Heart age influenced perceptions/comprehension of hypothetical risk in a way that seemed to support understanding. Heart age seems a fruitful risk communication approach in disease risk calculators. Copyright © 2018 Elsevier B.V. All rights reserved.

  11. \\Defining Patient Advocacy for the Context of Clinical Ethics Consultation: A Review of the Literature and Recommendations for Consultants. (United States)

    Brazg, Tracy; Lindhorst, Taryn; Dudzinski, Denise; Wilfond, Benjamin


    The idea of patient advocacy as a function of clinical ethics consultation (CEC) has been debated in the bioethics literature. In particular, opinion is divided as to whether patient advocacy inherently is in conflict with the other duties of the ethics consultant, especially that of impartial mediator. The debate is complicated, however, because patient advocacy is not uniformly conceptualized. This article examines two literatures that are crucial to understanding patient advocacy in the context of bioethical deliberations: the CEC literature and the literature on advocacy in the social work profession. A review of this literature identifies four distinct approaches to patient advocacy that are relevant to CEC: (1) the best interest approach, (2) the patient rights approach, (3) the representational approach, and (4) the empowerment approach. After providing a clearer understanding of the varied meanings of patient advocacy in the context of CEC, we assert that patient advocacy is not inherently inconsistent with the function of the ethics consultant and the CEC process. Finally, we provide a framework to help consultants determine if they should adopt an advocacy role. Copyright 2016 The Journal of Clinical Ethics. All rights reserved.

  12. The assessment of usefulness of the qualification card and ultrasonographic consultation

    Directory of Open Access Journals (Sweden)

    Zbigniew Pilecki


    Full Text Available The result of therapeutic success is always the effect of medical professionals coopera‑ tion. The creation of adequate mechanisms of cooperation of these teams demands time and appropriate examples. In the understanding of differentiated behaviors in the line patient – diagnostician – surgeon, particularly the mechanism of the cascade of errors formation, giving simple examples may help – their awareness will facilitate the forma‑ tion of an adequate pattern of diagnostic‑therapeutic chain. The therapeutic team formed in this way provides optimal forms of cooperation and positive result. One of the elements of the cooperation is the surgical procedure qualification card which is an example of the communication between surgeon and diagnostician. The propagation of proven examples seems to be justified by practical reasons. The introduction of the surgical procedure qual‑ ification card enabled maintaining of the preoperative and postoperative diagnoses in the range from 88.4% to 89.29%, the barrier of 90% however is still not achieved. The diag‑ noses discrepancy is still the most often occurring patient safety incident and our results should head towards its mineralization. In particularly complicated cases we come back to a well‑known form of medical consultation, that is the form of examination and treat‑ ment establishment basing on simultaneous physical and ultrasound examination – hence the colloquial name of ultrasound consultation. The universality of medical consultation makes out of it an excellent tool, particularly in cases of significant discrepancy between physical and ultrasound examination. This is excellent form of the experience exchange and learning about mutual possibilities. We believe that the mechanisms presented will influence the improvement of patient security.

  13. International Distance Consulting via Web Conferencing

    Directory of Open Access Journals (Sweden)

    Prachyanun Nilsook


    Full Text Available The objective of this research is to study the result of the use of international distance consulting via web conferencing. The research discovered that: 1 the open source programs can be only used with desktop computers, but not with laptop computers 2 the result of the use along the consulting process is considered normal 3 there are some observations that are different from the criteria of evaluation: the picture quality, the sound quality, the interaction during the consulting, and the files management of the system. The students agree with the international distance consulting via web conferencing process that consists of 5 steps: 1 Preparation of the consulting system 2 Problem survey 3 Problem study 4 Determine the objective and resolve the problem 5 Make the conclusion of the consulting system.

  14. Consultative exercise on dose assessments. (United States)

    Bridges, B A; Parker, T; Simmonds, J R; Sumner, D


    A summary is given of a meeting held at Sussex University, UK, in October 2000, which allowed the exchange of ideas on methods of assessment of dose to the public arising from potential authorised radioactive discharges from nuclear sites in the UK. Representatives of groups with an interest in dose assessments were invited, and hence the meeting was called the Consultative Exercise on Dose Assessments (CEDA). Although initiated and funded by the Food Standards Agency, its organisation, and the writing of the report, were overseen by an independent Chairman and Steering Group. The report contains recommendations for improvement in co-ordination between different agencies involved in assessments, on method development and on the presentation of data on assessments. These have been prepared by the Steering Group, and will be taken forward by the Food Standards Agency and other agencies in the UK. The recommendations are included in this memorandum.

  15. Doctor-patient communication: a comparison between telemedicine consultation and face-to-face consultation. (United States)

    Liu, Xiao; Sawada, Yoshie; Takizawa, Takako; Sato, Hiroko; Sato, Mahito; Sakamoto, Hironosuke; Utsugi, Toshihiro; Sato, Kunio; Sumino, Hiroyuki; Okamura, Shinichi; Sakamaki, Tetsuo


    The objective of this study was to compare doctor-patient communications in clinical consultations via telemedicine technology to doctor-patient communications in face-to-face clinical consultations. Five doctors who had been practicing internal medicine for 8 to 18 years, and twenty patients were enrolled in this study; neither doctors nor patients had previous experience of telemedicine. The patients received both a telemedicine consultation and a face-to-face consultation. Three measures--video observation, medical record volume, and participants' satisfaction--were used for the assessment. It was found that the time spent on the telemedicine consultation was substantially longer than the time spent on the face-to-face consultation. No statistically significant differences were found in the number of either closed or open-ended questions asked by doctors between both types of consultation. Empathy-utterances, praise-utterances, and facilitation-utterances were, however, seen less in the telemedicine consultations than in the face-to-face consultations. The volume of the medical records was statistically smaller in the telemedicine consultations than in the face-to-face consultations. Patients were satisfied with the telemedicine consultation, but doctors were dissatisfied with it and felt hampered by the communication barriers. This study suggests that new training programs are needed for doctors to develop improved communication skills and the ability to express empathy in telemedicine consultations.

  16. The Concept of Body Language in the Medical Consultation. (United States)

    Lindsley, Isabella; Woodhead, Sophie; Micallef, Claranne; Agius, Mark


    In this paper we wish to argue that the human body is an instrument of communication that can be used by the individual. This can be shown by the use of phenomenology, as described by Husserl, and that indeed empathy, as described by phenomenology, can be seen as a link enabling two human bodies/persons to communicate. We then wish to show from neuroscience that empathy can itself be seen as a bodily function. We then will describe how the doctor-patient relationship in the consultation is an extremely important type of communication between two persons, and how teaching of consultation skills has developed. We will show that, once consultation skills teaching was established, then study of body language became an essential part of this teaching, as soon as the technology was developed, and finally we will demonstrate that it is now possible to confirm by observational and controlled trials that appropriate use of body language does indeed enhance the effectiveness of the consultation, including, we would suggest, by appropriate communication of empathy and understanding.

  17. Expertise, Ethics Expertise, and Clinical Ethics Consultation: Achieving Terminological Clarity (United States)

    Iltis, Ana S.; Sheehan, Mark


    The language of ethics expertise has become particularly important in bioethics in light of efforts to establish the value of the clinical ethics consultation (CEC), to specify who is qualified to function as a clinical ethics consultant, and to characterize how one should evaluate whether or not a person is so qualified. Supporters and skeptics about the possibility of ethics expertise use the language of ethics expertise in ways that reflect competing views about what ethics expertise entails. We argue for clarity in understanding the nature of expertise and ethics expertise. To be an ethics expert, we argue, is to be an expert in knowing what ought to be done. Any attempt to articulate expertise with respect to knowing what ought to be done must include an account of ethics that specifies the nature of moral truth and the means by which we access this truth or a theoretical account of ethics such that expertise in another domain is linked to knowing or being better at judging what ought to be done and the standards by which this “knowing” or “being better at judging” is determined. We conclude with a discussion of the implications of our analysis for the literature on ethics expertise in CEC. We do think that there are clear domains in which a clinical ethics consultant might be expert but we are skeptical about the possibility that this includes ethics expertise. Clinical ethics consultants should not be referred to as ethics experts. PMID:27256848

  18. Owners and Veterinary Surgeons in the United Kingdom Disagree about What Should Happen during a Small Animal Vaccination Consultation. (United States)

    Belshaw, Zoe; Robinson, Natalie J; Dean, Rachel S; Brennan, Marnie L


    Dog and cat vaccination consultations are a common part of small animal practice in the United Kingdom. Few data are available describing what happens during those consultations or what participants think about their content. The aim of this novel study was to investigate the attitudes of dog and cat owners and veterinary surgeons towards the content of small animal vaccination consultations. Telephone interviews with veterinary surgeons and pet owners captured rich qualitative data. Thematic analysis was performed to identify key themes. This study reports the theme describing attitudes towards the content of the consultation. Diverse preferences exist for what should be prioritised during vaccination consultations, and mismatched expectations may lead to negative experiences. Vaccination consultations for puppies and kittens were described to have a relatively standardised structure with an educational and preventative healthcare focus. In contrast, adult pet vaccination consultations were described to focus on current physical health problems with only limited discussion of preventative healthcare topics. This first qualitative exploration of UK vaccination consultation expectations suggests that the content and consistency of adult pet vaccination consultations may not meet the needs or expectations of all participants. Redefining preventative healthcare to include all preventable conditions may benefit owners, pets and veterinary surgeons, and may help to provide a clearer structure for adult pet vaccination consultations. This study represents a significant advance our understanding of this consultation type.

  19. The Clinical Impact of Cardiology Consultation Prior to Major Vascular Surgery. (United States)

    Davis, Frank M; Park, Yeo June; Grey, Scott F; Boniakowski, Anna E; Mansour, M Ashraf; Jain, Krishna M; Nypaver, Timothy; Grossman, Michael; Gurm, Hitinder; Henke, Peter K


    To understand statewide variation in preoperative cardiology consultation prior to major vascular surgery and to determine whether consultation was associated with differences in perioperative myocardial infarction (poMI). Medical consultation prior to major vascular surgery is obtained to reduce perioperative risk. Despite perceived benefit of preoperative consultation, evidence is lacking specifically for major vascular surgery on the effect of preoperative cardiac consultation. Patient and clinical data were obtained from a statewide vascular surgery registry between January 2012 and December 2014. Patients were risk stratified by revised cardiac risk index category and compared poMI between patients who did or did not receive a preoperative cardiology consultation. We then used logistic regression analysis to compare the rate of poMI across hospitals grouped into quartiles by rate of preoperative cardiology consultation. Our study population comprised 5191 patients undergoing open peripheral arterial bypass (n = 3037), open abdominal aortic aneurysm repair (n = 332), or endovascular aneurysm repair (n = 1822) at 29 hospitals. At the patient level, after risk-stratification by revised cardiac risk index category, there was no association between cardiac consultation and poMI. At the hospital level, preoperative cardiac consultation varied substantially between hospitals (6.9%-87.5%, P 66%) had a reduction in poMI (OR, 0.52; confidence interval: 0.28-0.98; P cardiology consultation for vascular surgery varies greatly between institutions, and does not appear to impact poMI at the patient level. However, reduction of poMI was noted at the hospitals with the highest rate of preoperative cardiology consultation as well as a variety of medical services, suggesting that other hospital culture effects play a role.

  20. Effects of Consultee Problem Presentation and Consultant Training on Consultant Problem Definition. (United States)

    Conoley, Collie W.; And Others


    Examined consultee's influence on process of problem definition. Hypothesized that consultee would influence consultant's ability to formulate specific, descriptive problems by consultee's original problem conceptualization. Findings from 18 doctoral student consultants enrolled in mental health consultation course and behavioral analysis class…

  1. Behavior Consultation: A Five-Year Evaluation of Consultant and Client Outcomes. (United States)

    Kratochwill, Thomas W.; And Others


    Documents the effects of training in behavioral consultation on 17 school psychology graduate students and on 44 client outcomes. Training focused on principles and mastery of applied behavioral therapy and consultation, relationship skills, and systems entry issues. Consultees and consultants expressed overall consumer satisfaction with the…

  2. Consultant Skill and Efficiency and the Implementation and Outcomes of Consultation (United States)

    Bergan, John R.; Tombari, Martin L.


    This article describes an investigation of consultant services rendered by school psychologists to teachers. Results indicated that consultants lacking in skills failed to identify consultee problems and never reached the stage of plan development and implementation. Consultants successful in identifying problems were able to solve those problems.…

  3. Ubiquitous consultation tool for decentral knowledge workers


    Nazari Shirehjini, A.A.; Rühl, C.; Noll, S.


    The special issue of this initial study is to examine the current work situation of consulting companies, and to elaborate a concept for supporting decentralized working consultants. The concept addresses significant challenges of decentralized work processes by deploying the Peer-to-Peer methodology to decentralized expert and Knowledge Management, cooperation, and enterprise resource planning.

  4. Lessons Learned from a Consultation Process Overseas (United States)

    Merino-Soto, César


    In this commentary I discuss three international school consultation experiences, highlighting aspects that serve as lessons for professional development and the implementation of effective and helpful strategies that meet the needs of children and youth in school systems. Relationships developed and maintained between the consulting teams and the…

  5. 24 CFR 92.358 - Consultant activities. (United States)


    ... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Consultant activities. 92.358 Section 92.358 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development HOME INVESTMENT PARTNERSHIPS PROGRAM Other Federal Requirements § 92.358 Consultant activities. No...

  6. Bladder Pain Syndrome International Consultation on Incontinence

    DEFF Research Database (Denmark)

    Hanno, P.; Lin, A.; Nordling, J.


    Aims of Study: The Bladder Pain Syndrome Committee of the International Consultation on Incontinence was assigned the task by the consultation of reviewing the syndrome, formerly known as interstitial cystitis, in a comprehensive fashion. This included the topics of definition, nomenclature...

  7. Capturing the competence of management consulting work

    NARCIS (Netherlands)

    Visscher, Klaasjan


    Purpose: The purpose of this article is to assess whether the effort of consulting firms and branch organizations to establish a shared and standardized methodology as a means to professionalize consulting and as a standard for training is possible and sensible. - Design/methodology/approach: A

  8. ARL/OMS Consultant Training Program. (United States)

    Euster, Joanne R.


    Describes Academic Library Consultant Training Program begun in 1979, sponsored by Office of Management Studies (OMS) and designed to provide 80 consultants to aid academic libraries in improving performance. Viewpoints are included from OMS Director and participants concerning program objectives, trainee selection, workshops, internships, and the…

  9. Mental Health Consultation in Early Childhood Classrooms (United States)

    Bernzweig, Jane; Ramler, Malia; Alkon, Abbey


    Early childhood mental health consultation is a relationship-based intervention that promotes children's social and emotional development. Benefits include improved childhood behaviors, improved staff self-efficacy, and lowered parental stress. Child care center directors are more likely to be satisfied with consultation when they are involved in…

  10. Expectation Levels in Dictionary Consultation and Compilation ...

    African Journals Online (AJOL)

    Dictionary consultation and compilation is a two-way engagement between two parties, namely a dictionary user and a lexicographer. How well users cope with looking up words in a Bantu language dictionary and to what extent their expectations are met, depends on their consultation skills, their knowledge of the structure ...

  11. Consultant radiographers: Profile of the first generation

    International Nuclear Information System (INIS)

    Forsyth, Lesley J.; Maehle, Valerie


    Aim: The aim of this research is to examine the profile of first generation consultant radiographers: their demographics, educational backgrounds, qualifications and training, career experience and progression, teaching, lecturing and research activities. Method: Participant recruitment was drawn from the Society and College of Radiographers consultant radiographer group. Data collection involved a self-administered paper based and web based questionnaire. Results: Participant response rate of 55% (n = 11). Conclusions: The profile of the first consultant radiographer cohort reflects a diverse and eclectic mix. While some aspects of their development such as educational background, clinical training and skills enhancement are comparable to nurse consultants, clinical experience and employment history show some differences. Commitment to development of expert clinical skills is evident within the profile of the first generation cohort of consultant radiographers however research and leadership training are not strong features.

  12. Consultant radiographer leadership - A discussion

    International Nuclear Information System (INIS)

    Hogg, Peter; Hogg, Dianne; Henwood, Suzanne


    Effective leadership can be defined in many ways and is an essential element of successful organisations; poor leadership can result in problems such as low staff morale, high staff turnover and reduced productivity. Effective leadership behaviours are well documented in the literature and various leadership models have been proposed that illustrate these behaviours. This discussion paper does not focus on any particular model. Instead it considers the 'Leadership Qualities Framework' which was developed specifically for use within the UK National Health Service. This framework draws upon a range of leadership models and as such it gives a broad indication of leadership behaviours. The framework comprises three components - 'personal qualities', 'setting direction' and 'delivering the service'. This paper commences with an argument as to why effective leadership is important in organisations generally, and specifically within healthcare organisations. Various examples of leadership are illustrated from within and outside the NHS in order to demonstrate effective leadership behaviours. The Leadership Qualities Framework is then examined, along with scenarios to illustrate effective leadership behaviours in context (i.e. within a healthcare organisation). Subsequent reflections on the scenarios aim to identify leadership behaviours that are explained within the framework. The final element of this paper draws on [limited] published evidence of where consultant radiographers have demonstrated effective leadership behaviours. In this section the published evidence is examined and reflected upon. At the end of the article we indicate additional reading for those who wish to further develop their theoretical and practical leadership skills

  13. The Center for Intercultural Formation, Cuernavaca, Mexico, its reports (1962-1967 and Illich’s critical understanding of mission in Latin America

    Directory of Open Access Journals (Sweden)

    Bruno-Jofré, Rosa


    Full Text Available This paper examines the Reports of the Center for Intercultural Formation (CIF, which were produced in Cuernavaca, Mexico, between 1962-1967 by the Centro de Investigaciones Culturales (Center for Cultural Research (CIC, and supported since 1963 by the Centro Intercultural de Documentación (Center for Intercultural Documentation (CIDOC (an offshoot of CIC. The network is placed within the historical conjuncture of the early 1960s and the alignment of the Vatican with the Alliance for Progress and its anti-communist developmentalist community projects. The core of the paper centers in the ‘illocutionary force’ (Quentin Skinner behind Illich’s responses to John XXIII’s call to congregations and lay Catholics for a renewed mission in Latin America. It addresses Illich’s resignification of the understanding of mission and missioner rooted in the Gospel, the notion of incarnation in the culture rather than missioners being agents of their culture, and missionary “poverty” as a virtue of the community worker. Illich’s radicalization of his critical discourse led to a confrontation with the Vatican in 1967 and 1968 after he published “The Seamy Side of Charity” and “The Vanishing Clergyman” in the last year, 1967, of the CIF Report. The conflict with the Vatican signaled Illich’s turn to educational, health and other issues moving away from a critique of the institutionalized Catholic Church.Este artículo examina los Reports del Center of Intercultural Formation (CIF que fueron elaborados en Cuernavaca, México, entre 1962 y 1967 por el Centro de Investigaciones Culturales (CIC, y producidos desde 1963 por el Centro Intercultural de Documentación constituido dentro del CIC. Esta red de centros es situada dentro de la coyuntura histórica del principio de los años sesenta y de la convergencia entre el Vaticano y la Alianza para el Progreso y sus proyectos comunitarios desarrollistas. El artículo se centra en la

  14. From psychosomatic medicine to consultation-liaison psychiatry. (United States)

    Smith, G C

    To trace the movement from psychosomatic medicine to consultation-liaison psychiatry, the forces at work in shaping the change, and the extent to which the change is reflected in the latest revisions of the International classification of diseases (ICD-10) and the Diagnostic and statistical manual of mental disorders, third revision (DSM-III-R). Identification of important trends in the field was aided by discussions with fellow members of the panel of compilers of the consultation-liaison psychiatry literature review expert list published bi-annually in General Hospital Psychiatry. The expert list is based on appropriate literature searches. Psychosomatic medicine continues as a science, studying the relationships between biological, psychological and social phenomena in health and disease. The main advocates of the clinical application of the concepts and findings of psychosomatic medicine are now the general hospital consultation-liaison psychiatrists and their allied health professional colleagues. The mainstreaming of psychiatry into medicine has accentuated the role of the consultation-liaison psychiatrist. In attempting to translate the advances in the field into a new taxonomy, both ICD-10 and DSM-III-R have created a new language that hinders understanding by a medical profession perhaps now less prone to resistance to holism. There is a need for a valid taxonomy that addresses the most common form of psychiatric presentation in the community, that of physical/psychiatric co-morbidity, and for outcome studies based on such a taxonomy. Consultation-liaison psychiatrists need to educate their colleagues about the changes in concepts and terminology.

  15. Teaching Teaching & Understanding Understanding

    DEFF Research Database (Denmark)


    "Teaching Teaching & Understanding Understanding" is a 19-minute award-winning short-film about teaching at university and higher-level educational institutions. It is based on the "Constructive Alignment" theory developed by Prof. John Biggs. The film delivers a foundation for understanding what...

  16. From Solution Shop to Boutique Consulting? Capturing Recent Developments on the German Consulting Marke

    Directory of Open Access Journals (Sweden)

    Jörg Jasper DÖTSCH


    Full Text Available Digitalization, globalization, new technologies and shorter product life cycles are only a few keywords underlining the fact that companies are under increasing pressure for faster adaptation, innovation and hence applying a higher knowledge intensity. We assume that these conditions require an increasingly important role of consulting companies, because they seem to be the intermediaries needed to bridge the faster growing gaps between existing business models, organizational structures and accelerating market change. Market pressure is growing on the market for consultant companies as well. New technologies and digitalization should influence both the structure of the consultancy market and the business models of consultancies. Christensen suggested a trend from Dzsolution shop” to Dzboutique consulting.” To track current developments, we concentrate on the German consulting market as one of the most important consultant markets worldwide and explore changes of the last two years based on various studies. Processes of change seem to be both substantially driven by digitalization and to reflect change on the non-consultancy markets. A high willingness to switch among providers documents a high pressure on performance. The impact of digitalisation seem• to be observable in structural and qualitative change. With regard to the German consulting market and the latest available data we cannot validate a tendency from a dominance of “solution shop” consultancies to “boutique” consultancy services.

  17. "How long does it take?" A mixed methods evaluation of computer-related work in GP consultations. (United States)

    Hayward, James; Buckingham, Susan; Thomson, Fionagh; Milne, Heather; Sheikh, Aziz; Fernando, Bernard; Cresswell, Kathrin; Williams, Robin; Pinnock, Hilary


    Systematic reviews have suggested that time spent on computer-related tasks increases consultation length. However, these reviews pre-date the current ubiquitous use of computers in U.K. general practice. As part of a U.K. national study of the influence of information technology (IT) on the interaction between patients and healthcare professionals during consultations, we explored how IT functions affected time allocation and styles of computer use during general practitioner (GP) consultations. We drew on multichannel video recording of consultations and measured consultation phases and the duration of computer-related tasks. We related measures of actual time to GP's interpretation of computer use elicited in qualitative interviews. Our sample included recordings of 112 consultations from 6 GPs in three practices. The computer was used for about one-third of the greater consultation. However, its use was concentrated pre- and post- the patient consultation. The workflow of consultation was exemplified through six computer use cases. Most functionality was accepted and accommodated within the consultation, though disruptive and time-consuming tasks were generally delegated to administrative staff. Recognised styles of computer use (minimal, block and conversational) were apparent, but applied very flexibly by GPs according to the nature of the consultation. In contrast to earlier reports, contemporary computer use does not appear to have lengthened consultations. GPs adopted different styles of computer use in different consultations, challenging classifications that seek to stereotype GP computer use. Designing systems that support this versatility require an understanding of the fluid application of computer use within consultation structure.

  18. ENDF/B format

    International Nuclear Information System (INIS)

    Khalil, M.A.; Lemmel, H.D.


    This document is a brief user's description of the format of ENDF/B. This format, originally designed for the US Evaluated Nuclear Data File, is recommended for international use. This summary is an aid to customers of the IAEA Nuclear Data Section when receiving data retrievals in ENDF/B format. For more detailed information the report BNL-NCS-50496 (ENDF 102) should be consulted. An Appendix to the present document gives a summary of the format differences between ENDF/B-4 and ENDF/B-5. (author)

  19. The effects of infographics and several quantitative versus qualitative formats for cardiovascular disease risk, including heart age, on people's risk understanding.

    NARCIS (Netherlands)

    Damman, Olga C; Vonk, Suzanne I; Van den Haak, Maaike J; van Hooijdonk, Charlotte M J; Timmermans, Danielle R M


    To study how comprehension of cardiovascular disease (CVD) risk is influenced by: (1) infographics about qualitative risk information, with/without risk numbers; (2) which qualitative risk dimension is emphasized; (3) heart age vs. traditional risk format.

  20. An assessment of the Atomic Energy Control Board consultation process

    International Nuclear Information System (INIS)


    This report analyzes the consultation process followed by the AECB in discharging its responsibility for regulation development. It shows how the process could be improved by better targeting of the consultation towards groups that can be expected to provide valuable input. It also addresses the question of how best to convey to members of those groups the information they need before making comments on proposed regulatory changes. The study also looks at how effective the process is and at possible procedural improvements that might facilitate the preparation of comments by outside groups and improve the understanding among the public of the role played by the AECB and of the issues surrounding nuclear facilities and the use and handling of prescribed substances

  1. The role of the consultant pediatrician in community pediatrics--an Australian perspective. (United States)

    Menahem, S


    The consultant pediatrician plays an important role within the community. The task includes assessing the child in all parameters, appropriately treating organic disease, and making efforts to understand and manage the emotional difficulties that may be present. This paper reviews the work of a consultant pediatrician within the community, emphasizing the importance of preventing disease and emotional ill-health in the child and family.

  2. Eliciting Patients’ Health Concerns in Consulting Rooms and Wards in Vietnamese Public Hospitals

    Directory of Open Access Journals (Sweden)

    Huong Thi Linh Nguyen


    Full Text Available This article examines the doctor’s elicitation of the patient’s presenting health concern in two clinical settings in the Vietnamese public hospital system: the consulting room and the ward. The data were taken from 66 audio-recorded consultations. Our analysis shows that the elicitors used by the doctor in the consulting room often communicate a weak epistemic stance towards the patient’s health issue, while those used in the ward tend to signal a strong epistemic stance. In addition, this contrast between the elicitors employed in the consulting room and the ward is evident in our data regardless of whether the consultation is a first visit or a same follow-up (in which the doctor is the same one that treated the patient on their last visit, though the contrast is less clear for different follow-ups (in which the doctor has not treated the patient before. An additional finding is that the clinical setting has some bearing on the use of inappropriate elicitation formats (in which the doctor opens the visit with an elicitor which is more appropriate for another type of visit. The precise way in which each of the consulting room and the ward operates is, of course, a feature of the Vietnamese public hospital system itself. Hence, the overall contrast between the elicitors and elicitation formats used in these two settings illustrates how, on a more general level, the institutional context can have an impact on doctor-patient communication.

  3. Longer-term impact of cardiology e-consults. (United States)

    Wasfy, Jason H; Rao, Sandhya K; Kalwani, Neil; Chittle, Melissa D; Richardson, Calvin A; Gallen, Kathleen M; Isselbacher, Eric M; Kimball, Alexandra B; Ferris, Timothy G


    Cardiac e-consults may be an effective way to deliver value-oriented outpatient cardiology care in an accountable care organization. Initial results of cardiac e-consults have demonstrated high satisfaction among both patients and referring providers, no known adverse events, and low rates of diagnostic testing. Nevertheless, differences between e-consults and traditional consults, effects of e-consults on traditional consult volume, and whether patients seek traditional consults after e-consults are unknown. We established a cardiac e-consult program on January 13, 2014. We then conducted detailed medical record reviews of all patients with e-consults to detect any adverse clinical events and detect subsequent traditional visits to cardiologists. We also performed 2 comparisons. First, we compared age, gender, and referral reason for e-consults vs traditional consults. Second, we compared changes in volume of referrals to cardiology vs other medical specialties that did not have e-consults. From January 13 to December 31, 2014, 1,642 traditional referrals and 165 e-consults were requested. The proportion of e-consults of all evaluations requested over that period was 9.1%. Gender balance was similar among traditional consults and e-consults (44.8% male for e-consults vs 45.0% for traditional consults, P = .981). E-consult patients were younger than traditional consult patients (55.3 vs 60.4 years, P cardiology visit during the follow-up period. E-consults are an effective and safe mechanism to enhance value in outpatient cardiology care, with low rates of bounceback to traditional consults. E-consults can account for nearly one-tenth of total outpatient consultation volume at 1 year within an accountable care organization and are associated with a reduction in traditional referrals to cardiologists. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Improving the effectiveness of interpreted consultations: Australian interpreter, general practitioner and patient perspectives. (United States)

    Sturman, Nancy; Farley, Rebecca; Claudio, Fernanda; Avila, Patricia


    Healthcare consultations with patients lacking English proficiency are challenging for all parties, even in Australian primary care where the engagement of interpreters is encouraged and fully subsidised. Our objective was to understand these challenges from the perspectives of interpreters, patients and general practitioners in order to improve the effectiveness of interpreted consultations. Our investigator team approached the interpreted consultation as an interprofessional collaboration. A convenience sample of seven general practitioners, eight health interpreters and six representatives from culturally and linguistically diverse communities (representing the patient perspective) participated in three separate focus group discussions, lasting 60-90 min each, exploring participant experiences with healthcare consultations in which interpreters were present. Two semistructured interviews were undertaken subsequently with three additional community representatives purposively recruited to increase participant diversity. Data were collected in 2016 and analysed inductively using a method of constant comparison to identify, and reach consensus on, key emerging themes. All participant groups emphasised the importance of working with trained interpreters, rather than relying on family interpreters or a doctor's own second language skills. Although participants reported experiences of effective interpreted consultations, other reports suggested that some doctors are unaware of, or have difficulty following, accepted guidelines about speech, gaze and turn-taking. Challenges identified in relation to interpreted consultations fell into the five themes of contextual constraints, consultation complexity, communication difficulties, the interpreter role and collaboration. Some general practitioner participants appeared to be unsure and anxious about the etiquette of interpreted consultations, and there was some confusion between and within participant groups about

  5. On becoming a consultant: A study exploring the journey to consultant practice

    International Nuclear Information System (INIS)

    Henwood, S.; Booth, L.


    Background: This paper reports a qualitative study exploring the establishment of non-medical consultant roles in Radiography. Given the difficulties reported in recruiting and retaining staff in these posts, we hope this paper offers a historical documentation of those consultants who were some of the first in post, sharing their stories of how they obtained and transitioned into their roles. Methods: This paper is part of a two year case study exploring the leadership domain of consultant practice. The focus of this paper is a reflection, by the consultants, of their journey to becoming a consultant; a documentation of some of the practical issues in establishing the roles; and the transition to higher levels of practice. Eight consultant radiographers participated in the initial interviews (two consultants withdrew from the study subsequent to this). In-depth iterative interviewing was used to explore and record individual stories and experiences. Findings: The consultants shared their perceptions of being in post, including their own motivation to progress to a new role, how prepared they felt initially, the lack of role models, the lack of clarity surrounding the role and a perception of ‘being on display’. Conclusions: The paper offers insight into the journey of these consultants and some of the common characteristics they share. These characteristics give some indication of what motivated them to step into higher level roles, in particular the need to drive change and improvement. The paper also offers suggestions for how the transition into the role could be more effectively supported. - Highlights: • Identifies characteristics thought to contribute to effective consultant practice. • A desire to change practice is a major motivator in applying for a consultant post. • The consultant role was a natural evolution for some, not a desired career pathway. • There is recognition that the initial consultants were pioneers for the profession.

  6. The guideline "consultation psychiatry" of the Netherlands Psychiatric Association

    NARCIS (Netherlands)

    Leentjens, A.F.G.; Boenink, A.D.; Sno, H.N.; Strack van Schijndel, R.J.M.; Croonenborg, van J.J.; Everdingen, van J.J.E.; Feltz - Cornelis, van der C.M.; Laan, van der S.; Marwijk, van H.W.J.; Os, T.W.D.P. Van


    Background: In 2008, the Netherlands Psychiatric Association authorized a guideline "consultation psychiatry." Aim: To set a standard for psychiatric consultations in nonpsychiatric settings. The main objective of the guideline is to answer three questions: Is psychiatric consultation effective and,

  7. 76 FR 28446 - Policy on Consultation With Indian Tribes (United States)


    ... employees. VI. Innovative and Effective Consultation Practices The Department's leadership will strive to... or facilitating an effective consultation process, negotiated rulemaking or other collaborative... DEPARTMENT OF THE INTERIOR Office of the Secretary Policy on Consultation With Indian Tribes...

  8. A Non-randomized Comparison of Strategies for Consultation in a Community-Academic Training Program to Implement an Evidence-Based Psychotherapy. (United States)

    Stirman, Shannon Wiltsey; Pontoski, Kristin; Creed, Torrey; Xhezo, Regina; Evans, Arthur C; Beck, Aaron T; Crits-Christoph, Paul


    Despite the central role of training and consultation in the implementation of evidence-based psychological interventions (EBPIs), comprehensive reviews of research on training have highlighted serious gaps in knowledge regarding best practices. Consultation after initial didactic training appears to be of critical importance, but there has been very little research to determine optimal consultation format or interventions. This observational study compared two consultation formats that included review of session audio and feedback in the context of a program to train clinicians (n = 85) in community mental health clinics to deliver cognitive therapy (CT). A "gold standard" condition in which clinicians received individual feedback after expert consultants reviewed full sessions was compared to a group consultation format in which short segments of session audio were reviewed by a group of clinicians and an expert consultant. After adjusting for potential baseline differences between individuals in the two consultation conditions, few differences were found in terms of successful completion of the consultation phase or in terms of competence in CT at the end of consultation or after a 2 year follow-up. However, analyses did not support hypotheses regarding non-inferiority of the group consultation condition. While both groups largely maintained competence, clinicians in the group consultation condition demonstrated increases in competence over the follow-up period, while a sub-group of those in the individual condition experienced decreases. These findings, if replicated, have important implications for EBP implementation programs, as they suggest that observation and feedback is feasible in community mental health setting, and that employing this method in a group format is an effective and efficient consultation strategy that may enhance the implementation and sustainability of evidence-based psychotherapies.

  9. Performance Consulting: Get CREDIT from Your Clients. (United States)

    Atkinson, Vicki; Chalmers, Nancy


    Discusses client satisfaction criteria relevant to human performance consultants and explains the CREDIT model that represents what clients consider most important. Examines CREDIT: Client needs, Relationships, demonstrating Expertise and experience, creating Deliverables, Interpersonal skills, and Tracking and project managing. (LRW)

  10. Global Grid Telemedicine System: Expert Consult Manager

    National Research Council Canada - National Science Library

    May, Jerrold


    The Artificial Intelligence in Management (AIM) Laboratory of the Katz School of Business, University of Pittsburgh will employ AIM Lab personnel and consultants to design, develop and test a prototype of the following U.S...

  11. Consulting Informs Best Practice in Academia

    Directory of Open Access Journals (Sweden)

    Risa Blair


    Full Text Available The Conversational Plenary Session began with a clear agenda of describing the process and challenge of developing eLearning and eTraining. After a brief discussion of the benefits and challenges of the modality, the conversation quickly segued to a highly spirited conversation related to consulting and the negative implications when one calls oneself a consultant. In fact, this became an integral theme of multiple discussions throughout the rest of the conference. This author strives to identify a selection of literature which supports the viewpoint that consulting does indeed inform best practices in academia. Those professors with up-to-the-minute consultancies in their fields offer an enriched experience for their students.

  12. Bladder Pain Syndrome International Consultation on Incontinence

    DEFF Research Database (Denmark)

    Hanno, P.; Lin, A.; Nordling, J.


    Aims of Study: The Bladder Pain Syndrome Committee of the International Consultation on Incontinence was assigned the task by the consultation of reviewing the syndrome, formerly known as interstitial cystitis, in a comprehensive fashion. This included the topics of definition, nomenclature......, taxonomy, epidemiology, etiology, pathology, diagnosis, symptom scales, outcome assessment, principles of management, specific therapies, and future directions in research. Study Design, Materials, Methods: The emphasis was on new information developed since the last consultation 4 years previously. Where...... possible, existing evidence was assessed and a level of recommendation was developed according to the Oxford system of classification. Results: The consultation decided to refer to the condition as "bladder pain syndrome" (BPS) because the designation is more descriptive of the clinical condition...

  13. IT Consultants in Acquisition IT Integration

    DEFF Research Database (Denmark)

    Henningsson, Stefan; Øhrgaard, Christian


    strategic IT initiatives and how companies can draw effectively on their services. The paper investigates the use of consultants in relation to one type of major strategic IT initiative: acquisition IT integration. Acquisition IT integration, which is the integration of the acquirer’s and target......’s IT following a corporate acquisition, presents a difficult but crucial IT challenge for the many acquiring organizations. Through a comparative case study of four acquirers, theoretically grounded in the resource-based view of the firm, it is analyzed how acquirers draw on external consultants to realize...... acquisition IT integration. Two complementary and two supplementary roles consultants assume in these projects are identified. Additionally, three characteristics of the acquisition IT integration strategy are identified that influence how the acquirers assign different roles to IT consultants. The resulting...

  14. [A nurse consultation in victimology for minors]. (United States)

    Soudan, Corinne


    The nurse consultation is an integral part of the treatment of children and adolescents experiencing psychological distress following traumatic events. Specific support is therefore offered to young patients, in particular through the intervention of a clinical nurse specialist.

  15. Qualification of contractor/consultant instructors

    International Nuclear Information System (INIS)

    Hanson, H.D.


    Following a brief discussion of the role of consultant instructors in Public Service Electric and Gas Company's training organization, the qualification process is presented. Consultant instructors are provided with information regarding supervision of the trainees and the instructional process and procedures required. Each individual must have his or her instructional capability, supervisory skills and technical competence verified and documented prior to conducting training independently. Concluding comments describe the overall satisfactory experience with this program

  16. How doctors move from generic goals to specific communicative behavior in real practice consultations. (United States)

    Veldhuijzen, Wemke; Mogendorff, Karen; Ram, Paul; van der Weijden, Trudy; Elwyn, Glyn; van der Vleuten, Cees


    To understand how recommendations for communication can be brought into alignment with clinical communication routines, we explored how doctors select communicative actions during consultations. We conducted stimulated recall interviews with 15 GPs (general practitioners), asking them to comment on recordings of two consultations. The data analysis was based on the principles of grounded theory. A model describing how doctors select communicative actions during consultations was developed. This model illustrates how GPs constantly adapt their selection of communicative actions to their evaluation of the situation. These evaluations culminate in the selection of situation-specific goals. These multiple and often dynamic goals require constant revision and adaptation of communication strategies, leading to constant readjustments of the selection of communicative actions. When selecting consultation goals GPs weigh patients' needs and preferences as well as the medical situation and its consequences. GPs' selection of communicative actions during consultations is situational and goal driven. To help doctors develop communicative competence tailored to the specific situation of each consultation, holistic communication training courses, which pay attention to the selection of consultation goals and matching communication strategies besides training specific communication skills, seem preferable to current generic communication skills training. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  17. Managing your engineering consultants: Steps for simultaneously improving operations, project implementation, and your bottom line

    International Nuclear Information System (INIS)

    Kirchen, E.R.; Perilloux, B.L.


    The domestic oil and gas industry has responded to depleting reserves and increasing operating costs by downsizing the overhead required to maintain production and processing facilities. For many companies this downsizing has resulted in a reduced in-house engineering staff and a greater reliance on consulting engineering services. To get the most benefit from consulting engineering companies, the partnership between consultants and the oil and gas company needs to be carefully considered. Unfortunately, these partnerships are often developed at the home office with visionary goals in mind, only to be implemented reluctantly on a local level. A better strategy is to implement partnering tools on the local level and allow these partnerships to develop naturally, and at times, uniquely, at each location. The following such tools detailed in this paper are: manpower leveraging -- using field-trained consulting engineers to address project design/implementation and field/construction support so that the operating company's engineers may focus on management and detailed development of high-return projects; enhanced project scope and design review -- developing and reviewing project scope(s) and preliminary engineering designs to minimize engineering/construction costs as well as optimize the operability and constructability of the project; and consulting rate standardization -- understanding and structuring the consultant's rates so that neither side is exploited and so that the project is staffed in the interest of project execution and not maximum profits for the consultant

  18. The effect of different cardiovascular risk presentation formats on intentions, understanding and emotional affect: a randomised controlled trial using a web-based risk formatter (protocol).

    NARCIS (Netherlands)

    Waldron, C.A.; Gallacher, J.; Weijden, G.D.E.M. van der; Newcombe, R.; Elwyn, G.


    BACKGROUND: The future risk of heart disease can be predicted with increasing precision. However, more research is needed into how this risk is conveyed and presented. The aim of this study is to compare the effects of presenting cardiovascular risk in different formats on individuals' intention to

  19. Understanding causes of tree growth response to gap formation: D13C-values in tree rings reveal a predominant effect of light

    NARCIS (Netherlands)

    Sleen, van der J.P.; Soliz-Gamboa, C.C.; Helle, G.; Pons, T.L.; Anten, N.P.R.; Zuidema, P.A.


    Carbon isotope ratios in growth rings of a tropical tree species show that treefall gaps stimulate diameter growth mainly through changes in the availability of light and not water. The formation of treefall gaps in closed canopy forests usually entails considerable increases in light and nutrient

  20. Understanding causes of tree growth response to gap formation: D13C-values in tree rings reveal a predominant effect of light

    NARCIS (Netherlands)

    van der Sleen, Peter; Soliz Gamboa, Claudia; Helle, G.; Pons, Thijs; Anten, Niels; Zuidema, Pieter


    Key message Carbon isotope ratios in growth rings of a tropical tree species show that treefall gaps stimulate diameter growth mainly through changes in the availability of light and not water. The formation of treefall gaps in closed canopy forests usually entails considerable increases in light

  1. An approach of understanding acid volcanics and tuffaceous volcaniclastics from field studies: A case from Tadpatri Formation, Proterozoic Cuddapah basin, Andhra Pradesh, India (United States)

    Goswami, Sukanta; Upadhyay, P. K.; Bhagat, Sangeeta; Zakaulla, Syed; Bhatt, A. K.; Natarajan, V.; Dey, Sukanta


    The lower stratigraphic part of the Cuddapah basin is marked by mafic and felsic volcanism. Tadpatri Formation consists of a greater variety of rock types due to bimodal volcanism in the upper part. Presence of bimodal volcanism is an indication of continental rift setting. Various genetic processes involved in the formation of such volcanic sequence result in original textures which are classified into volcaniclastic and coherent categories. Detailed and systematic field works in Tadpatri-Tonduru transect of SW Cuddapah basin have provided information on the physical processes producing this diversity of rock types. Felsic volcanism is manifested here with features as finger print of past rhyolite-dacite eruptions. Acid volcanics, tuffs and associated shale of Tadpatri Formation are studied and mapped in the field. With supporting subordinate studies on geochemistry, mineralogy and petrogenesis of the volcanics to validate field features accurately, it is understood that volcanism was associated with rifting and shallow marine environmental condition. Four facies (i.e., surge, flow, fall and resedimented volcaniclastic) are demarcated to describe stratigraphic units and volcanic history of the mapped area. The present contribution focuses on the fundamental characterization and categorization of field-based features diagnostic of silica-rich volcanic activities in the Tadpatri Formation.

  2. Reflections on the role of consultant radiographers in the UK: What is a consultant radiographer?

    International Nuclear Information System (INIS)

    Booth, L.; Henwood, S.; Miller, P.


    Context: This paper is the second paper from a two year in depth case study, exploring the role of consultant radiographers in the UK. Methods: A longitudinal case study approach was used to determine the role of consultant radiographers. Interviews were used to explore experiences of being a consultant, which were analysed using thematic analysis. Eight consultant radiographers participated (Note, two of the consultants withdrew after the first interview due to workload). Therefore two consultants were interviewed only once. The remaining six consultants were interviewed twice over a 12 month period. Findings: The data presented in this paper explores the nature of the role, differences between roles, the four domains of practice, and how the role fits into local organisational structures. The study shows wide variation in the types of roles undertaken, reflecting that the creation of these roles were in response to local clinical need and often related to an individual practitioner's skills. The broad scope of the role was shown across all the consultants, with evidence of roles developing into new areas of service delivery. Conclusions: The paper offers insight into the role(s) of consultant radiographers in the UK. The range and scope of their practice is extensive, with much variation. It is evident that the clinical aspect of the role dominates, with research being the least supported domain of practice. There remains a lack of clarity around the role, with concerns about remuneration and other limitations that may restrict the role developing further. - Highlights: • This paper shows the variation in roles between consultant radiographers. • The commonality with medical roles is highlighted. • Problem solving is identified as a core skill in consultant radiography. • Consultants offered evidence of the roles developing service provision. • While all four domains of practice are covered, research is the least well supported.

  3. Intermediate Scale Laboratory Testing to Understand Mechanisms of Capillary and Dissolution Trapping during Injection and Post-Injection of CO2 in Heterogeneous Geological Formations

    Energy Technology Data Exchange (ETDEWEB)

    Illangasekare, Tissa [Colorado School of Mines, Golden, CO (United States); Trevisan, Luca [Colorado School of Mines, Golden, CO (United States); Agartan, Elif [Colorado School of Mines, Golden, CO (United States); Mori, Hiroko [Colorado School of Mines, Golden, CO (United States); Vargas-Johnson, Javier [Colorado School of Mines, Golden, CO (United States); Gonzalez-Nicolas, Ana [Colorado School of Mines, Golden, CO (United States); Cihan, Abdullah [Colorado School of Mines, Golden, CO (United States); Birkholzer, Jens [Colorado School of Mines, Golden, CO (United States); Zhou, Quanlin [Colorado School of Mines, Golden, CO (United States)


    Carbon Capture and Storage (CCS) represents a technology aimed to reduce atmospheric loading of CO2 from power plants and heavy industries by injecting it into deep geological formations, such as saline aquifers. A number of trapping mechanisms contribute to effective and secure storage of the injected CO2 in supercritical fluid phase (scCO2) in the formation over the long term. The primary trapping mechanisms are structural, residual, dissolution and mineralization. Knowledge gaps exist on how the heterogeneity of the formation manifested at all scales from the pore to the site scales affects trapping and parameterization of contributing mechanisms in models. An experimental and modeling study was conducted to fill these knowledge gaps. Experimental investigation of fundamental processes and mechanisms in field settings is not possible as it is not feasible to fully characterize the geologic heterogeneity at all relevant scales and gathering data on migration, trapping and dissolution of scCO2. Laboratory experiments using scCO2 under ambient conditions are also not feasible as it is technically challenging and cost prohibitive to develop large, two- or three-dimensional test systems with controlled high pressures to keep the scCO2 as a liquid. Hence, an innovative approach that used surrogate fluids in place of scCO2 and formation brine in multi-scale, synthetic aquifers test systems ranging in scales from centimeter to meter scale developed used. New modeling algorithms were developed to capture the processes controlled by the formation heterogeneity, and they were tested using the data from the laboratory test systems. The results and findings are expected to contribute toward better conceptual models, future improvements to DOE numerical codes, more accurate assessment of storage capacities, and optimized placement strategies. This report presents the experimental and modeling methods

  4. e-EPS News: Consultation on European Research, Innovation & Gender

    CERN Multimedia



    e-EPS News is a monthly addition to the CERN Bulletin line-up, showcasing an article by the e-EPS – the European Physical Society newsletter – as part of a new collaboration between the two publications.   EPS members have been invited to take part in a Public Consultation on the Future of Gender and Innovation in Europe. The consultation, which is intended to complement the EC Green Paper ‘From Challenges to Opportunities: Towards a Common Strategic Framework for EU Research and Innovation Funding’, will be published and discussed during the first European Gender Summit in Brussels on 8-9 November this year. It is hoped that the consultation – which is being coordinated by genSET and the organisers of the European Gender Summit – will create a better understanding of how Europe might benefit from a more effective mainstreaming of the gender dimension in research, innovation and scientific systems. Responses from the co...

  5. Physician communication styles in initial consultations for hematological cancer. (United States)

    Chhabra, Karan R; Pollak, Kathryn I; Lee, Stephanie J; Back, Anthony L; Goldman, Roberta E; Tulsky, James A


    To characterize practices in subspecialist physicians' communication styles, and their potential effects on shared decision-making, in second-opinion consultations. Theme-oriented discourse analysis of 20 second-opinion consultations with subspecialist hematologist-oncologists. Physicians frequently "broadcasted" information about the disease, treatment options, relevant research, and prognostic information in extended, often-uninterrupted monologs. Their communicative styles had one of two implications: conveying options without offering specific recommendations, or recommending one without incorporating patients' goals and values into the decision. Some physicians, however, used techniques that encouraged patient participation. Broadcasting may be a suboptimal method of conveying complex treatment information in order to support shared decision-making. Interventions could teach techniques that encourage patient participation. Techniques such as open-ended questions, affirmations of patients' expressions, and pauses to check for patient understanding can mitigate the effects of broadcasting and could be used to promote shared decision-making in information-dense subspecialist consultations. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  6. Experimental formation of Pb, Sn, Ge and Sb sulfides, selenides and chlorides in the presence of sal ammoniac: A contribution to the understanding of the mineral formation processes in coal wastes self-ignition

    Czech Academy of Sciences Publication Activity Database

    Laufek, F.; Veselovský, F.; Drábek, M.; Kříbek, B.; Klementová, Mariana

    176-177, May (2017), s. 1-7 ISSN 0166-5162 Institutional support: RVO:68378271 Keywords : coal wastes * metalloids * mineral formation * self-burning processes Subject RIV: DB - Geology ; Mineralogy OBOR OECD: Geology Impact factor: 4.783, year: 2016

  7. Surgical Consultation as Social Process: Implications for Shared Decision Making. (United States)

    Clapp, Justin T; Arriaga, Alexander F; Murthy, Sushila; Raper, Steven E; Schwartz, J Sanford; Barg, Frances K; Fleisher, Lee A


    This qualitative study examines surgical consultation as a social process and assesses its alignment with assumptions of the shared decision-making (SDM) model. SDM stresses the importance of patient preferences and rigorous discussion of therapeutic risks/benefits based on these preferences. However, empirical studies have highlighted discrepancies between SDM and realities of surgical decision making. Qualitative research can inform understanding of the decision-making process and allow for granular assessment of the nature and causes of these discrepancies. We observed consultations between 3 general surgeons and 45 patients considering undergoing 1 of 2 preference-sensitive elective operations: (1) hernia repair, or (2) cholecystectomy. These patients and surgeons also participated in semi-structured interviews. By the time of the consultation, patients and surgeons were predisposed toward certain decisions by preceding events occurring elsewhere. During the visit, surgeons had differential ability to arbitrate surgical intervention and construct the severity of patients' conditions. These upstream dynamics frequently displaced the centrality of the risk/benefit-based consent discussion. The influence of events preceding consultation suggests that decision-making models should account for broader spatiotemporal spans. Given surgeons' authority to define patients' conditions and control service provision, SDM may be premised on an overestimation of patients' power to alter the course of decision making once in a specialist's office. Considering the subordinate role of the risk/benefit discussion in many surgical decisions, it will be important to study if and how the social process of decision making is altered by SDM-oriented decision aids that foreground this discussion.

  8. Psychiatric consultation and substance use disorders. (United States)

    Specker, Sheila; Meller, William H; Thurber, Steven


    A substantial number of patients in general hospitals will evince substance abuse problems but a majority is unlikely to be adequately identified in the referral-consultation process. This failure may preclude patients from receiving effective interventions for substance use disorders. 1. To evaluate all referred patients for possible substance use disorders. 2. To ascertain the degree of convergence between patients referred for chemical problems and the corresponding DSM diagnosis. 3. To compare demographic data for substance abusing patients and referrals not so classified. 4. To evaluate conditions concomitant with substance use disorders. Consecutive one-year referrals (524) to consultation-liaison psychiatric services were scrutinized for chemically-related problems by psychiatric consultants. Of the referrals, 176 met criteria for substance use disorders (SUD) (57% alcohol; 25% other drugs; 18% both alcohol and other drugs). Persons diagnosed with SUD tended to be younger, male, non-Caucasian, unmarried, and unemployed. They were more likely to be depressed, have liver and other gastrointestinal problems, and to have experienced traumatic events; they also tended to have current financial difficulties. Most were referred for SUD evaluation by personnel in general medicine and family practice. Following psychiatric consultation, SUD designated patients were referred mainly to substance abuse treatment programs. The only variable related to recommended inpatient versus outpatient services for individuals with SUD was the Global Assessment of Functioning Axis (GAF) with persons having lower estimated functioning more likely to be referred for inpatient interventions. These data are similar to the results of past studies in this area. Unlike previous investigations in the domain of consultative-liaison psychiatry, financial stressors and specific consultant recommendations were included in data gathering. Although the results are encouraging in that individuals

  9. Psychiatric Consultation and Substance Use Disorders

    Directory of Open Access Journals (Sweden)

    Sheila Specker


    Full Text Available Background A substantial number of patients in general hospitals will evince substance abuse problems but a majority is unlikely to be adequately identified in the referral-consultation process. This failure may preclude patients from receiving effective interventions for substance use disorders. Objectives 1. To evaluate all referred patients for possible substance use disorders. 2. To ascertain the degree of convergence between patients referred for chemical problems and the corresponding DSM diagnosis. 3. To compare demographic data for substance abusing patients and referrals not so classified. 4. To evaluate conditions concomitant with substance use disorders. Method Consecutive one-year referrals (524 to consultation-liaison psychiatric services were scrutinized for chemically-related problems by psychiatric consultants. Results Of the referrals, 176 met criteria for substance use disorders (SUD (57% alcohol; 25% other drugs; 18% both alcohol and other drugs. Persons diagnosed with SUD tended to be younger, male, non-Caucasian, unmarried, and unemployed. They were more likely to be depressed, have liver and other gastrointestinal problems, and to have experienced traumatic events; they also tended to have current financial difficulties. Most were referred for SUD evaluation by personnel in general medicine and family practice. Following psychiatric consultation, SUD designated patients were referred mainly to substance abuse treatment programs. The only variable related to recommended inpatient versus outpatient services for individuals with SUD was the Global Assessment of Functioning Axis (GAF with persons having lower estimated functioning more likely to be referred for inpatient interventions. Conclusions These data are similar to the results of past studies in this area. Unlike previous investigations in the domain of consultative-liaison psychiatry, financial stressors and specific consultant recommendations were included in data

  10. Psychiatric Consultation and Substance Use Disorders

    Directory of Open Access Journals (Sweden)

    Sheila Specker


    Full Text Available Background: A substantial number of patients in general hospitals will evince substance abuse problems but a majority is unlikely to be adequately identified in the referral-consultation process. This failure may preclude patients from receiving effective interventions for substance use disorders. Objectives: 1. To evaluate all referred patients for possible substance use disorders. 2. To ascertain the degree of convergence between patients referred for chemical problems and the corresponding DSM diagnosis. 3. To compare demographic data for substance abusing patients and referrals not so classified. 4. To evaluate conditions concomitant with substance use disorders. Method: Consecutive one-year referrals (524 to consultation-liaison psychiatric services were scrutinized for chemically-related problems by psychiatric consultants. Results: Of the referrals, 176 met criteria for substance use disorders (SUD (57% alcohol; 25% other drugs; 18% both alcohol and other drugs. Persons diagnosed with SUD tended to be younger, male, non-Caucasian, unmarried, and unemployed. They were more likely to be depressed, have liver and other gastrointestinal problems, and to have experienced traumatic events; they also tended to have current financial difficulties. Most were referred for SUD evaluation by personnel in general medicine and family practice. Following psychiatric consultation, SUD designated patients were referred mainly to substance abuse treatment programs. The only variable related to recommended inpatient versus outpatient services for individuals with SUD was the Global Assessment of Functioning Axis (GAF with persons having lower estimated functioning more likely to be referred for inpatient interventions. Conclusions: These data are similar to the results of past studies in this area. Unlike previous investigations in the domain of consultative-liaison psychiatry, financial stressors and specific consultant recommendations were included in

  11. The OHS consultant as a facilitator of learning in workplace design processes

    DEFF Research Database (Denmark)

    Broberg, Ole; Hermund, Ingelise


    devices between different communities of practice. Certain boundary objects work better than others in promoting learning and collaborative workplace design processes. For both industry and OHS units it is of importance to properly understand learning models and to align their mutual expectations...... into the workplace design process, thereby making it easier for the enterprise to manage such a change in the future. The objective of this explorative study was to survey current practice of OHS consultants and put forward recom-mendations on how to improve the learning aspects of OHS consultancy. Four cases were...... learning were identified. This took place when the OHS consultant was working across organizational departments and borders and facilitated meetings between actors from different parts of the organization. It was also concluded that the OHS consultant should carefully choose boundary objects as learning...

  12. The contribution of nurse consultants in England to the public health leadership agenda. (United States)

    Franks, Helen


    To examine the contribution of nurse consultants in relation to UK public health outcomes by contrasting the health and public health skills frameworks with a study of the role of nurse consultants. Nurse consultants are the most senior advanced nurse practitioners in the UK. They work clinically, lead, research, develop policy and disseminate knowledge. A synthesis of research and data from the UK professional skills frameworks with data from a mixed-methods study of the role of nurse consultants. Data collected from nurse consultants and stakeholders in England (n = 10) were analysed to identify issues impacting on the skills, competencies and effectiveness of advanced nurses. This was contrasted with the skills and career frameworks for public health and advanced healthcare practice. Nurse consultants use their clinical expertise to lead practice, facilitate change and monitor effectiveness. Within healthcare organisations, they contribute servicewide to the implementation of public health policy, service delivery and policy development, mirroring expected competencies and improved health outcomes. Two barriers were identified. First, that there was little time or will for nurse consultants to undertake research, precluding them from demonstrating their value. Second, that a lack of interprofessional understanding and support of their roles meant that their worth was often not appreciated by decision-makers. Nurse consultants lead and influence public health on many levels and need support to develop needs-led and evidence-based local, national and international public health practice and policy development. This research contributes to the global discussion currently being held about the nomenclature of advanced nurse practitioner roles, their scope and influence. The challenge for nurses to contribute meaningfully to public health structures at an advanced level is a concern for all nations seeking the common goal of addressing public health needs within their

  13. Public consultation: regulatory requirement or business principle?

    International Nuclear Information System (INIS)

    Seeley, R.


    A summary is included of knowledge and experiences related to planning and implementing a public consultation program over a number of years in Shell Canada's Athabasca Oil Sands development. This project consists of three major sub- projects with a total estimated capital investment of $4 billion. The three sub- projects are: the Muskeg River Mine, the Scotford Upgrader, and the Corridor Pipeline. The facilities will produce 150,000 bbl/day of synthetic crude for over 25 years and are targeted to begin production in late 2002. From the title of the paper, although public consultation is required under environmental legislation, many companies are adopting a more pro-active approach to public consultation and participation as a business principle. This commitment to engage in and dialogue with stakeholders must be open, transparent and long term, not just during the regulatory process. Successful consultation begins with the prerequisites: senior management commitment, buy-in from the project or operating team that the process adds value, and the ability to listen and make changes. A consultation program is not a short term activity, but is rather an ongoing process linked to a business or operating principle. It requires long term resources and follow through on agreements and commitments made to stakeholders and communities

  14. [Memory loss: a reason for consultation]. (United States)

    Menéndez González, M; Garcia-Fernández, C; Antón González, C; Calatayud, M T; González González, S; Blázquez Menes, B


    Memory loss is an increasingly frequent reason for consultation in neurology. The aim of this work is to know the current frequency as well as the characteristics and disorders of the patients who come for this reason. We studied 200 patients who came to general neurology consultation due to loss of memory. 18.47% of the patients who came for the first time to a general neurology consultation did so due to memory loss, this being subjective loss of memory (SLM) in 39% of the cases and referred loss of memory (RLM) in 61% of the cases. The diagnostic groups to which the patients belonged are, in diminishing order, the following: degenerative primary dementia type Alzheimer's disease, mild cognitive impairment, mixed dementia, pure vascular dementia, depressive pseudodementia, attributable to drugs, secondary to systemic disease, non-Alzheimer's type disease primary degenerative dementia, structural reasons, transitory global amnesia and epilepsy. No disease was found in 13% of them, and the generally came due to SLM. Frequency of memory loss as a reason for consultation continues to growing. Patients studied due to memory loss, in whom no disease is found, are generally those having SLM. In spite of this, SLM is a good predictor of cognitive deterioration. It is important to systematically study of every patient and consults for loss of memory and to investigate the possible use of drugs or toxics that could alter the memory.

  15. Identifying challenges in project consultants engagement practices (United States)

    Shariffuddin, Nadia Alina Amir; Abidin, Nazirah Zainul


    Construction projects, green or conventional, involve multi-faceted disciplines engaged with the goal of delivering products i.e. building, infrastructure etc. at the best quality within stipulated budgets. For green projects, additional attention is added for environmental quality. Due to the various responsibilities and liabilities involved as well as the complexity of the construction process itself, formal engagement of multi-disciplinary professionals i.e. project consultants is required in any construction project. Poor selection of project consultants will lead to a multitude of complications resulting in delay, cost escalation, conflicts and poor quality. This paper explores the challenges that occur during the engagement of project consultants in a green project. As the engagement decision involves developers and architects, these two groups of respondents with green project backgrounds were approached qualitatively using interview technique. The challenges identified are limited experience and knowledge, consultants' fee vs. quality, green complexity, conflicts of interest, clients' extended expectation and less demand in green projects. The construction shifts to green project demands engagement of project consultants with added skills. It is expected that through the identification of challenges, better management and administration can be created which would give impact to the overall process of engagement in green projects.

  16. Development and Implementation of an Inpatient Otolaryngology Consultation Service at an Academic Medical Center. (United States)

    Huddle, Matthew G; London, Nyall R; Stewart, C Matthew


    To design and implement a formal otolaryngology inpatient consultation service that improves satisfaction of consulting services, increases educational opportunities, improves the quality of patient care, and ensures sustainability after implementation. This was a retrospective cohort study in a large academic medical center encompassing all inpatient otolaryngology service consultations from July 2005 to June 2014. Staged interventions included adding fellow coverage (July 2007 onward), intermittent hospitalist coverage (July 2010 onward), and a physician assistant (October 2011 onward). Billing data were collected for incidences of new patient and subsequent consultation charges. The 2-year preimplementation period (July 2005-June 2007) was compared with the postimplementation periods, divided into 2-year blocks (July 2007-June 2013). Outcome measures of patient encounters and work relative value units were compared between pre- and postimplementation blocks. Total encounters increased from 321 preimplementation to 1211, 1347, and 1073 in postimplementation groups ( P service was designed with supervisory oversight by non-Accreditation Council for Graduate Medical Education fellows and then expanded to include intermittent hospitalist management, followed by the addition of a dedicated physician assistant. These additions have led to the formation of a sustainable consultation service that supports the mission of high-quality care and service to consulting teams.

  17. The Czech Consulting company entering the Ukrainian market


    Shokalo, Oles


    The goal of this diploma paper is to present Business Consulting, describe characteristics of european and global consultancy market, give detailed description of the Ukrainian consultancy market and finally to propose the strategic steps necessary for the Czech consultancy company with intention to enter the Ukrainian market.

  18. Participants' Evaluation of Consultation: Implications for Training in School Psychology (United States)

    Klose, Laurie McGarry; Plotts, Cynthia; Lasser, Jon


    Evaluation of graduate students' consultation skills is essential to competent practice in school settings. Congruence of evaluation of the consultation experience has been shown as an important factor in the development of competent consultants in other, related disciplines. The current study analysed student consultant and teacher consultee…

  19. 42 CFR 493.1417 - Standard; Clinical consultant qualifications. (United States)


    ... Testing Laboratories Performing Moderate Complexity Testing § 493.1417 Standard; Clinical consultant qualifications. The clinical consultant must be qualified to consult with and render opinions to the laboratory's... 42 Public Health 5 2010-10-01 2010-10-01 false Standard; Clinical consultant qualifications. 493...

  20. 42 CFR 493.1455 - Standard; Clinical consultant qualifications. (United States)


    ... Testing Laboratories Performing High Complexity Testing § 493.1455 Standard; Clinical consultant qualifications. The clinical consultant must be qualified to consult with and render opinions to the laboratory's... 42 Public Health 5 2010-10-01 2010-10-01 false Standard; Clinical consultant qualifications. 493...

  1. Language in Consultation: The Effect of Affect and Verb Tense (United States)

    Newman, Daniel S.; Guiney, Meaghan C.; Barrett, Courtenay A.


    This study was an exploration of school consultation interactions between instructional consultants and consultees. Of specific interest was how consultants (n = 18) and consultees (n = 18) used verb tense and emotion words during the problem identification and analysis instructional consultation stage, similarities and differences in…

  2. Interaction of amines with native aluminium oxide layers in non-aqueous environment: Application to the understanding of the formation of epoxy-amine/metal interphases

    Energy Technology Data Exchange (ETDEWEB)

    Mercier, D.; Rouchaud, J.-C. [Centre d' Etudes de Chimie Metallurgique, CNRS, 15 rue Georges Urbain, 94407 Vitry Cedex (France); Barthes-Labrousse, M.-G. [Centre d' Etudes de Chimie Metallurgique, CNRS, 15 rue Georges Urbain, 94407 Vitry Cedex (France)], E-mail:


    Interaction of propylamine (PA), 1,2-diaminoethane (DAE) or 3-aminomethyl-3,5,5-trimethylcyclohexylamine (isophorone diamine, IPDA) with native aluminium oxide layers in non-aqueous environment has been studied using time-resolved inductively coupled plasma optical emission spectroscopy (ICP-OES) and X-ray photoelectron spectroscopy (XPS). The formation of several surface complexes has been evidenced. Monodentate and bidentate metal-bond surface complexes (MBSC) result from interactions between the amine terminations of the molecule and aluminium cations by donation of the N lone electron pair to the metal ion (Lewis-like mechanism leading to O-Al...N bonds). Monodentate and bidentate hydrogen-bond surface complexes (HBSC) are due to interaction of the amino group with surface hydroxyl groups by protonation of the amine termination (Bronsted-like mechanism leading to the formation of Al-OH...N bonds) or interaction with carbonaceous contamination (C{sub x}O{sub y}H{sub z}...N bonds). Diamines can also form mixed complexes with one amino group forming an O-Al...N bond and the other group forming an Al-OH...N or C{sub x}O{sub y}H{sub z}...N bond. Al-OH...N and C{sub x}O{sub y}H{sub z}...N bonds are less stable under vacuum than O-Al...N bonds, leading to partial desorption of the DAE molecules in vacuum and modification of the interaction modes. Only DAE and IPDA can lead to partial dissolution of the aluminium native (hydr)oxide films. A detailed mechanism of dissolution has been proposed based on the formation of mononuclear bidentate (chelate) MBSC by ligand exchange between the terminal {eta}{sup 1}-OH and bridged {mu}{sub 2}-OH surface sites and the amino terminations of the molecule. The detachment of this complex from the surface is likely to be the precursor step to the formation of the interphase in epoxy-amine/metal systems.

  3. Antenatal consultation for parents whose child may require admission to neonatal intensive care: a focus group study for media design. (United States)

    von Hauff, Patrick; Long, Karen; Taylor, Barbara; van Manen, Michael A


    For parents whose child may require admission to a neonatal intensive care unit (NICU), the antenatal consultation is often their first point of contact with the child's medical team. Consultation challenges health professionals, as parents may be anxious, overwhelmed, or even exhausted by what is and what might occur. Despite consultation being a common practice, there is a paucity of research on how to support practitioners and parents. The purpose of this study was to gain insights into important relational aspects of antenatal consultation that may be used to spur the development of media to support consultation. Focus group, as a data collection method, was employed to gather insights about antenatal consultation from a total of 50 hospital staff and 17 NICU parents from a large urban NICU program in western Canada. Qualitative content analysis was applied to the obtained materials to explicate themes that may serve as necessary understandings for media design. Participating hospital staff and parents expressed their desire for a good antenatal consultation with comments grouped under the following themes: supporting the building of a caring relation; sharing information in conversation; and, preparing for what is to come. To support the emerging relations of baby, parent, and hospital staff, a good antenatal consultation needs to convey care, understanding, and empathy; create possibilities for open and genuine conversations; and, foster the buildings of respect, confidence, and trust.

  4. Therapists perspectives on the effective elements of consultation following training. (United States)

    Beidas, Rinad S; Edmunds, Julie M; Cannuscio, Carolyn C; Gallagher, Mark; Downey, Margaret Mary; Kendall, Philip C


    Consultation is an effective implementation strategy to improve uptake of evidence-based practices for youth. However, little is known about what makes consultation effective. The present study used qualitative methods to explore therapists perspectives about consultation. We interviewed 50 therapists who had been trained 2 years prior in cognitive-behavioral therapy for child anxiety. Three themes emerged regarding effective elements of consultation: (1) connectedness with other therapists and the consultant, (2) authentic interactions around actual cases, and (3) the responsiveness of the consultant to the needs of individual therapists. Recommendations for the design of future consultation endeavors are offered.

  5. Therapists’ Perspectives on the Effective Elements of Consultation Following Training (United States)

    Beidas, Rinad S.; Edmunds, Julie M.; Cannuscio, Carolyn C.; Gallagher, Mark; Downey, Margaret Mary; Kendall, Philip C.


    Consultation is an effective implementation strategy to improve uptake of evidence-based practices for youth. However, little is known about what makes consultation effective. The present study used qualitative methods to explore therapists’ perspectives about consultation. We interviewed 50 therapists who had been trained 2 years prior in cognitive-behavioral therapy for child anxiety. Three themes emerged regarding effective elements of consultation: (1) connectedness with other therapists and the consultant, (2) authentic interactions around actual cases, and (3) the responsiveness of the consultant to the needs of individual therapists. Recommendations for the design of future consultation endeavors are offered. PMID:23435832

  6. User Consultation Behaviour in Internet Dictionaries

    DEFF Research Database (Denmark)

    Simonsen, Henrik Køhler


    the participants looked, but also how they accessed lexicographic data. The paper presents a suitable method for using eye-tracking studies in Internet lexicography and advocates an increased use of this method to produce empirical data upon which additional theoretical considerations on the information and data......The purpose of this paper is to explore and discuss user consultation behaviour on the basis of eye-tracking data and interview data. To date the focus has been almost exclusively on the use of log files in Internet lexicography - an approach which is questioned in this article. The paper is based...... on empirical data from an exploratory eyetracking study of the user consultation behaviour of six participants and on interview data from a follow-up post-study interview of the participants. The paper elucidates and discusses the consultation behaviour in Internet lexicography and shows not only at what...

  7. The use of an online comment system in clinical ethics consultation. (United States)

    Hauschildt, Katrina; Paul, Trisha K; De Vries, Raymond; Smith, Lauren B; Vercler, Christian J; Shuman, Andrew G


    Although a mechanism for resolving ethical issues in patient care is required for accreditation of American hospitals, there are no formal qualifications for providing clinical ethics consultation (CEC), and there remains great variability in the composition of ethics committees and consult services. Consequently, the quality of CEC also varies depending on the qualifications of those performing CEC services and the format of CEC utilized at an institution. Our institution implemented an online CEC comment system to build upon existing practices to promote consistency and broad consensus in CEC services and enable quality assurance. This qualitative study explored the use of an online comment system in ethics consultation and its impact on consensus building and quality assurance. All adult ethics consultations recorded between January 2011 and May 2015 (n = 159) were analyzed for themes using both open and directed coding methods. We found that comments broadly reflected three categories: expressions of approval/agreement (87% of consults), comments about the case (89%), and comments about the written record (72%). More than one-third of consults included responses to other comments (37%). The most common types of "comments about the case" included requests for additional information (36%), recommendations for additional services (21%), and references to formal policies/standards (28%). Comments often spanned multiple categories and themes. Comments about the written record emphasized accessibility, clarity, and specificity in ethics consultation communication. We find the online system allows for broad committee participation in consultations and helps improve the quality of CEC provided by allowing for substantive discussion and consensus building. Further, we find the use of an online comment system and subsequent records can serve as an educational tool for students, trainees, and ethics committee members.

  8. Valued Components of a Consultant Letter from Referring Physicians' Perspective: a Systematic Literature Synthesis. (United States)

    Rash, Arjun H; Sheldon, Robert; Donald, Maoliosa; Eronmwon, Cindy; Kuriachan, Vikas P


    Effective communication between the consultants and physicians form an integral foundation of effective and expert patient care. A broad review of the literature has not been undertaken to determine the components of a consultant's letter of most value to the referring physician. We aimed to identify the components of a consultant's letter preferred by referring physicians. We searched Embase and MEDLINE (OVID) Medicine (EBM) Reviews and Cochrane Database of Systematic Reviews for English articles with no restriction on initial date to January 6, 2017. Articles containing letters from specialists to referring physicians regarding outpatient assessments with either an observational or experimental design were included. Studies were excluded if they pertained to communications from referring physicians to consultant specialists, or pertained to allied health professionals, inpatient documents, or opinion articles. We enumerated the frequencies with which three common themes were addressed, and the positive or negative nature of the comments. The three themes were the structure of consultant letters, their contents, and whether referring physicians and consultants shared a common opinion about the items. Eighteen articles were included in our synthesis. In 11 reports, 91% of respondents preferred structured formats. Other preferred structural features were problem lists and brevity (four reports each). The most preferred contents were oriented to insight: diagnosis, prognosis, and management plan (16/21 mentions in the top tertile). Data items such as history, physical examination, and medication lists were less important (1/23 mentions in the top tertile). Reports varied as to whether referring physicians and consultants shared common opinions about letter features. Referring physicians prefer brief, structured letters from consultants that feature diagnostic and prognostic opinions and management plans over unstructured letters that emphasize data elements such as

  9. ngVLA Key Science Goal 5: Understanding the Formation and Evolution of Stellar and Supermassive Black Holes in the Era of Multi-Messenger Astronomy (United States)

    Lazio, T. Joseph W.; Maccarone, Thomas J.; Chomiuk, Laura; ngVLA Science Working Group 2, ngVLA Science Working Group 4


    The ngVLA will be a powerful telescope for finding and studying black holes, surveying everything from the remnants of massive stars to the supermassive black holes that lurk in the centers of galaxies. High-resolution imaging abilities will allow the separation of low-luminosity black holes in the local Universe from background sources, thereby providing critical constraints on the formation and growth of black holes of all sizes. Its combination of sensitivity and angular resolution will provide new constraints on the physics of black hole accretion and jet formation. Combined with facilities across the spectrum and gravitational wave observatories, the ngVLA will provide crucial constraints on the interaction of supermassive black holes with their environments, with implications for the evolution of galaxies and the emission of gravitational waves from in-spiraling supermassive black holes. The ngVLA will identify the radio counterparts to transient sources discovered by gravitational wave, neutrino, and optical observatories, and its high-resolution, fast-mapping capabilities will make it the preferred instrument to pinpoint electromagnetic counterparts to events such as supermassive black hole mergers.Part of this research was carried out at the Jet Propulsion Laboratory, California Institute of Technology, under a contract with the National Aeronautics and Space Administration.

  10. Standardization Versus Innovation In Management Consultancy

    Directory of Open Access Journals (Sweden)

    Ciumara Tudor


    Full Text Available This paper is supported by the Sectoral Operational Programme Human Resources Development (SOP HRD, financed from the European Social Fund and by the Romanian Government under the contract number SOP HRD/89/1.5/S/62988. In this paper we propose some perspectives on the relationship between standardization and innovation in the management consulting business. Most of the consulting services are situated somewhere between absolute standardization and absolute innovation. Approaching any of these poles brings some advantages and disadvantages, both to the service providers and to their customers. It is important to find a balance between innovation and standardization to maximize the results of all agents involved.

  11. What to listen for in the consultation

    DEFF Research Database (Denmark)

    Jensen, Christian Gaden; Elsass, Peter; Neustrup, Line


    OBJECTIVE: To analyze whether qualitative themes in breast cancer patients' self-presentations predicted symptoms of psychological distress and depression in order to improve the consultation process. METHODS: Ninety-seven breast cancer patients gave unstructured, 10-min self-presentations...... at their first consultation in a clinical registered trial (CRT identifier: NCT00990977). Self-presentations were categorized thematically and the most prevalent themes investigated as predictors for scores on the symptom check-list 90-revised (SCL-90-R) and the center for epidemiological studies depression...

  12. Minimizing the legal risk with 'curbside' consultation. (United States)

    Kreichelt, Ray; Hilbert, Mary Lou; Shinn, Deidre


    "Curbside consultations"--in which a physician obtains insights on a medical case from another physician who has not seen the patient or reviewed the record--can yield advantages to the requesting physician. However, shortcomings are inherent in this common type of exchange and pose legal risk to the curbside consultant. This article provides background and practical tips that might help avoid being caught up in a lawsuit by surprise, or if named as a party, avoid being held culpable when the only involvement was a brief conversation with a colleague.

  13. Guidelines for Education and Training at the Doctoral and Postdoctoral Levels in Consulting Psychology/Organizational Consulting Psychology (United States)

    American Psychologist, 2007


    The purpose of these "Guidelines for Education and Training at the Doctoral and Postdoctoral Levels in Consulting Psychology/Organizational Consulting Psychology" is to provide a common framework for use in the development, evaluation, and review of education and training in consulting psychology/organizational consulting psychology (CP/OCP). The…

  14. The impact of the law on consultation practices and purpose: A case study of Aboriginal cultural heritage consultations in NSW

    Directory of Open Access Journals (Sweden)

    Kylie Lingard


    Full Text Available Consultation research to date has largely concentrated on how consultation practices generally serve only the purpose of procedural compliance. This article identifies and explores the gap in existing research on the impact of law on consultation practices and purposes. To explore current practices and the potential contribution of law to the nature of consultation practices, the article focuses on the NSW duty to consult Aboriginal people before permitting harm to Aboriginal cultural heritage. Conventional regulatory approaches to consultation assume that Aboriginal interests are accommodated by the same consultation strategies applied to other stakeholders in rural law and policy. This article uses an administrative law doctrinal research approach to identify the specific issues and requirements for Aboriginal consultation relating to cultural heritage. Consideration is given to the effectiveness of the case study consultation requirements, the duty design, and the recent Land and Environment Court judgment of Ashton Coal Operations Pty Limited v Director-General, Department of Environment, Climate Change and Water. The article argues that statutory consultation requirements and purposes can, and should, be taken more seriously. The law reform discussion highlighted in the paper considers how identified consultation requirements can be incorporated into Australian Cultural Heritage legislation, and the possible impact of such incorporation on the purpose of the consultation. More broadly, the law reform discussion indicates that when consultation requirements are tailored to suit the purpose of the consultation and the consultation parties, the law can play a positive role in consultation, engagement and capacity building.

  15. Expanding Technical Assistance Consultation to Public Schools: District-Wide Evaluation of Instructional and Behavior Support Practices for Students with Developmental Disabilities. (United States)

    Putnam, Robert F.; Luiselli, James K.; Jefferson, Gretchen, L.


    Describes consultation to a public school district in the form of a systems-wide evaluation of instructional and behavior support practices for students with developmental disabilities. The format of the evaluative model, respective findings, suggested remedies, and implications for large-scale public school consultation are provided. (Contains 22…

  16. Rates of star formation

    International Nuclear Information System (INIS)

    Larson, R.B.


    It is illustrated that a theoretical understanding of the formation and evolution of galaxies depends on an understanding of star formation, and especially of the factors influencing the rate of star formation. Some of the theoretical problems of star formation in galaxies, some approaches that have been considered in models of galaxy evolution, and some possible observational tests that may help to clarify which processes or models are most relevant are reviewed. The material is presented under the following headings: power-law models for star formation, star formation processes (conditions required, ways of achieving these conditions), observational indications and tests, and measures of star formation rates in galaxies. 49 references

  17. Understanding the formation and influence of attitudes in patients' treatment choices for lower back pain: Testing the benefits of a hybrid choice model approach

    DEFF Research Database (Denmark)

    Kløjgaard, Mirja Elisabeth; Hess, S.


    A growing number of studies across different fields are making use of a new class of choice models, labelled variably as hybrid model structures or integrated choice and latent variable models, and incorporating the role of attitudes in decision making. To date, this technique has not been used...... in health economics. The present paper looks at the formation of such attitudes and their role in patients treatment choices in the context of low back pain. We use stated choice data collected from a sample of 561 patients with 348 respondents referred to a regional spine centre in Middelfart, Denmark...... in spring/summer 2012. We show how the hybrid model structure is able to make a link between attitudinal questions and treatment choices, and also explains variation of these attitudes across key socio-demographic groups. However, we also show how, in this case, only a small share of the overall...

  18. Department of Training And Consulting - Overview

    International Nuclear Information System (INIS)

    Dobrzynski, L.


    Full text: The Department of Training and Consulting is regularly serving secondary school pupils and teachers, university students and the public. As usual we have been visited by more than 5000 visitors, mainly students from secondary schools. Since January 2003, the Department participated in an European program called NUPEX (from Nuclear Physics Experience) that aimed at creating an internet platform of educational material from nuclear physics and its applications. The platform was finally prepared in eight languages (English, French, German, Italian, Flemish, Greek, Hungarian and Polish) and is dedicated to pupils from secondary schools and to science teachers. The whole material can be found at The Polish part is displayed additionally at It is worth mentioning that the Polish group played an important role in the whole project. Seven modules were fully prepared by us; we also were active in helping the other Project's participants to understand technicalities connected with preparation of the material for internet. New educational posters have been designed by the Department. The titles of these posters are: Energy and its transformations; typical electric power plants; Nuclear Power Plants; Nuclear Power Plants in Europe and in the World. The posters are offered to visiting schools. The number of possible experiments at our Laboratory of Atomic Physics is still increasing. Recently a computer simulation of the process of start-up of the nuclear reactor was prepared. Although it can be considered as a game, in fact the animation reflects the reality of the process and can be used for training of nuclear reactor's operators. For the first time one, of the leading secondary schools in Warsaw, the Stefan Batory School, participated in a Summer School of Physics organized at our Department, which lasted 10 days. Most of the educational program was filled with the basics of nuclear physics with emphasis

  19. Department of Training and Consulting - Overview

    International Nuclear Information System (INIS)

    Dobrzynski, L.


    Full text: The Department of Training and Consulting regularly serves secondary schools pupils and teachers, university students and the public. Almost 6600 visitors, mainly students from secondary schools in Poland, visited the Department. In addition to regular lectures, demonstrations, visits to the reactor MARIA and two current exhibitions (on nuclear waste and the WWER reactor model), several laboratory experiments have been organized for secondary schools. A one-day summer workshop on '' Basics of nuclear radiation, its properties and use in science, technology and medicine '' offered secondary school teachers a general understanding of the problems connected with radioactivity. The Department is constantly developing experiments that can be conducted by students of secondary schools and universities, as well as by professionals. At the moment, there are about 25 experiments available for the guests of the Department. They cover the measurement of lifetimes, essential elements of radioprotection, absorption of radiation in various materials, excitation of fluorescence radiation, influence of magnetic fields on beta radiation as well as on electrons emitted from a typical electron gun, Compton scattering and elements of gamma spectroscopy, search for radioactive pollutions etc. Three experiments were modernized to enable them to be conducted over the Internet. This project is a bit delayed but should be finished by the end of April 2009. For the third time the Department organized (together with the Institute of Physics of the Polish Academy of Sciences, Warsaw) '' The Physical Pathways '' competition for secondary school students. The students could choose one of three possibilities (even all of them): either to submit a scientific paper, to present a demonstration of a physical phenomenon, or to write an essay on the connection between physics and the development of civilization. They could also submit work prepared by a team of up to three persons. The

  20. Department of Training and Consulting - Overview

    International Nuclear Information System (INIS)

    Dobrzynski, L.


    Full text: The Department of Training and Consulting is regularly serving secondary schools' pupils and teachers, university students and the public. As usual, we have been visited by over 5000 visitors, mainly students from secondary schools in Poland. In this contest, it is worth to mention the organization of the two 3-days Workshops '' On the nuclear energy from the very basics '', aimed to offer the teachers of secondary schools general understanding of the problems connected with nuclear energy. The Workshops were organized in collaboration with the International Atomic Energy Agency and Polish Atomic Agency. Also two other one-day courses on the nuclear radiation were organized for teachers from rather remote parts of Poland. In the teachers' opinion all these events were very successful. The Department is constantly developing experiments that can be conducted by students of secondary schools and universities, as well as by professionals. At the moment there are about 20 experiments available for the guests of the Department. They cover the measurements of lifetimes, essential elements of radioprotection, absorption of radiation in various materials, excitation of fluorescence radiation, influence of magnetic field on beta radiation as well as on electrons emitted from a typical electron gun, Compton scattering and elements of gamma spectroscopy, search for radioactive pollutions etc. A new task of preparing some experiments to be driven through the internet was put forward. It is hoped that this project will end within 2008. For the second time the Department has organized (together with the Institute of Physics of the Polish Academy of Sciences, Warsaw) '' The Physical Pathways '' competition for the students of secondary schools. The students could choose one of three possibilities (even all of them): either to submit a scientific paper, or to present demonstration of a physical phenomena, or to write an essay on the connection between physics and the

  1. Collaborative Care in Ambulatory Psychiatry: Content Analysis of Consultations to a Psychiatric Pharmacist (United States)

    Gotlib, Dorothy; Bostwick, Jolene R.; Calip, Seema; Perelstein, Elizabeth; Kurlander, Jacob E.; Fluent, Thomas


    Objectives To determine the volume and nature (or topic) of consultations submitted to a psychiatric pharmacist embedded in an ambulatory psychiatry clinic, within a tertiary care academic medical center and to increase our understanding about the ways in which providers consult with an available psychiatric pharmacist. Experimental Design Authors analyze and describe the ambulatory psychiatric pharmacist consultation log at an academic ambulatory clinic. All consultation questions were submitted between July 2012 and October 2014. Principal Observations Psychiatry residents, attending physicians, and advanced practice nurse practitioners submitted 280 primary questions. The most common consultation questions from providers consulted were related to drug-drug interactions (n =70), drug formulations/dosing (n =48), adverse effects (n =43), and pharmacokinetics/lab monitoring/cross-tapering (n =36). Conclusions This is a preliminary analysis that provides information about how psychiatry residents, attending physicians, and advanced practice nurse practitioners at our health system utilize a psychiatric pharmacist. This collaborative relationship may have implications for the future of psychiatric care delivery. PMID:28936009

  2. Knowledge-Intensive Business Services and Business Consulting Services in Romanian Changing Economic Environment

    Directory of Open Access Journals (Sweden)

    Iacob Cătoiu


    Full Text Available The impact of the knowledge based society, especially on knowledge intensive business services, proved to have a really significant influence on the development of services industry. Consultancy services are acknowledged as innovation-intensive and knowledge-intensive business services at the same time. On the base of qualitative and quantitative research, by combining the disparities analysis with logical ranking, critical assessments and explanatory associations, comparative analysis, and empirical research, this article aims to contribute to a better appreciation and understanding of the consultancy services sector in Romania, as part of the larger family of knowledge intensive business services. The regional differences of business and personalized consultancy services are considered for discussion and revealed in the specific of the national network that has a clearly defined center. The concentration of the consultancy companies and most employees in four regions reflects the theory according to which the supply of these services is unevenly distributed, following the potential clients from better developed areas of the country. In all four types of analyzed consultancy activities, the total profit is bigger than economic loss. The disparities between regions are also supported by the dynamic evolution of the consultancy sector in Romania.

  3. Practical and ethical considerations for using social media in community consultation and public disclosure activities. (United States)

    Galbraith, Kyle L


    Social media are becoming increasingly integrated into both the clinical and the research dimensions of emergency medicine. They can provide methods for sharing crucial information to targeted individuals or groups in a rapid fashion. As a result, investigators conducting emergency research under the exception from prospective informed consent requirements are beginning to turn to social media platforms as they engage in required community consultation and public disclosure activities before their research begins. At present, there are limited data regarding how effectively social media have been used for performing those consultation and disclosure activities. This article offers investigators four specific areas to consider before using social media in consultation and outreach efforts. First, understand the forms of outreach social media platforms can provide. Second, recognize how those outreach methods relate to the specific goals of community consultation and public disclosure. Third, consider whether or not the intended audiences of community consultation and public disclosure will be available via social media. Finally, think about how social media outreach efforts will be measured and assessed before consultation and disclosure activities are under way. © 2014 by the Society for Academic Emergency Medicine.

  4. Quality Management in Project Management Consulting. A Case Study in an International Consulting Company

    Directory of Open Access Journals (Sweden)

    Eduard-Gabriel Ceptureanu


    Full Text Available The present paper addresses quality management from the specific perspective of project management consulting service providers, in the framework of large infrastructure projects. Because of their supposed superiority in knowledge and experience, project management consultants have an ultimate responsibility for the proper implementing of the project. Therefore, quality management in consulting organizations should focus on critical success factors. As there is no consensus yet regarding the most important aspects of the consulting activity on which depend the achievement of the project aims, there is scope for further investigating this subject. Here, the case of a project management consulting organization involved in large infrastructure projects in Romania, Bulgaria, Moldova, Ukraine and Serbia is analyzed. Data collected through a questionnaire-based survey among international consultants and support personnel suggest that factors related to leadership style and communication skills are more closely tied to the success of the project than more technical aspects. The results constitute an empirical evidence of main success factors for specialized consulting services in project management and can be useful in improving business and project performance and achieving business excellence.

  5. Adaptive radiation of Pseudomonas fluorescens SBW25 in experimental microcosms provides an understanding of the evolutionary ecology and molecular biology of A-L interface biofilm formation. (United States)

    Koza, Anna; Kusmierska, Anna; McLaughlin, Kimberley; Moshynets, Olena; Spiers, Andrew J


    Combined experimental evolutionary and molecular biology approaches have been used to investigate the adaptive radiation of Pseudomonas fluorescens SBW25 in static microcosms leading to the colonisation of the air-liquid interface by biofilm-forming mutants such as the Wrinkly Spreader (WS). In these microcosms, the ecosystem engineering of the early wild-type colonists establishes the niche space for subsequent WS evolution and colonisation. Random WS mutations occurring in the developing population that deregulate diguanylate cyclases and c-di-GMP homeostasis result in cellulose-based biofilms at the air-liquid interface. These structures allow Wrinkly Spreaders to intercept O2 diffusing into the liquid column and limit the growth of competitors lower down. As the biofilm matures, competition increasingly occurs between WS lineages, and niche divergence within the biofilm may support further diversification before system failure when the structure finally sinks. A combination of pleiotropic and epistasis effects, as well as secondary mutations, may explain variations in WS phenotype and fitness. Understanding how mutations subvert regulatory networks to express intrinsic genome potential and key innovations providing a selective advantage in novel environments is key to understanding the versatility of bacteria, and how selection and ecological opportunity can rapidly lead to substantive changes in phenotype and in community structure and function. © FEMS 2017. All rights reserved. For permissions, please e-mail:

  6. Consultation as an implementation strategy for evidence-based practices across multiple contexts: unpacking the black box. (United States)

    Nadeem, Erum; Gleacher, Alissa; Beidas, Rinad S


    There is great interest in the dissemination and implementation of evidence-based treatments and practices for children across schools and community mental health settings. A growing body of literature suggests that the use of one-time workshops as a training tool is ineffective in influencing therapist behavior and patient outcomes and that ongoing expert consultation and coaching is critical to actual uptake and quality implementation. Yet, we have very limited understanding of how expert consultation fits into the larger implementation support system, or the most effective consultation strategies. This commentary reviews the literature on consultation in child mental health, and proposes a set of core consultation functions, processes, and outcomes that should be further studied in the implementation of evidence-based practices for children.

  7. 40 CFR 93.105 - Consultation. (United States)


    ... Implementation Plans of Transportation Plans, Programs, and Projects Developed, Funded or Approved Under Title 23... EPA with MPOs, State departments of transportation, and DOT in developing applicable implementation...) through (e) of this section. Public consultation procedures will be developed in accordance with the...

  8. The representations of adolescents about gynecological consultation

    Directory of Open Access Journals (Sweden)

    Vera Lúcia de Oliveira Gomes


    Full Text Available Objective: To analyze the social representation of adolescents about gynecological consultation and the influence of those in searching for consultations. Method: Qualitative descriptive study based on the Social Representations Theory, conducted with 50 adolescents in their last year of middle school. The data was collected between April and May of 2010 by Evocations and a Focal Group. The software EVOC and contextual analysis were used in the data treatment. Results: The elements fear and constraint, constant in the central nucleus, can justify the low frequency of adolescents in consultations. The term embarrassment in the peripheral system reinforce current sociocultural norms, while prevention, associated with learning about sex and clarifying doubts, allows to envision an educative function. Obtained testimonies in the focal groups exemplify and reinforce those findings. Conclusion: For an effective health education, professionals, including nurses, need to clarify the youth individually and collectively about their rights to privacy, secrecy, in addition to focus the gynecological consultation as a promotion measure to sexual and reproductive health.

  9. Arriving at the postmodern medical consultation.

    NARCIS (Netherlands)

    Elwyn, G.


    The analysis of the medical consultation is characterised by mainly prescriptive attempts to recommend 'best practice'. As the role of the individual in society has gained prominence, the power relationships in medical practice have had to change to reflect the increasing recognition of autonomy and

  10. 76 FR 18583 - Draft Tribal Consultation Policy (United States)


    ... drug-related crime, violence, and disease. In addition to its leadership role in developing and..., reduce drug-related crime, violence, and disease. In addition to its leadership role in developing and... organizations, and urban Indian organizations. ONDCP's tribal consultation activities will support Indian self...

  11. The PLAN Classroom. A Guide for Consultants. (United States)


    This document is a guide for consultants observing teacher behavior, its effects on students, and learning environment conditions in a PLAN (Program for Learning in Accordance with Needs) classroom. (Appended are a series of 27 questions and answers which describe PLAN, an individualized, computer-assisted instructional system initially operating…

  12. Full Circle Program's Family Consulting Services. (United States)

    Administration for Children, Youth, and Families (DHHS), Washington, DC.

    In 1989-90, Full Circle Program's Family Consulting Services (FCS) staff provided family reunification services to 50 children and their families in San Francisco and Marin counties. Staff members developed individualized treatment strategies for each family, acting as advocates for the needs of the child. These services included medical and…

  13. 18 CFR 16.8 - Consultation requirements. (United States)


    ... influence the financial (e.g., instream flow study) or technical feasibility of the project (e.g., study of... project operation or modify project facilities. (2) If, after the end of the first stage of consultation... Office of Energy Projects determines under paragraph (b)(5) of this section either that the study or...

  14. 18 CFR 4.38 - Consultation requirements. (United States)


    ... feasibility of the project (e.g., study of potential mass soil movement); or (B) Are needed to determine the... enhancement measures (e.g., post-construction monitoring studies), or would be used to refine project operation or modify project facilities. (2) If, after the end of the first stage of consultation as defined...

  15. Psychoanalytic School Consultation: A Collaborative Approach (United States)

    Kerzner, Stephen


    This article describes a psychoanalytic consultation model to an independent grade 7-12 school that offers a practical and efficient approach to improve school climate. This model may stand alone or complement other approaches, and it can be implemented in both independent and public school settings. It focuses not only on "at risk" students,…

  16. Behavior Analytic Consultation for Academic Referral Concerns (United States)

    Dufrene, Brad A.; Zoder-Martell, Kimberly A.; Dieringe, Shannon Titus; Labrot, Zachary


    Applied behavior analysis provides a technology of human behavior that demonstrates great potential for improving socially important outcomes for individuals. School-based consultation may provide a vehicle for delivering applied behavior analysis services in schools to address academic referral concerns. In this article, we propose that…

  17. 77 FR 13338 - Tribal Consultation Meetings (United States)


    ..., Public Law 110-134, notice is hereby given of one-day Tribal Consultation Sessions to be held between the... American Indian and Alaska Native children and their families, taking into consideration funding... consideration funding allocations, distribution formulas, and other issues affecting the delivery of Head Start...

  18. 78 FR 11891 - Tribal Consultation Meeting (United States)


    ... Law 110-134, notice is hereby given of two 1-day Tribal Consultation Sessions to be held between the... American Indian and Alaska Native children and their families, taking into consideration funding... families, taking into consideration funding allocations, distribution formulas, and other issues affecting...

  19. 77 FR 5027 - Tribal Consultation Meetings (United States)


    ..., Public Law 110-134, notice is hereby given of a one-day Tribal Consultation Session to be held between... American Indian and Alaska Native children and their families, taking into consideration funding... the needs of American Indian and Alaska Native children and families, taking into consideration...

  20. 76 FR 48865 - Tribal Consultation Meetings (United States)


    ..., Public Law 110-134, notice is hereby given of one-day Tribal Consultation Sessions to be held between the... American Indian and Alaska Native children and their families, taking into consideration funding... meeting the needs of American Indian and Alaska Native children and families, taking into consideration...

  1. 78 FR 57858 - Tribal Consultation Meeting (United States)


    ... Law 110-134, notice is hereby given of two 1-day Tribal Consultation Sessions to be held between the... American Indian and Alaska Native children and their families, taking into consideration funding... Native children and families, taking into consideration funding allocations, distribution formulas, and...

  2. 77 FR 19020 - Tribal Consultation Meeting (United States)


    ... Law 110-134, notice is hereby given of a one-day Tribal Consultation Session to be held between the... needs of American Indian and Alaska Native children and their families, taking into consideration... children and families, taking into consideration funding allocations, distribution formulas, and other...

  3. Expectation Levels in Dictionary Consultation and Compilation*

    African Journals Online (AJOL)

    Abstract: Dictionary consultation and compilation is a two-way engagement between two par- ties, namely a dictionary user and a lexicographer. How well users cope with looking up words in a Bantu language dictionary and to what extent their expectations are met, depends on their con- sultation skills, their knowledge of ...

  4. School Neuropsychology Consultation in Neurodevelopmental Disorders (United States)

    Decker, Scott L.


    The role of school psychologists with training in neuropsychology is examined within the context of multitiered models of service delivery and educational reform policies. An expanded role is suggested that builds on expertise in the assessment of neurodevelopmental disorders and extends to broader tiers through consultation practice. Changes in…

  5. 78 FR 20658 - Tribal Consultation Meeting (United States)


    ... 9, 2013--Green Bay, Wisconsin--Radisson Hotel & Conference Center, 2040 Airport Drive, Green Bay, WI 54313; and Friday, July 26, 2013--Tulsa, Oklahoma--Renaissance Tulsa Hotel & Convention Center, 6808 S... of concern and recommendations. Hotel and logistical information for the Consultation Session has...

  6. Organizational design approaches in management consulting

    NARCIS (Netherlands)

    Visscher, Klaasjan; Visscher-Voerman, Irene


    Purpose: The purpose of this paper is to map the variety in organizational design approaches, to clarify their differences, and to find out what constitutes good designing in practice. - Design/methodology/approach: A series of in-depth interviews with experienced, high-reputation consultants is

  7. 34 CFR 300.134 - Consultation. (United States)


    ... private school children with disabilities during the design and development of special education and... 34 Education 2 2010-07-01 2010-07-01 false Consultation. 300.134 Section 300.134 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND...

  8. 34 CFR 200.63 - Consultation. (United States)


    ... 34 Education 1 2010-07-01 2010-07-01 false Consultation. 200.63 Section 200.63 Education Regulations of the Offices of the Department of Education OFFICE OF ELEMENTARY AND SECONDARY EDUCATION, DEPARTMENT OF EDUCATION TITLE I-IMPROVING THE ACADEMIC ACHIEVEMENT OF THE DISADVANTAGED Improving Basic...

  9. Delivering an MBA Management Consulting Experience (United States)

    LeMaire, Ryan; Fisher, Kirk; Watson, Edward F., III


    This article reports on an innovative MBA elective consulting course that attempts to address how to better prepare inexperienced MBA students for a competitive job market. This article is a best practice paper designed to provide insights and encouragement to educators.

  10. Gynaegological consultations at Bowen University Teaching ...

    African Journals Online (AJOL)

    Conclusion: Infertility was the commonest reason for gynaecological consultations in this newly established teaching hospital, hence, establishment of assisted reproductive technology unit will be highly valuable to these patients who come to the hospital from different parts of southwestern Nigeria, where all assisted ...

  11. Developing Critical Thinking through Student Consulting Projects (United States)

    Canziani, Bonnie; Tullar, William L.


    The authors present survey results from faculty at 44 universities on the role of student consulting projects in developing business students' critical thinking. They conclude that students can improve critical thinking by engaging in guided primary and secondary research to inform their business assumptions that underpin business planning and…

  12. The Writing Consultation: Developing Academic Writing Practices (United States)

    Murray, Rowena; Thow, Morag; Moore, Sarah; Murphy, Maura


    This article describes and analyses a specific mechanism, the writing consultation, designed to help academics to prioritise, reconceptualise and improve their writing practices. It makes the case for its potential to stimulate consideration of writing practices and motivations, a possible precondition for creating time for writing in academic…

  13. A Consultation Model to Facilitate Reading Success (United States)

    Lilles, Elena; Griffiths, Amy-Jane; Lee, Allison; Cardenas, Santiago; Chacko, Yasmin; Jimerson, Shane R.


    Poor reading ability is associated with numerous negative consequences. School psychologists should provide teachers with resources and support to improve student reading ability and prevent these negative outcomes. This paper offers a guide for school psychologists to use in the consultation process when working with teachers to address students'…

  14. Counselor-Consultant As Quasi-Ombudsman (United States)

    Koltveit, Thomas H.


    The secondary school counselor, as quasi-ombudsman, differentiates between the role of counselor as consultant (where the counselor's primary task is to aid the individual to develop strength to resolve personal difficulties himself) and role of counselor as ombudsman (where the counselor can go over the head of a recalcitrant teacher to correct…


    Directory of Open Access Journals (Sweden)

    Craig J. Della Vale


    chapter there are revision questions including painful total knee arthroplasty, periprosthetic infection, exposure in revision knee arthroplasty, surgical technique, using stem, offset stems, massive bone loss, retaining patellar component, severe patellar bone loss, assessing joint line position, inserts, chronic extensor mechanism deficiency, spacers, knee fusion, positive culture. AUDIENCE Mainly orthopedic surgeons and residents who are interested in knee arthroplasty have been targeted but the current information related to total knee replacement surgery will also be welcomed by experienced clinicians practicing in knee arthroplasty. Also non-physician personnel may benefit the brief knowledge. ASSESSMENT The brief answers including current concepts and opinions of expert arthroplasty surgeons to carefully chosen questions related to the problems faced in the daily practice of knee artroplasty forming the sections are making almost comprehensive source knowledge for total knee replacement surgery. This reference of complicated cases and controversies in knee arthroplasty by Craig J. Della Vale, MD.and his collaborators will be one of the most practical source of current solutions in the management of knee arthroplasty . Providing straightforward, brief and useful advices, in the form of pearls and pitfalls for frequently encountered problems in total knee replacement surgery makes the text a user friendly, essential reference. The casual style of articles resembling the advices in a dialog of colleagues on a curbside consult makes the text easier to read and understand. Various image and diagrams enhances the knowledge in the text

  16. The guideline "consultation psychiatry" of the Netherlands Psychiatric Association. (United States)

    Leentjens, Albert F G; Boenink, Annette D; Sno, Herman N; Strack van Schijndel, Rob J M; van Croonenborg, Joyce J; van Everdingen, Jannes J E; van der Feltz-Cornelis, Christina M; van der Laan, Niels C; van Marwijk, Harm; van Os, Titus W D P


    In 2008, the Netherlands Psychiatric Association authorized a guideline "consultation psychiatry." To set a standard for psychiatric consultations in nonpsychiatric settings. The main objective of the guideline is to answer three questions: Is psychiatric consultation effective and, if so, which forms are most effective? How should a psychiatric consultations be performed? What increases adherence to recommendations given by the consulting psychiatrist? Systematic literature review. Both in general practice and in hospital settings psychiatric consultation is effective. In primary care, the effectiveness of psychiatric consultation is almost exclusively studied in the setting of "collaborative care." Procedural guidance is given on how to perform a psychiatric consultation. In this guidance, psychiatric consultation is explicitly looked upon as a complex activity that requires a broad frame of reference and adequate medical and pharmacological expertise and experience and one that should be performed by doctors. Investing in a good relation with the general practitioner, and the use of a "consultation letter" increased efficacy in general practice. In the hospital setting, investing in liaison activities and an active psychiatric follow-up of consultations increased adherence to advice. Psychiatric consultations are effective and constitute a useful contribution to the patients' treatment. With setting a standard consultations will become more transparent and checkable. It is hoped that this will increase the quality of consultation psychiatry.

  17. Telemedicine consultations and medication errors in rural emergency departments. (United States)

    Dharmar, Madan; Kuppermann, Nathan; Romano, Patrick S; Yang, Nikki H; Nesbitt, Thomas S; Phan, Jennifer; Nguyen, Cynthia; Parsapour, Kourosh; Marcin, James P


    To compare the frequency of physician-related medication errors among seriously ill and injured children receiving telemedicine consultations, similar children receiving telephone consultations, and similar children receiving no consultations in rural emergency departments (EDs). We conducted retrospective chart reviews on seriously ill and injured children presenting to 8 rural EDs with access to pediatric critical care physicians from an academic children's hospital. Physician-related ED medication errors were independently identified by 2 pediatric pharmacists by using a previously published instrument. The unit of analysis was medication administered. The association of telemedicine consultations with ED medication errors was modeled by using hierarchical logistic regression adjusting for covariates (age, risk of admission, year of consultation, and hospital) and clustering at the patient level. Among the 234 patients in the study, 73 received telemedicine consultations, 85 received telephone consultations, and 76 received no specialist consultations. Medications for patients who received telemedicine consultations had significantly fewer physician-related errors than medications for patients who received telephone consultations or no consultations (3.4% vs. 10.8% and 12.5%, respectively; P medications for patients who received telemedicine consultations had a lower odds of physician-related errors than medications for patients who received telephone consultations (odds ratio: 0.19, P Pediatric critical care telemedicine consultations were associated with a significantly reduced risk of physician-related ED medication errors among seriously ill and injured children in rural EDs.

  18. Understanding the formation and evolution of early-type galaxies based on newly developed single-burst stellar population synthesis models in the infrared (United States)

    Roeck, Benjamin


    whole optical and infrared wavelength range between 3500 and 50000Å which are almost completely based on spectra of observed stars (apart from two gaps which were fitted with theoretical stellar spectra) . We analyze the behaviour of the near-infrared (J - K) and the Spitzer ([3.6]-[4.5]) colour calculated from our models. For ages older than 3 Gyr, both colours depend only slightly on age and metallicity. However, for younger ages, both colours become redder which is caused by the asymptotic giant branch stars contributing significantly to the light in the infrared at ages between 0.1 and 3 Gyr. Furthermore, we find a satisfactory agreement between the optical and near-infrared colours measured from our models and the colours observed from various samples of globular clusters and early-type x galaxies. However, our model predictions are only able to reproduce correctly the Spitzer ([3.6]-[4.5]) colours of older, more massive galaxies that resemble a single-burst population. Younger, less massive and more metal-poor galaxies show redder colours than our models. This mismatch can be explained by a more extended star formation history of these galaxies which includes a metal-poor or/and young population. The Spitzer ([3.6]-[4.5]) colours derived from our models also agree very well with those from most other models available in this wavelength range as long as they also correctly take into account a strong CO absorption band situated at 4.5 μm. The model predictions for colours in the near-infrared, such as (J - K), differ more between the different sets of models, depending on the underlying prescriptions for the asymptotic giant branch stellar evolutionary phase. Compared to other authors, we adopt only a moderate contribution of asymptotic giant branch stars to our models. Our stellar population models allow us also to determine mass-to-light ratios in different infrared bands. Consequently, we can confirm that the massto- light ratio determined in the Spitzer [3

  19. [Reasons why musicians consult hand surgeons]. (United States)

    Nourissat, G; Chamagne, P; Dumontier, C


    Musicians occasionally consult orthopedic surgeons, particularly upper limb specialists. We wanted to learn more about the reasons why musicians attend orthopedic clinics. We analyzed retrospectively 227 case files of musicians who consulted our center between 1994 and 2001. We noted patient related factors (age, gender, musical experience, level of performance, daily practice schedule) and their reasons for consulting (pain, discomfort, advice). We studied the medical history of the patients and searched for predisposing or triggering elements. We also recorded therapeutic options proposed. Our series included 119 men (52%) and 108 women, mean age 35 years with 27 years of musical experience on the average. Instruments played were mainly the piano (41%), the violin (19%), and the guitar (15%). Patients playing wind instruments, who consult more often for ENT problems, were exceptional. On the average, the patients played their instrument 4 hours daily. One-third of the patients were high-level amateurs, one-third were professionals, and one-quarter were lower-level amateurs. There was a small proportion of soloists or professors. Two-thirds of the musicians presented disorders of the musculoskeletal system, particularly trauma sequelae. Signs of overuse were present in 18% of the patients, mainly women, signs of misuse due to inappropriate or defective technique in 8.8%, and dystonia in 5.7%. Psychological problems were noted in 4 patients. More than one half of the patients had obtained medical advice prior to consulting an orthopedic surgeon and the very large majority had been referred by specialized physical therapists. A surgical procedure was proposed for only 19% of the patients presenting an orthopedic disorder. This study presents a diversified panel of musicians consulting orthopedic surgery clinics. Practicing schedules varied in the study population from one to five hours daily. More than half the patients complained of pain but 18% consulted because

  20. Understanding the formation of ancient intertropical disjunct distributions using Asian and Neotropical hinged-teeth snakes (Sibynophis and Scaphiodontophis: Serpentes: Colubridae). (United States)

    Chen, Xin; Huang, Song; Guo, Peng; Colli, Guarino R; Nieto Montes de Oca, Adrián; Vitt, Laurie J; Pyron, R Alexander; Burbrink, Frank T


    Numerous taxa show ancient intertropical disjunct distributions. Many can be explained by well-known processes of historical vicariance, such as the breakup of Gondwanaland. Others, such as Asian-Neotropical divergences are not as well understood. To clarify the phylogenetic position and understand biogeographic and temporal origins of the geographically disjunct and morphologically unique genera of hinged-teeth snakes, Scaphiodontophis (n=1) and Sibynophis (n=9; Colubridae), we inferred a time-calibrated phylogeny with additional 107 taxa representing the superfamily Colubroidea using four genes (c-mos, cyt-b, ND2, RAG-1; 3085 bp). We used this tree to estimate ancestral areas for the group. The results show that Scaphiodontophis is sister to Sibynophis, both originated in the late Eocene/Oligocene in Asia and likely dispersed through Beringia to the New World, but unlike other snake groups left no extant species in temperate North America. Current recognition of Scaphiodontophiinae renders Colubrinae paraphyletic, and we resurrect the previously named subfamily Sibynophiinae to encompass both genera and use the tribes Sibynophiini (Sibynophis) and Scaphiodontophiini (Scaphiodontophis) to highlight the geographically distinct areas occupied by these taxa. These results suggest that intercontinental dispersal with extinction in intermediate areas can explain puzzling patterns of ancient intertropical disjunct distributions. Copyright © 2012 Elsevier Inc. All rights reserved.

  1. On becoming a consultant: a study exploring the journey to consultant practice


    Henwood, Suzanne; Booth, Lisa


    Background: This paper reports a qualitative study exploring the establishment of non-medical consultant roles in Radiography. Given the difficulties reported in recruiting and retaining staff in these posts, we hope this paper offers a historical documentation of those consultants who were some of the first in post, sharing their stories of how they obtained and transitioned into their roles.\\ud \\ud Methods: This paper is part of a two year case study exploring the leadership domain of consu...

  2. [Validation of a short questionnaire to use in clinical consultations to detect gender violence]. (United States)

    Majdalani, María Pía; Alemán, María; Fayanás, Roberto; Guedes, Alexandra; Mejía, Raúl Mariano


    To validate a Spanish-language questionnaire to be used in primary care consultations to detect cases of violence against women. The validation study was carried out between October 2002 and October 2003 in the Program of General Internal Medicine of the Clinical Hospital of the University of Buenos Aires, in the city of Buenos Aires, Argentina. The original version of this Spanish-language questionnaire had been developed in sexual and reproductive health clinics of five countries of Latin America and the Caribbean. The questionnaire covered the most frequent forms of gender-based violence (emotional, physical, sexual, and sexual abuse during childhood); explored how and when the violence occurred and who perpetrated it; and investigated the patient's perception of her current risk. In the research in Buenos Aires the format and theoretical content of the survey were evaluated, and linguistic and psychometric validations were also carried out. The reliability of the tool was assessed in terms of its reproducibility, stability, and internal consistency. The study found that the women surveyed in Buenos Aires had a good understanding of the questions, the examples given with the questions, and the response options. The women did not perceive the survey as being intimidating or as an intrusion into their private lives. The women generally regarded the use of the survey in primary care settings as a key opportunity for them to express their suffering and to receive assistance. The level of agreement for the answers to the questions in all five areas (psychological violence, physical violence, sexual violence, sexual abuse during childhood, and perception of current risk) was very high, in terms of both reproducibility (kappa values of 0.63 to 1.00) and stability (kappa values of 0.62 to 1.00). The alpha correlation coefficient for internal consistency was 0.755 for psychological violence and physical violence, 0.498 for psychological violence and sexual violence, 0

  3. Getting Together to Improve the School Environment: User Consultation, Participatory Design and Student Voice (United States)

    Woolner, Pam; Hall, Elaine; Wall, Kate; Dennison, David


    This article first investigates historical trends in both the practice and the understanding of consultation, considering the often contrasting perspectives of architects and designers, compared to teachers and educationalists. Differing assumptions held by these two broad groups of professionals can lead to conflicting aims and objectives for…

  4. Not beyond the tipping point: restrained emotions and the functionality of business meals in consultancy

    NARCIS (Netherlands)

    Taminiau, Y.T.A.; Das, E.; Berghman, L.A.; Fangman, Y.


    This paper explores the importance of business meals in shaping boundaries in informal contacts, through in-depth interviews with consultants. Building on the sociology of food and embodiment, we propose three concepts as being important to understanding food mediating mechanisms: liminality,

  5. 40 CFR Appendix C-1 to Subpart E... - Required Provisions-Consulting Engineering Agreements (United States)


    ... contract upon an agreement or understanding for a commission, percentage, brokerage, or contingent fee... this clause in all his contracts and all tier subcontracts directly related to project performance that... the owner and the engineer hereby agree) of the contract price to subcontractors or consultants...

  6. Audit of the consultation process on general internal medicine services. (United States)

    Conley, J; Jordan, M; Ghali, W A


    To determine the proportion of consultations requested by general internal medicine services that communicate key components of the consultation process to medical subspecialists. Retrospective chart review by two researchers, using a standardised chart abstraction instrument (93.1% agreement, kappa 0.85). Calgary, Alberta, Canada. A random sample of medical consultations was selected from those generated on two medical teaching units (MTUs) from 2003 to 2004. The primary measure of interest was whether a "clear clinical question" was posed to the subspecialist, a binary variable. Two hundred consultations were sampled from the 2885 subspecialty consultations. Of the selected consultations, 94.0% (188/200) were available for review. A clear clinical question was posed in 69.7% (131/188) of consultations (CI 0.63 to 0.74). In a secondary analysis involving a larger sample permitting comparison across subspecialties, 95.1% (368/387) of the consultations, representative of the subspecialties, were available for review. An MTU member contacted the subspecialist for 74.2% of consultations. If a consultation was urgent, a member of the MTU contacted the subspecialist in 81.0% of consultations. Of these urgent consultations, 63.3% had a clear clinical question. More than one in four consultations does not contain a clear clinical question, illustrating suboptimal communication between physicians. Innovative strategies that provide a sustainable solution for overcoming barriers to communication could have a significant impact on quality of care.

  7. “How long does it take?” A mixed methods evaluation of computer-related work in GP consultations

    Directory of Open Access Journals (Sweden)

    James Hayward


    Full Text Available Background Systematic reviews have suggested that time spent on computerrelated tasks increases consultation length. However, these reviews pre-date the current ubiquitous use of computers in U.K. general practice.Objective As part of a U.K. national study of the influence of information technology (IT on the interaction between patients and healthcare professionals during consultations, we explored how IT functions affected time allocation and styles of computer use during general practitioner (GP consultations.Methods We drew on multichannel video recording of consultations and measured consultation phases and the duration of computer-related tasks. We related measures of actual time to GP’s interpretation of computer use elicited in qualitative interviews.Results Our sample included recordings of 112 consultations from 6 GPs in three practices. The computer was used for about one-third of the greater consultation. However, its use was concentrated pre- and post- the patient consultation. The workflow of consultation was exemplified through six computer use cases. Most functionality was accepted and accommodated within the consultation, though disruptive and time-consuming tasks were generally delegated to administrative staff. Recognised styles of computer use (minimal, block and conversational were apparent, but applied very flexibly by GPs according to the nature of the consultation.Conclusions In contrast to earlier reports, contemporary computer use does not appear to have lengthened consultations. GPs adopted different styles of computer use in different consultations, challenging classifications that seek to stereotype GP computer use. Designing systems that support this versatility require an understanding of the fluid application of computer use within consultation structure.

  8. Nuclear fuel waste disposal. Canada's consultative approach

    International Nuclear Information System (INIS)

    Hillier, J.A.R.; Dixon, R.S.


    Over the past two decades, society has increasingly demanded more public participation and public input into decision-making by governments. Development of the Canadian concept for deep geological disposal of used nuclear fuel has proceeded in a manner that has taken account of the requirements for social acceptability as well as technical excellence. As the agency responsible for development of the disposal concept, Atomic Energy of Canada Limited (AECL) has devoted considerable effort to consultation with the various publics that have an interest in the concept. This evolutionary interactive and consultative process, which has been underway for some 14 years, has attempted to keep the public informed of the technical development of the concept and to invite feedback. This paper describes the major elements of this evolutionary process, which will continue throughout the concept assessment and review process currently in progress. (author)

  9. Case studies of computer model applications in consulting practice (United States)

    Siebein, Gary; Paek, Hyun; Lorang, Mark; McGuinnes, Courtney


    Six case studies of computer model applications in a consulting practice will be presented to present the range of issues that can be studied with computer models as well as to understand the limitations of the technique at the present time. Case studies of elliptical conference rooms demonstrate basic acoustic ray principles and suggest remediation strategies. Models of a large themed entertainment venue with multiple amplified sound sources show how visualization of the acoustic ray paths can assist a consultant and client in value engineering locations and amounts of acoustic materials. The acoustic problems with an angled ceiling and large rear wall were studied when an historic church was converted to a music performance hall. The computer model of an historic hall did not present enough detailed information and was supplemented with physical model studies and full size mock-up tests of the insertion of an elevator door that would open directly into the concert room. Studies to demonstrate the amount of room model detail to obtain realistic auralizations were also conducted. The integration of architectural acoustic design and audio system design were studied in computer models of a large church sanctuary.

  10. Users enlist consultants to calculate costs, savings

    Energy Technology Data Exchange (ETDEWEB)


    Consultants who calculate payback provide expertise and a second opinion to back up energy managers' proposals. They can lower the costs of an energy-management investment by making complex comparisons of systems and recommending the best system for a specific application. Examples of payback calculations include simple payback for a school system, a university, and a Disneyland hotel, as well as internal rate of return for a corporate office building and a chain of clothing stores. (DCK)

  11. Affections rhumatologiques du sujet age en consultation ...

    African Journals Online (AJOL)

    Le "sujet âgé" répondait à la définition de l'Organisation mondiale de la Santé. Résultats: 768 (10,31%) patients âgés de plus de 65 ans ont été recrutés ... Mots clés: Affections rhumatologiques ; Sujet âgé ; Afrique Noire. English Title: Rheumatological disorders of the elderly in a rheumatologic consultation in Lome (Togo).

  12. The Application of Cognitive Dissonance Theory to Consultation. (United States)

    Hughes, Jan N.


    Summarizes aspects of cognitive dissonance theory (theory that predicts when a particular persuasive attempt will be successful) that are most relevant to consultation. Reviews the corresponding experimental support and suggests practical applications of dissonance research and theory to consultation. (LLL)

  13. Can audio recording improve patients' recall of outpatient consultations?

    DEFF Research Database (Denmark)

    Wolderslund, Maiken; Kofoed, Poul-Erik; Axboe, Mette

    Introduction In order to give patients possibility to listen to their consultation again, we have designed a system which gives the patients access to digital audio recordings of their consultations. An Interactive Voice Response platform enables the audio recording and gives the patients access...... to replay their consultation. The intervention is evaluated in a randomised controlled trial with 5.460 patients in order to determine whether providing patients with digital audio recording of the consultation affects the patients overall perception of their consultation. In addition to this primary...... objective we want to investigate if replay of the consultations improves the patients’ recall of the information given. Methods Interviews are carried out with 40 patients whose consultations have been audio recorded. Patients are divided into two groups, those who have listened to their consultation...

  14. Services of strategic consulting: special features and types

    Directory of Open Access Journals (Sweden)

    Klenin Oleh Volodymyrovych


    Full Text Available In the article essence of terms “consulting” and “strategic consulting” was studied. It was proved that strategic consulting must be analyzed as professional activity in the system of enterprise strategic management. Specific features of consultative services and its composition was added from the point of view of strategic management and innovative development were studied. In the process of providing consulting services it was suggested to take into account the strategic orientation of human capital of consulting company that was accepted to determine as professional actions of consultants. It was found out main problems that could prevent stable activity of industrial enterprises. It was proved necessity of researches concerning authentication factors of industrial enterprises innovative development and the role of consulting company in its decision making. It was made review of the most widespread classifications of consulting services. Was shown author`s view concerning forming more demanded services of strategic consulting by subject basis.

  15. Exploring employment in consultation reports of patients with neuromuscular diseases

    NARCIS (Netherlands)

    Minis, M.A.H; Cup, E.H.C.; Heerkens, Y.H.; Engels, J.A.; Engelen, B.G.M. van; Oostendorp, R.A.B.


    Minis MA, Cup EH, Heerkens YF, Engels JA, van Engelen BG, Oostendorp RA. Exploring employment in consultation reports of patients with neuromuscular diseases. OBJECTIVES: To explore consultation reports for patient and employment characteristics and recommendations on employment regarding patients

  16. Understanding the visual resource (United States)

    Floyd L. Newby


    Understanding our visual resources involves a complex interweaving of motivation and cognitive recesses; but, more important, it requires that we understand and can identify those characteristics of a landscape that influence the image formation process. From research conducted in Florida, three major variables were identified that appear to have significant effect...

  17. Communication in the initial paediatric consultation. (United States)

    van Dalen, Jan; van den Eertwegh, Valerie


    The first time a paediatrician meets with a patient, either with or without parents or caretakers, there are generally two aims with this consultation. Aside from exchanging relevant information for diagnosis, a relationship develops. This relationship is an important factor in the encounter: it can facilitate or impede collaboration between the partners in the consultation. The paediatrician can influence this relationship so that it becomes beneficial in the diagnostic process and in creating a collaborative atmosphere in the consultation, which in turn will prove useful for adherence. This paper addresses this second aim: how can we use the relationship between the patients (with or without parents) and their doctors to enhance the quality and effectiveness of the encounter. Below we will first address why investing in a relationship is beneficial. Next we will describe how this can be done. The review will continue with a discussion of three important pitfalls and how to avoid them, and a small epilogue will provide a brief summary. Copyright © 2013 Elsevier Ltd. All rights reserved.

  18. A report on the green plan consultations

    International Nuclear Information System (INIS)


    This document is a summary of what Canadians who participated in the consultations had to say about environmental issues and concerns; the solutions, roles and responsibilities, and priorities for action. It is based on detailed reports from 41 information sessions and 17 consultation workshops held across Canada. It is based on some 3,000 pages of comments and suggestions, an analysis of 4,500 question response forms, and written submissions from more than 1,000 individuals and organizations. The report is organized into two sections: improving decision making; and, action on environmental issues. The first section deals with science, education, enforcement, decision-making processes and partnerships. The second section deals with specific environmental issues identified in the consultation document, such as global warming and toxic substances, and other publicly identified issues, including energy and land use. Suggestions for further consideration represent possible policy, program and legislative elements of 'The Green Plan'. They are intended as a basis for a more focused debate which will help in the establishment of priorities

  19. Virtual slides: application in pulmonary pathology consultations.

    Directory of Open Access Journals (Sweden)

    Michał Wojciechowski


    Full Text Available The Virtual Slide (VS is an interactive microscope emulator that presents a complete digitized tissue section via the Internet. A successful implementation of VS has been observed for educational, research venues and quality control. VS acquisition for consultative pathology is not so common. The purpose of this study was to explore the efficacy and usability of VS in the consultative pulmonary telepathology. 20 lung tumors entered the study. The performance was programmed for 2 medical centers specialized in pulmonary pathology (beginner and advancer in telepathology. A high-quality VSs were prepared by Coolscope (Nikon, Eclipsnet VSL, Japan, and were evaluated via the Internet. The cases were reviewed for the second time with conventional light microscope. VS diagnostic accuracy and the interobserver variability were evaluated. Also the time taken by examiners to render the diagnoses and time needed to scan the microscopic slide were analyzed. Percentage concordance between original glass-slides diagnosis and diagnosis for VSs was very high. Pathologists found the download speed of VSs adequate; experience in telepathology reduced the time of VS diagnosis. VS implementation suggests advantages for teleconsulation and education but also indicate some technical limitations. This is the first Polish trial of VS implementation in telepathology consultative service.

  20. Therapists’ Perspectives on the Effective Elements of Consultation Following Training


    Beidas, Rinad S.; Edmunds, Julie M.; Cannuscio, Carolyn C.; Gallagher, Mark; Downey, Margaret Mary; Kendall, Philip C.


    Consultation is an effective implementation strategy to improve uptake of evidence-based practices for youth. However, little is known about what makes consultation effective. The present study used qualitative methods to explore therapists’ perspectives about consultation. We interviewed 50 therapists who had been trained 2 years prior in cognitive-behavioral therapy for child anxiety. Three themes emerged regarding effective elements of consultation: (1) connectedness with other therapists ...

  1. Industrial Buying Behavior Related to Human Resource Consulting Services

    DEFF Research Database (Denmark)

    Grünbaum, Niels Nolsøe; Hollensen, Svend; Kahle, Lynn


    of buying behavior in B2B services. Based on a comprehensive exploratory study of Danish companies’ purchases of HR consulting services, the authors provide insights into the factors that determine how Danish companies choose a consulting services supplier. Five hypotheses are developed based...... relationships with customers is one of the most important key success factors in the consulting industry. Another important result that emerged from the study is customers’ specific desire to actively participate in the production of consulting services....

  2. Consultancy and knowledge management for radioactive waste disposal. Use of external knowledge of the Asse archive

    International Nuclear Information System (INIS)

    Driftmann, Christian; Josipovic, Neven


    The booklet on consultancy and knowledge management for radioactive waste disposal - use of external knowledge of the Asse archive covers the following topics: (i) Basic principles for consulting the government by external consultants: terminology, external consultancy in the legislative process, external consultancy in the administration. (ii) External consultancy in the frame of the final repository search: external consultancy profiles, legal appraisal.

  3. Summary report of the consultants' meeting on nuclear data for production of therapeutic radioisotopes

    International Nuclear Information System (INIS)

    Haight, R.C.; Paviotti-Corcuera, R.


    This report summarizes the presentations, recommendations and conclusions of the Consultants' Meeting on Nuclear Data for Production of Therapeutic Radioisotopes. The purpose of this meeting was to discuss scientific and technical matters related to the subject and to advise the IAEA Nuclear Data Section (NDS) on the need and possible formation of a Coordinated Research Programme (CRP). Accurate and complete knowledge of nuclear data are essential for the production of radionuclides for therapy to achieve the specific activity and purity required for efficient and safe clinical application. The Consultants recommended updating and completing the data for production of radionuclides that are recognized to be important in therapy. In addition, the consultants recommend investigating other radionuclides that have a potential interest and for which there exists a medical rationale for therapeutic use. To date no serious effort has been devoted to evaluation of nuclear data for the reactor and accelerator production of therapeutic radionuclides. The IAEA is in the unique and privileged position to address this important public health related problem. Therefore, the consultants highly recommend the formation of a CRP with the title: 'Nuclear Data for Production of Therapeutic Radionuclides.' (author)

  4. Psychiatric outpatient consultation for seniors. Perspectives of family physicians, consultants, and patients / family: A descriptive study

    Directory of Open Access Journals (Sweden)

    Dendukuri Nandini


    Full Text Available Abstract Background Family practitioners take care of large numbers of seniors with increasingly complex mental health problems. Varying levels of input may be necessary from psychiatric consultants. This study examines patients'/family, family practitioners', and psychiatrists' perceptions of the bi-directional pathway between such primary care doctors and consultants. Methods An 18 month survey was conducted in an out-patient psychogeriatric clinic of a Montreal university-affiliated community hospital. Cognitively intact seniors referred by family practitioners for assessment completed a satisfaction and expectation survey following their visits with the psychiatric consultants. The latter completed a self-administered process of care questionnaire at the end of the visit, while family doctors responded to a similar survey by telephone after the consultants' reports had been received. Responses of the 3 groups were compared. Results 101 seniors, referred from 63 family practitioners, met the study entry criteria for assessment by 1 of 3 psychogeriatricians. Both psychiatrists and family doctors agreed that help with management was the most common reason for referral. Family physicians were accepting of care of elderly with mental health problems, but preferred that the psychiatrists assume the initial treatment; the consultants preferred direct return of the patient; and almost 1/2 of patients did not know what to expect from the consultation visit. The rates of discordance in expectations were high when each unique patient-family doctor-psychiatrist triad was examined. Conclusion Gaps in expectations exist amongst family doctors, psychiatrists, and patients/family in the shared mental health care of seniors. Goals and anticipated outcomes of psychogeriatric consultation require better definition.

  5. Department of Training and Consulting: Overview

    International Nuclear Information System (INIS)

    Dobrzynski, L.


    Full text: The Department of Training and Consulting is a training centre for high-school students and their teachers, for students of physics and natural sciences in general, last but not least for society broadly understood, including professionals dealing with nuclear radiation. In 2002 the Department was visited by about 5000 high-school students who could listen to the lectures, and take part in experimental demonstrations on ionising radiation, its role in everyday life, technical and medical applications. In addition, the Department led the radiation protection course for the accelerators' operators employed by the Institute for Nuclear Studies. One-day courses on physics of radiation were also arranged for teachers. The Laboratory of Atomic and Nuclear Physics for Schools is still developing. The Laboratory permits high-school students to make simple experiments of qualitative and quantitative character. Its main purpose is to teach the elements of experimental work. In addition, university students of physics can conduct quite complicated experiments. Indeed, the Laboratory is also used for this purpose. The actual list of experiments available to students includes: the behaviour of charged particles in electric and magnetic fields, excitation and properties of photoluminescence, production and properties of X-rays, wave-particle duality, properties of alpha, beta and gamma radiation, elements of gamma spectroscopy including identification of elements by means of induced X-ray fluorescence. The first experience gathered recently is positive although there is still some work to do in order to make the Laboratory more educational. In particular, one of the conclusions drawn from our meetings at the instruments is that although high-school students can follow instructions and understand briefly the physical processes, they are not prepared for reporting the results of the observations or experiments. It is clear that we have to help them in overcoming this

  6. Alternatives to the face-to-face consultation in general practice: focused ethnographic case study. (United States)

    Atherton, Helen; Brant, Heather; Ziebland, Sue; Bikker, Annemieke; Campbell, John; Gibson, Andy; McKinstry, Brian; Porqueddu, Tania; Salisbury, Chris


    NHS policy encourages general practices to introduce alternatives to the face-to-face consultation, such as telephone, email, e-consultation systems, or internet video. Most have been slow to adopt these, citing concerns about workload. This project builds on previous research by focusing on the experiences of patients and practitioners who have used one or more of these alternatives. To understand how, under what conditions, for which patients, and in what ways, alternatives to face-to-face consultations present benefits and challenges to patients and practitioners in general practice. Focused ethnographic case studies took place in eight UK general practices between June 2015 and March 2016. Non-participant observation, informal conversations with staff, and semi-structured interviews with staff and patients were conducted. Practice documents and protocols were reviewed. Data were analysed through charting and the 'one sheet of paper' mind-map method to identify the line of argument in each thematic report. Case study practices had different rationales for offering alternatives to the face-to-face consultation. Beliefs varied about which patients and health issues were suitable. Co-workers were often unaware of each other's practice; for example, practice policies for use of e-consultations systems with patients were not known about or followed. Patients reported benefits including convenience and access. Staff and some patients regarded the face-to-face consultation as the ideal. Experience of implementing alternatives to the face-to-face consultation suggests that changes in patient access and staff workload may be both modest and gradual. Practices planning to implement them should consider carefully their reasons for doing so and involve the whole practice team. © British Journal of General Practice 2018.

  7. The role of ethics committees and ethics consultation in allocation decisions: a 4-stage process. (United States)

    Strech, Daniel; Hurst, Samia; Danis, Marion


    Decisions about the allocation and rationing of medical interventions likely occur in all health care systems worldwide. So far very little attention has been given to the question of what role ethics consultation and ethics committees could or should play in questions of allocation at the hospital level. This article argues for the need for ethics consultation in rationing decisions using empirical data about the status quo and the inherent nature of bedside rationing. Subsequently, it introduces a 4-stage process for establishing and conducting ethics consultation in rationing questions with systematic reference to core elements of procedural justice. Qualitative and quantitative findings show a significant demand for ethics consultation expressed directly by doctors, as well as additional indirect evidence of such a need as indicated by ethically challenging circumstances of inconsistent and structurally disadvantaging rationing decisions. To address this need, we suggest 4 stages for establishing and conducting ethics consultation in rationing questions we recommend: (1) training, (2) identifying actual scarcity-related problems at clinics, (3) supporting decision-making, and (4) evaluation. This process of ethics consultation regarding rationing decisions would facilitate the achievement of several practical goals: (i) encouragement of an awareness and understanding of ethical problems in bedside rationing, (ii) encouragement of achieving efficiency along with rationing, (iii) reinforcement of consistency in inter- and intraindividual decision-making, (iv) encouragement of explicit reflection and justification of the prioritization criteria taken into consideration, (v) improvement in internal (in-house) and external transparency, and (vi) prevention of the misuse of the corresponding consulting structures.

  8. The Role of Ethics Committees and Ethics Consultation in Allocation Decisions (United States)

    Strech, Daniel; Hurst, Samia; Danis, Marion


    Background Decisions about the allocation and rationing of medical interventions likely occur in all health care systems worldwide. So far very little attention has been given to the question of what role ethics consultation and ethics committees could or should play in questions of allocation at the hospital level. Objectives and Methods This article argues for the need for ethics consultation in rationing decisions using empirical data about the status quo and the inherent nature of bedside rationing. Subsequently, it introduces a 4-stage process for establishing and conducting ethics consultation in rationing questions with systematic reference to core elements of procedural justice. Results Qualitative and quantitative findings show a significant demand for ethics consultation expressed directly by doctors, as well as additional indirect evidence of such a need as indicated by ethically challenging circumstances of inconsistent and structurally disadvantaging rationing decisions. To address this need, we suggest 4 stages for establishing and conducting ethics consultation in rationing questions we recommend: (1) training, (2) identifying actual scarcity-related problems at clinics, (3) supporting decision-making, and (4) evaluation. Conclusion This process of ethics consultation regarding rationing decisions would facilitate the achievement of several practical goals: (i) encouragement of an awareness and understanding of ethical problems in bedside rationing, (ii) encouragement of achieving efficiency along with rationing, (iii) reinforcement of consistency in inter- and intraindvidual decision-making, (iv) encouragement of explicit reflection and justification of the prioritization criteria taken into consideration, (v) improvement in internal (in-house) and external transparency, and (vi) prevention of the misuse of the corresponding consulting structures. PMID:20706163

  9. Consultancy and innovation the business service revolution in Europe

    CERN Document Server

    Wood, Peter


    Consultancy and Innovation links two important aspects of European economic development in the past thirty years: the pace of technical and management innovation, and the growing significance of technical and business consultancy. This book includes detailed studies of consultancy activities or 'knowledge intensive services' (KIS) in eight EU countries, written by national experts in the field.

  10. Consultant Jokes about Managing Uncertainty: Coping by Humor

    NARCIS (Netherlands)

    Bouwmeester, O.


    Consultants and clients who experience difficulties in coping with challenges might start making coping jokes. This might happen, for example, when facing a challenge such as managing uncertainty. A content analysis of consultants' jokes reveals that both consultants and clients apply tactics to

  11. 20 CFR 416.919t - Consultative examination oversight. (United States)


    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Consultative examination oversight. 416.919t... Examination § 416.919t Consultative examination oversight. (a) We will ensure that referrals for consultative... monitoring may include reviews by independent medical specialists under direct contract with SSA. (b) Through...

  12. 20 CFR 404.1519t - Consultative examination oversight. (United States)


    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Consultative examination oversight. 404.1519t... Examination § 404.1519t Consultative examination oversight. (a) We will ensure that referrals for consultative... monitoring may include reviews by independent medical specialists under direct contract with SSA. (b) Through...

  13. Bridging Theory and Practice: A Conceptual Framework for Consulting Organisations (United States)

    Mohammed, Meca B.; Welch, Jennie; Hazle Bussey, Leslie


    A growing number of organisations are emerging as partners to districts pursuing systemic improvement. Given the critical role a consulting organisation could play in supporting system reform efforts, how does a district leader looking to establish a consulting partnership determine what characteristics in a consulting organisation may be more…

  14. The Development of Behaviorally Based Public School Consultation Services (United States)

    Putnam, Robert F.; Handler, Marcie W.; Rey, Jannette; McCarty, Joseph


    This article describes the development of behavioral school care consultation services to public schools within a not-for-profit community behavioral health organization. An overview of the process of behavior consultation is presented. A description of the growth of behavioral school consultation services is outlined in regard to (a) the types of…

  15. Crisis Communication Consultation of the Federal Reserve Bank System (United States)

    Chandler, Robert C.; Wallace, J. D.


    This article, designed for both consulting practitioners and academics, reveals what it is like to do a high-level and high-profile client consultancy. This consultancy was highly informed by and assumes a working knowledge of instructional communication theory, research, and methods as well as drawing upon contemporary communication scholarship…

  16. 42 CFR 493.1419 - Standard; Clinical consultant responsibilities. (United States)


    ... Testing Laboratories Performing Moderate Complexity Testing § 493.1419 Standard; Clinical consultant... clinical consultation to the laboratory's clients; (b) Be available to assist the laboratory's clients in... 42 Public Health 5 2010-10-01 2010-10-01 false Standard; Clinical consultant responsibilities. 493...

  17. Introducing Farouk's Process Consultation Group Approach in Irish Primary Schools (United States)

    Hayes, Marie; Stringer, Phil


    Research has shown that teacher consultation groups increase teachers' behaviour management skills through discussion and collaborative problem-solving. Unlike the United Kingdom, at the time of this research consultation groups were not widely used in Irish schools. This research introduced Farouk's process consultation approach in three Irish…

  18. Using Mental Health Consultation: Supporting Teachers, Children, and Families (United States)

    Rubin, Lenore


    Mental health consultation can be very valuable in supporting children with behavioral difficulties and mental health issues in the classroom. Research has shown that consultation improves teacher efficacy--an important ingredient for teacher success. Consultants vary in the roles they play in child care programs. Most behavioral consultants…

  19. GPs' interactional styles in consultations with Dutch and ethnic minority patients. (United States)

    Schouten, Barbara C; Meeuwesen, Ludwien; Harmsen, Hans A M


    The aim of this study was to examine interactional styles of general practitioners (GPs) in consultations with Dutch patients as compared to ethnic minority patients, from the perspective of level of mutual understanding between patient and GP. Data of 103 transcripts of video-registered medical interviews were analyzed to assess GPs' communication styles in terms of involvement, detachment, shared decision-making and patient-centeredness. Surveys were used to collect data on patients' characteristics and mutual understanding. Results show that overall, GPs communicate less adequately with ethnic minority patients than with Dutch patients; they involve them less in decision-making and check their understanding of what has been discussed less often. Intercultural consultations are thus markedly distinguishable from intracultural consultations by a lack of adequate communicative behavior by GPs. As every patient has a moral and legal right to make informed decisions, it is concluded that GPs should check more often whether their ethnic minority patients have understood what has been said during the medical consultation.

  20. Addressing Palliative Sedation during Expert Consultation: A Descriptive Analysis of the Practice of Dutch Palliative Care Consultation Teams.

    Directory of Open Access Journals (Sweden)

    Patrick Hoek

    Full Text Available Since palliative sedation is considered a complex intervention, consultation teams are increasingly established to support general practice. This study aims to offer insight into the frequency and characteristics of expert consultations regarding palliative sedation.We performed a retrospective analysis of a longitudinal database. This database contained all patient-related consultations by Dutch Palliative Care Consultation teams, that were requested between 2004 and 2011. We described the frequency and characteristics of these consultations, in particular of the subgroup of consultations in which palliative sedation was addressed (i.e. PSa consultations. We used multivariate regression analysis to explore consultation characteristics associated with a higher likelihood of PSa consultations.Of the 44,443 initial consultations, most were requested by general practitioners (73% and most concerned patients with cancer (86%. Palliative sedation was addressed in 18.1% of all consultations. Palliative sedation was relatively more often discussed during consultations for patients with a neurologic disease (OR 1.79; 95% CI: 1.51-2.12 or COPD (OR 1.39; 95% CI: 1.15-1.69 than for patients with cancer. We observed a higher likelihood of PSa consultations if the following topics were also addressed during consultation: dyspnoea (OR 1.30; 95% CI: 1.22-1.40, agitation/delirium (OR 1.57; 95% CI: 1.47-1.68, exhaustion (OR 2.89; 95% CI: 2.61-3.20, euthanasia-related questions (OR 2.65; 95% CI: 2.37-2.96 or existential issues (OR 1.55; 95% CI: 1.31-1.83.In conclusion, PSa consultations accounted for almost one-fifth of all expert consultations and were associated with several case-related characteristics. These characteristics may help clinicians in identifying patients at risk for a more complex disease trajectory at the end of life.

  1. Indigenous Political and Intellectual Elite in Ecuador: Notes on its formation in Western modernity

    Directory of Open Access Journals (Sweden)

    Leticia Cristina Bizarro Barbosa


    Full Text Available This article synthesizes the discussion of some actors about the formation and transformation of political elites in Ecuador and the emancipatory rise of an indigenous political elite in this country. The main objective was to understand the formation of a political and intellectual political elite in Ecuador. It is a predominantly theoretical study based on a bibliographic review and consultation of government documents and journals. The methodology used a bibliographic review and systematization of concepts for the field observation conducted during a doctoral fellowship in Ecuador in 2016. The article presents the theme and the context in which the process takes place; the formation and maintenance of elites; and discusses the formation of an indigenous political and intellectual elite in Ecuador, verifying how indigenous political and social movements appear in the national situation.


    Directory of Open Access Journals (Sweden)

    Walter W. Virkus


    displaced bimalleolar fracture in insulin dependant middle aged woman; Man-agement of calcaneal fractures; Fixation technic for a displaced talar neck fracture in a patient in ER; Indica-tions for surgical treatment of metatarsal fractures; Bone grafting in acute fractures; Management of a nonunion of plated midshaft tibia fracture; Management of a child with a twisted ankle and normal x-rays; Assessment of com-partment syndrome in foot.The Section III is about “GENERAL FRACTURE CARE” including: Management of multiple orthopedic injuries and damage control orthopedics; Bone stimula-tion in nonunion; Indications for locking plates; Fractures requiring anatomic reduction.AUDIENCE: Mainly trauma fellows and practicing or-thopedists are the targeted audience of the book, but not only the basic knowledge for the orthopedic residents but also the expert advices for complicated and controversial cases pointing experienced surgeons widen the spectrum of audience. Also non-physician personnel may benefit the basic knowledge from brief answers given in a casual format.ASSESMENT: “Curbside Consultation in Fracture Man-agement:49 Clinical Questions” offering practical, brief, evidence based answers to frequently asked questions especially those have been often left controversial related with the treatment of fractures of upper and lower extrem-ity, pelvic fractures is a useful resource mainly for resi-dents, fellows and junior orthopedists. Casual format that mimics a “curbside” dialog of colleagues and also the rich illustrations by images and diagrams makes the advanced knowledge in the text easier to understand and learn. Questions are carefully chosen from a wide spectrum of subjects related to fracture management to form a unique reference including high and low energy trauma fractures, pediatric fractures, fractures in elderly, multiple orthope-dic injury, and general fracture care. Assessment of frac-tures and diagnostic approach, postoperative care and

  3. Web-Based Depression Screening and Psychiatric Consultation for College Students: A Feasibility and Acceptability Study

    Directory of Open Access Journals (Sweden)

    Aya Williams


    Full Text Available Background. A steady rise in the prevalence of depression among college students has negatively affected student quality of life. This study investigates the feasibility and acceptability of a Web-based model, including Skype, to screen and provide psychiatric consultation to depressed college students. Methods. Students completed the 9-item Patient Health Questionnaire (PHQ-9 online; those who screened positive (PHQ-9 ≥ 10 or endorsed any level of suicidal ideation were offered Web-based psychiatric consultation using Skype. After the consultation, students filled out a 7-item satisfaction questionnaire to report on the acceptability of this Web-based method. Results. A total of 972 students consented to the online depression screening and 285 screened positive. Of those, 69 students consented and 17 students successfully completed the psychiatric consultation via Skype. Thirteen (76.4% students found the interview useful in helping them understand their depression. Fifteen (88.2% students thought that psychologists and psychiatrists could successfully see patients via videoconferencing. Conclusions. Current online technologies can provide depression screening and psychiatric consultation to college students; those who participated reported a positive experience. Future studies will need to address the low levels of participation among college students and attract students who are underserved, as well as use a videoconferencing platform that adequately protects data confidentiality.

  4. Attracting Child Psychiatrists to a Televideo Consultation Service: The TeleLink Experience

    Directory of Open Access Journals (Sweden)

    Tiziana Volpe


    Full Text Available Objective. Identify aspects of psychiatry work that are rewarding, as well as those that are challenging, from the perspective of psychiatrists and residents participating in televideo consultation services. Method. A web-based survey was distributed to psychiatrists within the Division of Child Psychiatry at the University of Toronto. Also, semistructured interviews were conducted with six child psychiatrists providing services to a telepsychiatry program. Finally, a focus group interview was held with four psychiatry residents. Results. Child psychiatrists are very comfortable conducting assessments via televideo. Factors identified as being important in the decision to participate in telepsychiatry include assisting underserved communities, supportive administrative staff, enhanced rural provider capacity, financial incentives, and convenience. The study’s qualitative phase identified four themes in the decision to participate in telepsychiatry: (1 organizational, (2 shared values, (3 innovation, and (4 the consultation model. Conclusion. The success of televideo consultation programs in attracting child psychiatrists to provide consultation services to underresourced communities makes an important contribution to psychiatric workforce shortages. Understanding what aspects of telepsychiatry are most appreciated by consulting psychiatrists and residents offers useful strategies to telepsychiatry administrators and medical school educators seeking to attract, train, and retain psychiatry practitioners.

  5. Criteria in consultant selection: public procurement of architectural and engineering services

    Directory of Open Access Journals (Sweden)

    Josefin Sporrong


    Full Text Available The competence, commitment and attitudes of design consultants strongly influence the quality and costs of built facilities. However, in the selection of professional services it is often difficult to specify and assess non-price criteria related to both firms and individual consultants. Therefore, clients traditionally rely on long term relations or recommendations from clients or colleagues. Public procurement regulation, however, restricts the use of such informal data. This study seeks to understand how procurers act to reconcile these conflicting demands.An explorative questionnaire survey distributed to Swedish municipalities investigates which selection criteria and information sources are used, as well as perceived difficulties and shortcomings related to consultancy procurement. Results show a high focus on price or more easily measured non-price criteria. This might limit the ability of municipal officials to evaluate consultant competence, especially aspects related to design and execution of projects. Furthermore, personal information sources are widely used, indicating a conflict between procurement practice and existing regulation. Unexpectedly, procurement officials were generally satisfied with their procurement practice. However, managers and more experienced procurers tend to be more satisfied than other officials. Satisfaction also appears to be connected to the existence of a procurement policy and more advanced selection methods. Keywords: public procurement, selection, consultants, Sweden

  6. Are patients' and doctors' accounts of the first specialist consultation for chronic back pain in agreement?

    Directory of Open Access Journals (Sweden)

    White KB


    Full Text Available Kathy B White,1 John Lee,2 Amanda C de C Williams3 1Central and North West London NHS Foundation Trust, 2School of Life and Medical Sciences, University College London, 3Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, London, UK Introduction: The first consultation at a specialist pain clinic is potentially a pivotal event in a patient’s pain history, affecting treatment adherence and engagement with longer term self-management. What doctors communicate to patients about their chronic pain and how patients interpret doctors’ messages and explanations in pain consultations are under-investigated, particularly in specialist care. Yet, patients value personalized information about their pain problem.Patients and methods: Sixteen patients in their first specialist pain clinic consultation and the doctors they consulted were interviewed shortly after the consultation. Framework analysis, using patient themes, was used to identify full match, partial match, or mismatch of patient–doctor dyads’ understandings of the consultation messages.Results: Patients and doctors agreed, mainly implicitly, that medical treatment aiming at pain relief was primary and little time was devoted to discussion of self-management. Clinically relevant areas of mismatch included the explanation of pain, the likelihood of medical treatments providing relief, the long-term treatment plan, and the extent to which patients were expected to be active in achieving treatment goals.Discussion: Overall, there appears to be reasonable concordance between doctors and patients, and patients were generally satisfied with their first consultation with a specialist. Two topics showed substantial mismatch, the estimated likely outcome of the next planned intervention and, assuming (as doctors but not patients did that this was unsuccessful, the long-term treatment plan. It appeared that more complex issues

  7. Reflections on the role of consultant radiographers in the UK: The perceived impact on practice and factors that support and hinder the role

    International Nuclear Information System (INIS)

    Henwood, S.; Booth, L.; Miller, P.K.


    Study context: This paper is the third paper arising from a two year long, in-depth case study exploring various components of the role of consultant radiographers in the UK. This paper focuses particularly upon the perceived impact of the role and factors that support and hinder the role in practice. Methods: A longitudinal case study method was used to explore the role of consultant radiographers. Interviewing was informed and guided by a phenomenological approach to promote a deeper understanding of consultants' experiences in the role. Eight consultant radiographers participated, with six involved throughout the whole study. Over an 18 month period each of those six consultants was interviewed three times. Two consultants only participated in the first interview; these interviews are also reported here. A total of 20 interviews were conducted. Findings: Interviews explored the impact of the consultant role as perceived by consultants themselves, and encouraged individual reflection on factors which had both supported and hindered success therein. Analysis demonstrated that there was substantial variation in the experiences communicated yet, and without any exception, all consultants reported that the introduction of their role had been beneficial to service delivery and quality of patient care. A number of obstacles were outlined, as well as a range of support mechanisms. Recommendations are thus made as to how the consultant role might be more effectively supported in the future. - Highlights: • The perceived impact of the consultant radiographer role in practice. • Reflections upon what supported the consultants in their role. • Reflections upon what hindered the consultants in their role.

  8. Traditional finals and OSCEs in predicting consultant and self-reported clinical skills of PRHOs: a pilot study. (United States)

    Probert, Christopher S; Cahill, David J; McCann, Gemma L; Ben-Shlomo, Yoav


    As we move from standard 'long case' final examinations to new objective structured formats, we need to ensure the new is at least as good as the old. Furthermore, knowledge of which examination format best predicts medical student progression and clinical skills development would be of value. A group of medical students sat both the standard long case examination and the new objective structured clinical examination (OSCE) to introduce this latter examination to our Medical School for final MB. At the end of their pre-registration year, the group and their supervising consultants submitted performance evaluation questionnaires. Thirty medical students sat both examinations and 20 returned evaluation questionnaires. Of the 72 consultants approached, 60 (83%) returned completed questionnaires. No correlation existed between self- and consultant reported performance. The traditional finals examination was inversely associated with consultant assessment. Better performing students were not rated as better doctors. The OSCE (and its components) was more consistent and showed positive associations with consultant ratings across the board. Major discrepancies exist between the 2 examination formats, in data interpretation and practical skills, which are explicitly tested in OSCEs but less so in traditional finals. Standardised marking schemes may reduce examiner variability and discretion and weaken correlations across the 2 examinations. This pilot provides empirical evidence that OSCEs assess different clinical domains than do traditional finals. Additionally, OSCEs improve prediction of clinical performance as assessed by independent consultants. Traditional finals and OSCEs correlate poorly with one another. Objective structured clinical examinations appear to correlate well with consultant assessment at the end of the pre-registration house officer year.

  9. Worker expectations of occupational health consultations. (United States)

    Stilz, R; Madan, I


    Worker beliefs and expectations influence their health and rehabilitation. However, little is known about worker expectations of occupational health (OH) consultations and if these are associated with their perceptions of health and work. To examine worker expectations of OH consultations, and whether the variability of worker expectations is associated with their perception of health and work and personal characteristics. A questionnaire on OH physicians' professional standards was developed from national guidance and validated by a survey of OH physicians. We explored 81 workers' expectations of professional standards along with their perception of health and work. Worker expectations were compared with the OH physician validation score. Associations of worker characteristics, their health and work perceptions and their expectations of professional standards were analysed by linear regression. Worker expectations of professional standards were lower when compared with the OH physician validation score (E = 3.9 versus 4.3, ΔE = 0.48, 95% confidence interval [CI] 0.30-0.66). Perceived manager support and work apprehension were associated with worker expectations (ΔE = 0.58, 95% CI: 0.29-0.86 for least versus most support; ΔE = 0.89, 95% CI: 0.41-1.36 for least versus highest apprehension). Job title, previous OH consultations and recovery expectations were not associated with worker expectations. Worker expectations of OH physicians' professional standards were lower than the standards set by national guidance as validated by the sampled OH physicians. Workers who felt more supported by their manager, and workers who were more apprehensive about the health impact of work had higher expectations of OH physicians' standards.

  10. Implementation of an Arranged Preventive Consultation in Danish General Practice

    DEFF Research Database (Denmark)

    Junge, Anne Gram; Kirkegaard, Pia; Thomsen, Janus Laust

    Background: In 2006 an arranged preventive consultation (0106-service) was implemented in Danish general practice. The purpose of the consultation is an attempt to improve the systematic prevention of the main chronic lifestyle diseases. Aim: This study examines the GP's experiences...... with the arranged preventive consultation with focus on facilitators and barriers in the implementation of the consultation. Material & Method: Semi-structured interviews with 10 GPs and nurses in general practice. Results & Conclusions: Economically lucrative services are not an isolated motivation for the GPs....../nurses, but must be accompanied with a basic belief in the effect of preventive consultations in general practice. The better payment of the 0106-service is used to spend more time per consultation and it makes the GPs/nurses feel rewarded for the preventive work they perform. The consultation frames a social...

  11. Ethics and lactation consultants: developing knowledge, skills, and tools. (United States)

    Noel-Weiss, Joy; Walters, Gregory J


    This article studies the role of ethics in the context of the work of International Board Certified Lactation Consultants. It provides an overview of some of the main ethical approaches with the goal of contributing to the knowledge, skills, and tools required by lactation consultants. Five main sections structure the article: background, current literature, ethical theory and principles, implications for lactation consultants, and decision-making frameworks. Background about the International Board of Lactation Consultant Examiners and International Board Certified Lactation Consultants and the significance of applied ethics in their work are described. Current literature regarding ethics and lactation consultants is reviewed. Because a computer-based literature search yielded a lack of articles, ethics in nursing literature is also presented. Three main ethical theories and 5 key ethical principles are explored with a view to their implications for lactation consultants. Finally, decision-making frameworks are considered as systematic tools for making ethical decisions.


    Directory of Open Access Journals (Sweden)

    Botezat Elena


    Full Text Available Management consulting helping organizations improve their performance, primarily through the thorough analysis of existing business problems and development of plans for improvement. There is probably no activity about which the opinions are so divided as management consulting. The purpose of this paper is to make some reflections upon what role play the consulting management services as professional service to the firms and how offering these services affects the offering and delivery of other services of the firms. The study is based on an office documentation research within consulting firms and resources. The approach tries to be critical and reflective, examines different consulting roles by developing a typology. The purpose is to aware of these professional services young business people. The FAQ of this service are: “How to choose the best consultant?” and “Why did fail consultant?”.

  13. Selecting a healthcare consultant, Part I: How to get started. (United States)

    Scheuerman, J L; Smith, V A


    Janet L. Scheuerman and Vaughan A. Smith outline the factors that determine why and when consulting services are appropriate, presenting an overview of the initial steps in consultant selection. The expertise of a consultant is often needed for specialized problems, problems needing immediate assessment, drastic rescue situations, difficulties that defy standard solutions, and changes in the regulatory and competitive environment. Many organizational and planning issues also require outside consulting expertise. Institutions use consultants for specialized information, an independent perspective, as catalysts for change, and for cost-effective service and education. The consulting process consists of five phases; Part I provides a careful analysis of crucial preliminary selection activities. An organizational commitment to the process must be made, and needs, key issues, and expectations defined before selecting a committee and identifying potential consulting sources. Part II will appear in the next issue of the JQA.

  14. The selection factors of consultants in Serbian agro-sector

    Directory of Open Access Journals (Sweden)

    Mihailović Branko


    Full Text Available The selection of consultants should be paid special attention, because in Serbia, or its agro-sector, the awareness of the criteria for the selection of consultancy services is not sufficiently raised. The research itself is based on the assumption of manager experience and knowledge gained by reading expert books, greeted with scepticism. Thus, the relevance of certain criteria for the consultant selection is in the form of a hypothesis, with the aim to determine the real situation in this field. Determination of consultant selection basic factors in Serbia is imposed by the law of nature. The process of selecting a consultant starts with defining the requirement of the consultancy task and criteria for the degree of performance of the task. This process usually leads to the reference list that a consultant is supposed to have.

  15. Saudi Arabia; 2013 Article IV Consultation


    International Monetary Fund


    This staff report on Saudi Arabia’s 2013 Article IV Consultation discusses economic policies and development. As the largest crude oil exporter, and the only producer with significant spare capacity, Saudi Arabia plays a systemic and stabilizing role in the global oil market. In 2011, Saudi Arabia formally committed through the G20 to use its systemic position in the oil market to promote global stability. Saudi Arabia raised oil production to a 30-year high to ensure demand was met the abrup...

  16. Client/consultant model services agreement

    CERN Document Server

    International Federation of Consulting Engineers


    The terms of the Client Consultant Model Services agreement (The White Book) have been prepared by the Fédération Internationale des Ingénieurs-Conseils (FIDIC) and are recommended for general use for the purposes of pre-investment and feasibility studies, designs and administration of construction and project management, where proposals for such services are invited on an international basis. They are equally adaptable for domestic agreements. - See more at:

  17. Search and nonsearch protocols for radiographic consultation

    International Nuclear Information System (INIS)

    Swensson, R.G.; Theodore, G.H.


    Six radiologists, acting as film reviewers, used two different consultation protocols to differentiate among 292 ambiguous findings on chest films: 120 simulated nodules and 172 normal findings (previous readers' false-positive reports of nodules). The non-search protocol identified each finding (by location), and reviewers rated its likelihood as a nodule. The search protocol, which asked reviewers to report and rate all locations regarded as possible nodules on each film, assigned a default negative rating to any unreported finding (nodule or normal). Receiver operator characteristic analyses demonstrated a significantly higher accuracy for each reviewer's search- protocol discriminations between these nodules and confusing normal findings

  18. A rock characterisation facility consultative document

    International Nuclear Information System (INIS)


    This U.K. Nirex Ltd., consultative document describes a proposed underground rock characterisation facility, east of Sellafield, for conducting geophysical surveys as a basis for refining long-term safety analysis of an underground repository for intermediate-level and low-level radioactive wastes. Planning application will be submitted in 1993. The construction of shafts and galleries is described and the site's geologic, topographical, climatic and archaeological features discussed. The effects to the local environment and on local populations and other socio-economic factors are discussed. (UK)

  19. New hospital consultant: surviving a difficult period. (United States)

    Robinson, Geoffrey; Morreau, Johan; Leighton, Marion; Beasley, Richard


    The first years of consultant practice are amongst the most stressful in a medical specialist's career. Recognising the likely difficulties is essential if measures are to be put in place to lessen their impact. In this article, recommendations are made on how to balance clinical and non-clinical duties and to obtain the support required for professional development. Self-care of mental and physical health is vital and planning is necessary to ensure that both personal health and a work/life balance are maintained.

  20. Scientific decision-making and stakeholder consultations: the case of salt recommendations. (United States)

    Timotijevic, Lada; Barnett, Julie; Brown, Kerry; Raats, Monique M; Shepherd, Richard


    Scientific advisory committees (SACs) are seen as "boundary organisations" working at the interface between science, policy and society. Although their narrowly defined remit of risk assessment is anchored in notions of rationality, objectivity, and reason, in reality, their sources for developing recommendations are not limited to scientific evidence. There is a growing expectation to involve non-scientific sources of information in the formation of knowledge, including the expectation of stakeholder consultation in forming recommendations. Such a move towards "democratisation" of scientific processes of decision-making within SACs has been described and often studied as "post-normal science" (PNS) (Funtowicz & Ravetz, 1993). In the current paper we examine the application of PNS in practice through a study of stakeholder consultations within the workings of the UK Scientific Advisory Committee for Nutrition (SACN). We use the theoretical insights from PNS-related studies to structure the analysis and examine the way in which PNS tenets resonate with the practices of SACN. We have selected a particular case of the SACN UK recommendations for salt as it is characterized by scientific controversy, uncertainty, vested interests and value conflict. We apply the tenets of PNS through documentary analysis of the SACN Salt Subgroup (SSG) consultation documents published in 2002/2003: the minutes of the 5 SACN SSG's meetings which included summary of the SACN SSG's stakeholder consultation and the SSG's responses to the consultation. The analysis suggests that the SACN consultation can be construed as a process of managing sources of risk to its organisation. Thus, rather than being an evidence of post-normal scientific practice, engagement became a mechanism for confirming the specific framing of science that is resonant with technocratic models of science holding authority over the facts. The implications for PNS theory are discussed. Copyright © 2013 Elsevier Ltd. All

  1. Radiology Consultation in the Era of Precision Oncology: A Review of Consultation Models and Services in the Tertiary Setting. (United States)

    DiPiro, Pamela J; Krajewski, Katherine M; Giardino, Angela A; Braschi-Amirfarzan, Marta; Ramaiya, Nikhil H


    The purpose of the article is to describe the various radiology consultation models in the Era of Precision Medicine. Since the inception of our specialty, radiologists have served as consultants to physicians of various disciplines. A variety of radiology consultation services have been described in the literature, including clinical decision support, patient-centric, subspecialty interpretation, and/or some combination of these. In oncology care in particular, case complexity often merits open dialogue with clinical providers. To explore the utility and impact of radiology consultation services in the academic setting, this article will further describe existing consultation models and the circumstances that precipitated their development. The hybrid model successful at our tertiary cancer center is discussed. In addition, the contributions of a consultant radiologist in breast cancer care are reviewed as the archetype of radiology consultation services provided to oncology practitioners.

  2. Radiology consultation in the era of precision oncology: A review of consultation models and services in the tertiary setting

    Energy Technology Data Exchange (ETDEWEB)

    DiPiro, Pamela J.; Krajewski, Katherine M.; Giardino, Angela A.; Braschi-Amirfarzan, Marta; Ramaiya, Nikhil H. [Dept. of Radiology, Brigham and Women' s Hospital, Harvard Medical School, Boston (United States)


    The purpose of the article is to describe the various radiology consultation models in the Era of Precision Medicine. Since the inception of our specialty, radiologists have served as consultants to physicians of various disciplines. A variety of radiology consultation services have been described in the literature, including clinical decision support, patient-centric, subspecialty interpretation, and/or some combination of these. In oncology care in particular, case complexity often merits open dialogue with clinical providers. To explore the utility and impact of radiology consultation services in the academic setting, this article will further describe existing consultation models and the circumstances that precipitated their development. The hybrid model successful at our tertiary cancer center is discussed. In addition, the contributions of a consultant radiologist in breast cancer care are reviewed as the archetype of radiology consultation services provided to oncology practitioners.

  3. Radiology consultation in the era of precision oncology: A review of consultation models and services in the tertiary setting

    International Nuclear Information System (INIS)

    DiPiro, Pamela J.; Krajewski, Katherine M.; Giardino, Angela A.; Braschi-Amirfarzan, Marta; Ramaiya, Nikhil H.


    The purpose of the article is to describe the various radiology consultation models in the Era of Precision Medicine. Since the inception of our specialty, radiologists have served as consultants to physicians of various disciplines. A variety of radiology consultation services have been described in the literature, including clinical decision support, patient-centric, subspecialty interpretation, and/or some combination of these. In oncology care in particular, case complexity often merits open dialogue with clinical providers. To explore the utility and impact of radiology consultation services in the academic setting, this article will further describe existing consultation models and the circumstances that precipitated their development. The hybrid model successful at our tertiary cancer center is discussed. In addition, the contributions of a consultant radiologist in breast cancer care are reviewed as the archetype of radiology consultation services provided to oncology practitioners

  4. Gynecologic Oncologist as surgical consultant: intraoperative consultations during general gynecologic surgery as an important focus of gynecologic oncology training. (United States)

    Aviki, Emeline M; Rauh-Hain, J Alejandro; Clark, Rachel M; Hall, Tracilyn R; Berkowitz, Lori R; Boruta, David M; Growdon, Whitfield B; Schorge, John O; Goodman, Annekathryn


    The aim of this study is to explore the previously unexamined role of the Gynecologic Oncologist as an intraoperative consultant during general gynecologic surgery. Demographic and clinical data were collected on 98 major gynecologic surgeries that included both a general Gynecologist and a Gynecologic Oncologist between October 2010 and August 2014. Data were analyzed using XLSTAT-Prov2014.2.02. Of 794 major gynecologic surgeries, 98 (12.3%) cases that involved an intraoperative consultation were identified. There were 36 (37%) planned consults and 62 (63%) unplanned consults. Significantly more planned consults were during laparoscopy (100% v 58%; pGynecologic Oncologists play a pivotal role in the support of generalist colleagues during pelvic surgery. In this series, Gynecologic Oncologists were consulted frequently for complex major benign surgeries. It is important to incorporate the skills required of an intraoperative consultant into Gynecologic Oncology fellowship training. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Acute surgical unit: The consultant experience

    Directory of Open Access Journals (Sweden)

    Patrick J Stokes


    Full Text Available Background Establishment of the Acute Surgical Unit (ASU has redefined the approach to emergency surgery in Australia with quantitative data showing improvement in patient outcomes. However, as qualitative data regarding the ASU remains scarce, we sought to determine the impact of the ASU on overall surgeon job satisfaction. Aims The aim of this paper was to specifically address the impact of the ASU on consultant surgeons overall job satisfaction. Methods We designed a 34 – item questionnaire with consultant general surgeons addressing important aspects of the ASU. Themes included on – call rostering and workload, academic pursuits, surgical training, work – life balance and overall job satisfaction. Results We received responses from 88 surgeons currently working on ASU units, responding correctly and in full to the survey. Overall, our surveyed cohort reported better on – call rostering, improved surgical training and higher levels of job satisfaction and overall work – life balance with ASU implementation. Conclusion Preliminary qualitative results indicate that the ASU may improve on – call rostering, work – life balance and overall job satisfaction.

  6. Interpersonal Consulting Skills for Instructional Technology Consultants: A Multiple Case Study (United States)

    van Leusen, Peter; Ottenbreit-Lefwich, Anne T.; Brush, Thomas


    Building a trust-based relationship with faculty is one of the most important attributes of effective Instructional Technology Consultants (ITC) in order to integrate emerging technologies into higher education. Utilizing a multiple case study research design, four experienced ITCs at a large urban research university located in the Midwest showed…

  7. "Take me seriously and do something!" - a qualitative study exploring patients' perceptions and expectations of an upcoming orthopaedic consultation. (United States)

    Samsson, Karin S; Bernhardsson, Susanne; Larsson, Maria Eh


    Patients' perceptions of care is an important factor in evaluation of health care, in quality assessment, and in improvement efforts. Expectations of assessments or procedures such as surgery have been found to be related to perceptions of outcome as well as satisfaction, and are therefore of interest to both clinicians and researchers. Increased understanding of these patient views is important so that orthopaedic assessments, regardless of who performs them, can be further developed and patient-centred to better meet patients' needs. The purpose of this study was therefore to explore patients' perceptions and expectations of an upcoming orthopaedic consultation. This was an explorative qualitative study with an inductive approach. Thirteen patients who were referred for orthopaedic consultation were included using a purposeful sampling strategy. Patients participated in individual, semi-structured interviews that were recorded, transcribed verbatim and analysed with qualitative content analysis. The participants' expressed perceptions and expectations of the upcoming orthopaedic surgeon consultation were classified into 5 categories: Hoping for action, Meeting an expert, A respectful meeting, Participating in the consultation, and A belief that hard facts make evidence. Across the categories, an overarching theme was formulated: Take me seriously and do something! The participants emphasised a desire to be taken seriously and for something to happen, both during the consultation itself and as a result of the orthopaedic consultation. They described a trust in the expertise of the orthopaedic surgeon and stressed the importance of the surgeon's attitude, but still expected to participate in the consultation as well as in the decision-making process. The study findings illuminate aspects that are important for patients in an orthopaedic consultation. The descriptions of patients' perceptions and expectations can serve to improve patient-clinician relationships as

  8. The role, costs and value for money of external consultancies in the health sector: A study of New Zealand's District Health Boards. (United States)

    Penno, Erin; Gauld, Robin


    Public spending on external consultancies, particularly within the health sector, is highly controversial in many countries. Yet, despite the apparently large sums of money involved, there is little international analysis surrounding the scope of activities of consultants, meaning there is little understanding of how much is spent, for what purpose and with what result. This paper examines spending on external consultancies in each of New Zealand's 20 District Health Boards (DHB). Using evidence obtained from DHBs, it provides an insight into the cost and activities of consultants within the New Zealand health sector, the policies behind their engagement and the processes in place to ensure value for money. It finds that DHB spending on external consultants is substantial, at $NZ10-60 million annually. However, few DHBs had policies governing when consultants should be engaged and many were unable to easily identify the extent or purpose of consultancies within their organisation, making it difficult to derive an accurate picture of consultant activity throughout the DHB sector. Policies surrounding value for money were uncommon and, where present, were rarely applied. Given the large sums being spent by New Zealand's DHBs, and assuming expenditure is similar in other health systems, our findings point to the need for greater accountability for expenditure and better evidence of value for money of consultancies within publicly funded health systems. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. Parameters of consultee satisfaction with inpatient academic psychiatric consultation services: a multicenter study. (United States)

    Lavakumar, Mallika; Gastelum, Emily D; Choo, Tse-Hwei; Gerkin, Jonathan S; Kahn, Debra; Lee, Seonjoo; Nicolson, Stephen E; Rosenthal, Lisa J; Schwartz, Ann C; Tobin, Marie B; Wharton, Ralph N; Shapiro, Peter A


    Consultation-liaison psychiatrists commonly perceive consultee satisfaction as a useful global measure of consultation-liaison service performance. No tool exists to measure consultee satisfaction. A single-site study at Columbia University Medical Center elicited ratings of parameters importantly contributing to consultee satisfaction within consultation-liaison services. The purpose of this study was to assess the generalizability of the rating of importance of these parameters in a larger, multicenter sample. From October 2013 to January 2014, a confidential and voluntary Web-based survey was distributed to 133 physicians at 7 academic centers in the United States asking them to rate the importance of 16 performance parameters (identified in the previous single-site study) in determining consultee satisfaction. Overall, 87 recipients (65%) responded to the survey. Among all the 16 items, there was no significant difference between sites in ratings of item importance. Of the 16 parameters, 9 received a mean rating in the "important" to "very important" range. Three items, "completion of consultation within 24 hours of request," "understanding the core questions being asked," and "practical and helpful management suggestions for medical staff" were rated as the most important. Quickly managing behavioral problems, management suggestions for nursing staff, verbal communication of recommendations, providing diagnostic clarification, facilitating transfer to inpatient psychiatry, and providing follow-up consultation were other parameters that were highly valued by consultees. We found good generalizability across academic medical centers for ratings of parameters important for consultee satisfaction with consultation-liaison services, which can provide the basis for a consultee satisfaction measurement tool. Copyright © 2015 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

  10. Consultative team to assess manual handling and reduce the risk of occupational injury. (United States)

    Carrivick, P J; Lee, A H; Yau, K K


    To describe the formation of a consultative team to assess the risk of manual handling in the workplace that started in October 1992 within the cleaning services department of a 600 bed hospital, and to evaluate the effectiveness of its recommendations in reducing the rate and severity (time lost and cost) of workers' compensation injury. The consultative team identified, assessed, and recommended controls for manual handling and other injury risks. Data on injuries counted before and after implementation of the team's recommendations were obtained for the cleaning services study group, an orderly services comparison group, as well as cleaners from a peer hospital and for the State of Western Australia. Evaluation of the four groups was undertaken 3 years after the end of the study period, to allow maturation of the costs of the claims (adjusted to July 1998 consumer price index) and hours lost from work. Statistical analysis showed that implementation of the recommendations significantly reduced numbers and rates of injury, but not the severity of injury, in the cleaning services study group. There was no difference in numbers or severity of injuries for the comparison groups before and after implementation of the recommendations. The recommendation of the consultative team can produce a meaningful and sustained reduction in rates of injury within an at risk population. The results support a consultative approach to reducing workplace injuries from manual handling. The team process has potential for application to occupational groups at risk of exposure to other types of hazards.

  11. Understanding Carbohydrates (United States)

    ... Size: A A A Listen En Español Understanding Carbohydrates How much and what type of carbohydrate foods ... glucose levels in your target range. Explore: Understanding Carbohydrates Glycemic Index and Diabetes Learn about the glycemic ...

  12. Psychoimmunology Consultation - A Study on Comorbidity

    Directory of Open Access Journals (Sweden)

    Mariana Marinho


    Full Text Available Introduction: In comparison to the general population, notified  HIV-positive patients have higher prevalence  rates for most mental disorders, with values reaching 30-60%. Objectives: To characterize the population that is referred to Psychiatry-Psychoimmunology consultation; to explore the possible relationship  between  psychiatric  diagnosis, antiretroviral treatment and HCV co-infection, with sociodemographic and clinical variables. Methods: We have selected HIV-positive patients referred for the first time to Psychiatry-Psychoimmunology consultation, between January 2012 and July 2015. Information was collected through the clinical process in electronic form. Statistical analy- sis was performed using the statistical analysis  program  Statistical  Package for Social Sciences, version 20. Results: The sample contained 209 patients, with a median age of 43 years, mostly men, with four years of schooling, single, professionally inactive, infected via heterosexual behavior. However, we found statistically significant differences between sexes for the last three variables. The majority was under antiretroviral treatment, with no significant differences between sexes. In the first consultation, 29.0% and 30.1% had, respectively, substance use and HCV co-infection, with a significant predominance in men. Depressive symptoms and adjustment disorder to the disease constituted, respectively, the referral reason and the most common psychiatric diagnosis, in both sexes. More than half had psychiatric history. HCV co-infection showed a statistical significant correlation between variables like sex, occupational status, infection transmission route,  psychiatric  history  and  use  of  alcohol and/or illicit drugs. The same was true between the psychiatric diagnosis and some variables like infection notification  time, alcohol and/or drugs and HCV co-infection. Conclusions: During the course of infection, these patients often face

  13. Digital audio recordings improve the outcomes of patient consultations

    DEFF Research Database (Denmark)

    Wolderslund, Maiken; Kofoed, Poul-Erik; Holst, René


    OBJECTIVES: To investigate the effects on patients' outcome of the consultations when provided with: a Digital Audio Recording (DAR) of the consultation and a Question Prompt List (QPL). METHODS: This is a three-armed randomised controlled cluster trial. One group of patients received standard care......, while the other two groups received either the QPL in combination with a recording of their consultation or only the recording. Patients from four outpatient clinics participated: Paediatric, Orthopaedic, Internal Medicine, and Urology. The effects were evaluated by patient-administered questionnaires...... of their consultation positively influences the patients' perception of having adequate information after the consultation. PRACTICE IMPLICATIONS: The implementation of a QPL and audio recording of consultations should be considered in routine practice....

  14. OHS consultants as facilitators of learning processes in client enterprises

    DEFF Research Database (Denmark)

    Broberg, Ole


    in a public institution, and 4) new factory building. The results indicated differences across the OHS consultants studied when it came to the learning aspects of their work practice. In terms of organizational learning, the most com-mon observed effect in the client enterprise was single loop learning......In carrying out consultancy the Danish occupational health services (OHS) are supposed to support and develop the capabilities of enterprises to manage work environment issues. This may be interpreted in a learning perspective: As part of the process consultancy the OHS consultants have to put...... emphasis on initiating learning processes in the client enter-prise in a way that will develop the OHS management capabilities of that enterprise. This presentation is based on a research program focussing on how OHS consultants go about when they are involved in consultancy on technological change...

  15. Assisted Living Facilities: The Next Frontier for Consultant Pharmacists. (United States)

    Coulson, Eva; Blaszczyk, Amie Taggart


    Consultant pharmacists improve the lives of older adults by providing medication management, avoiding adverse drug reactions, and uncovering duplicative therapy. Despite this, there is a lack of legislation supporting the role of the consultant pharmacist in many of the settings-other than nursing facilities-where seniors reside. Specifically, federal and state laws do not recognize consultant pharmacists for their specialized role in pharmacotherapy and the potential benefits they bring to older adults in assisted living facilities. Among many services, consultant pharmacists may provide monthly medication reviews, staff medication education, and medication system management in assisted living facilities. A literature search was conducted to identify literature supporting the benefits of consultant pharmacists in assisted living facilities. Gaps in available literature are discussed as are ideas for expanding the role of consultant pharmacists in assisted living facilities.

  16. Research on clinical ethics and consultation. Introduction to the theme. (United States)

    Reiter-Theil, Stella; Agich, George J


    Clinical ethics consultation has developed from local pioneer projects into a field of growing interest among both clinicians and ethicists. What is needed are more systematic studies on the ethical challenges faced in clinical practice and problem solving through ethics consultation from interdisciplinary perspectives. The Thematic Issue covers a range of topics and includes five recent studies from various European countries and the USA, focusing on issues such as the ethical difficulties of end of life decisions, experiences with newly developed or well established ethics consultation services, and the expectations of physicians in various clinical fields who are still unfamiliar with clinical ethics consultation. The papers included illustrate the interface between different socio-cultural contexts and their ways of dealing with clinical ethics consultation. They deepen the dialogue on clinical ethics consultation that has emerged at the European and International level.

  17. Cap and trade offsets regulation - consultation paper

    Energy Technology Data Exchange (ETDEWEB)



    Due to increasing concerns about the environment, British Columbia has committed to reducing its 2007 greenhouse gas emissions levels by 33% in 2020 and 80% in 2050. To reach those objectives, emissions trading and offset regulations are being developed by the Climate Action Secretariat. The aim of this document is to present a first draft of the regulations to the various stakeholders, including First Nations and the general public, together with the proposed offset eligibility criteria and related process, and to get their feedback. This document is itself part of the 5-phase process of developing the regulations. Following the 45 days during which comments on the proposed regulation were sought, the climate action secretariat will complete legal drafting of the regulations, drawing on help from this stakeholder input, and the regulation will subsequently be implemented. An accompanying response form was attached to this consultation paper.

  18. Expert-System Consultant To Operating Personnel (United States)

    Heard, Astrid E.; Pinkowski, Patrick P.; Adler, Richard M.; Hosken, R. Bruce


    Artificial intelligence aids engineers and technicians in controlling and monitoring complicated systems. Operations Analyst for Distributed Systems (OPERA) software is developmental suite of expert-system computer programs helping engineers and technicians operating from number of computer workstations to control and monitor spacecraft during prelaunch and launch phases of operation. OPERA designed to serve as consultant to operating engineers and technicians. It preprocesses incoming data, using expertise collected from conglomerate of specialists in design and operation of various parts of system. Driven by menus and mouse-activated commands. Modified versions of OPERA used in chemical-processing plants, factories, banks, and other enterprises in which there are distributed-computer systems including computers that monitor or control other computers.

  19. Animal Welfare: Data from an Online Consultation. (United States)

    Sechi, Paola; Baldinelli, Chiara; Iulietto, Maria F; Goga, Beniamino T Cenci


    This paper analyses data obtained from an online survey related to animal welfare and religious slaughter topics. The questionnaire was conducted with the purpose of examining the purchase behaviour of a group of consumers (with different religious orientation) and their views on animal protection and ritual slaughter. The main results of the consultation were two. The first evidenced the respondents' great interest about the question on animal welfare, which is in accordance with the growing interest of European citizens concerning this issue. The second was the demand for a more transparent labelling of animal products, which would also reflect animal welfare and the slaughter method used. These results are in contrast with marketing analysis, which finds that consumers want to only receive positive information. Paradoxically, the more information is transmitted to reassure consumers, the higher is the risk to alarm them.

  20. Structural analysis consultation using artificial intelligence (United States)

    Melosh, R. J.; Marcal, P. V.; Berke, L.


    The primary goal of consultation is definition of the best strategy to deal with a structural engineering analysis objective. The knowledge base to meet the need is designed to identify the type of numerical analysis, the needed modeling detail, and specific analysis data required. Decisions are constructed on the basis of the data in the knowledge base - material behavior, relations between geometry and structural behavior, measures of the importance of time and temperature changes - and user supplied specifics characteristics of the spectrum of analysis types, the relation between accuracy and model detail on the structure, its mechanical loadings, and its temperature states. Existing software demonstrated the feasibility of the approach, encompassing the 36 analysis classes spanning nonlinear, temperature affected, incremental analyses which track the behavior of structural systems.

  1. Role of the nurse consultant in tissue viability. (United States)

    Harker, J

    Nurse consultant posts were introduced in 2000 with a view to expanding the role of nurses. The author was appointed as a nurse consultant in tissue viability to develop the service already in place in her trust and improve patient care. This article describes the role of the nurse consultant working in tissue viability and identifies the qualities and skills needed to undertake this role.

  2. Specialty Palliative Care Consultations for Nursing Home Residents With Dementia. (United States)

    Miller, Susan C; Lima, Julie C; Intrator, Orna; Martin, Edward; Bull, Janet; Hanson, Laura C


    U.S. nursing home (NH) residents with dementia have limited access to specialty palliative care beyond Medicare hospice. The objective of this study was to examine the value of expanded palliative care access for NH residents with moderate-to-very severe dementia. We merged palliative care consultation data in 31 NHs in two states to Medicare data to identify residents with consultations, moderate-to-very severe dementia, and deaths in 2006-2010. Initial palliative consultations were identified as occurring later and earlier (1-30 days and 31-180 days before death, respectively). Three controls for each consultation recipient were selected using propensity score matching. Weighted multivariate analyses evaluated the effect of consultations on hospital or acute care use seven and 30 days before death and on (potentially) burdensome transitions (i.e., hospital or hospice admission three days before death or two plus acute care transitions 30 days before death). With earlier consultation (vs. no consultation), hospitalization rates in the seven days before death were on average 13.2 percentage points lower (95% confidence interval [CI] -21.8%, -4.7%) and with later consultation 5.9 percentage points lower (95% CI -13.7%, +4.9%). For earlier consultations (vs. no consultations), rates were 18.4 percentage points lower (95% CI -28.5%, -8.4%) for hospitalizations and 11.9 lower (95% CI -20.7%, -3.1%) for emergency room visits 30 days before death; they were 20.2 percentage points lower (95% CI -28.5%, -12.0%) for burdensome transitions. Consultations appear to reduce acute care use and (potentially) burdensome transitions for dying residents with dementia. Reductions were greater when consultations were earlier. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  3. Experience of a year of adult hospital dermatology consultations. (United States)

    Storan, Eoin R; McEvoy, Marian T; Wetter, David A; El-Azhary, Rokea A; Camilleri, Michael J; Bridges, Alina G; Davis, Mark D P


    Dermatology consultations are frequently requested by inpatient hospital services. As inpatient dermatology services in the USA decline, dermatology hospital consultations are becoming increasingly important. We aim to describe the spectrum of skin diseases encountered and the health care subspecialties requesting dermatology hospital consultations. We performed a retrospective chart review of adult patient (age: ≥18 years) dermatology hospital consultations from January 1 to December 31, 2010. We examined patient demographic characteristics, consultation requesting services, and consultation diagnoses. Among dermatology services, 614 patients had 674 separate inpatient dermatology consultations during 2010. Of these patients, 55.9% were male (mean age: 59 years). In total, 205 consultations (30.4%) were requested by the internal medicine subspecialty, 137 (20.3%) by the hematology and oncology subspecialty, and 93 (13.8%) by the surgical subspecialty. The most common conditions seen by the hospital dermatology consulting service were skin infections (n = 125, 18.5%), dermatitis (n = 120, 17.8%), drug eruptions (n = 87, 12.9%), chronic wounds and ulcers (n = 55, 8.1%), cutaneous neoplasms (n = 39, 5.8%), graft-versus-host disease (n = 37, 5.5%), ecchymosis, purpura simplex or petechia (n = 26, 3.8%), intertrigo (n = 21, 3.1%), and urticaria (n = 20, 3.0%). The majority of consultations conducted by the dermatology hospital consulting service were for the management of common skin diseases, such as cutaneous infections, dermatitis, and drug eruptions. Most consultations were requested by the departments of internal medicine, hematology and oncology, and surgical services. © 2014 The International Society of Dermatology.

  4. A novel AIDS/HIV intelligent medical consulting system based on expert systems. (United States)

    Ebrahimi, Alireza Pour; Toloui Ashlaghi, Abbas; Mahdavy Rad, Maryam


    The purpose of this paper is to propose a novel intelligent model for AIDS/HIV data based on expert system and using it for developing an intelligent medical consulting system for AIDS/HIV. In this descriptive research, 752 frequently asked questions (FAQs) about AIDS/HIV are gathered from numerous websites about this disease. To perform the data mining and extracting the intelligent model, the 6 stages of Crisp method has been completed for FAQs. The 6 stages include: Business understanding, data understanding, data preparation, modelling, evaluation and deployment. C5.0 Tree classification algorithm is used for modelling. Also, rational unified process (RUP) is used to develop the web-based medical consulting software. Stages of RUP are as follows: Inception, elaboration, construction and transition. The intelligent developed model has been used in the infrastructure of the software and based on client's inquiry and keywords related FAQs are displayed to the client, according to the rank. FAQs' ranks are gradually determined considering clients reading it. Based on displayed FAQs, test and entertainment links are also displayed. The accuracy of the AIDS/HIV intelligent web-based medical consulting system is estimated to be 78.76%. AIDS/HIV medical consulting systems have been developed using intelligent infrastructure. Being equipped with an intelligent model, providing consulting services on systematic textual data and providing side services based on client's activities causes the implemented system to be unique. The research has been approved by Iranian Ministry of Health and Medical Education for being practical.

  5. Clinical Ethics Consultation After God: Implications for Advocacy and Neutrality. (United States)

    Parker, J Clint


    In After God: Morality and Bioethics in a Secular Age, H. Tristram Engelhardt, Jr. explores the broad implications for moral reasoning once a culture has lost a God's-eye perspective. In this paper, I focus on the implications of Engelhardt's views for clinical ethics consultation. I begin by examining the question of whether clinical ethics consultants (CECs) should advocate a particular viewpoint and/or process during consultations or adopt a neutral stance. I then examine the implications of Engelhardt's views for this question. Finally, I discuss some of Engelhardt's foundational ontological, metaphysical, meta-ethical, and epistemological commitments and how these commitments connect to his views on clinical ethics consultation.

  6. The role of consultant-researchers in the design and implementation process of a programme budget in a local government organization

    NARCIS (Netherlands)

    ter Bogt, H.J.; van Helden, G.J.

    This paper deals with our role as consultant-researchers in the improvement trajectory of a programme budget used in a Dutch province. For the 2009s programme budget the newly designed budget format was used in two pilot programmes. One year later we participated in the implementation of this format

  7. Public consultation in public policy information: a state-of-the-art report

    International Nuclear Information System (INIS)

    Bishop, A.B.; McKee, M.; Hansen, R.D.


    The purpose of the National Waste Terminal Storage (NWTS) Program is to site, construct and operate nuclear waste repositories at several locations. Recent experience indicates that the public is aware of the problems of nuclear waste disposal, and correspondingly there is public concern about how and where to dispose of nuclear wastes. The selection of sites involves a wide range of considerations including geological, technical and environmental feasibility. In addition to these, it is important that societal acceptance of repository options also be taken into account in moving foward with the NWTS Program. Such an incorporation of social considerations and preferences correspondingly implies the need for public consultation in the site selection process. In exploring the concept and state-or-the-art of public involvement in public policy decision, a number of important questions are relevant: (1) What are the basic objectives of public participation in policy formation and program decisions. (2) Who are the ''publics'' that should be involved and how can they be identified. (3) What information should be communicated between the agency and the publics. (4) What techniques are available to elicit public participation and involvement and what are their capabilities. At the outset, it should be noted that the purpose of this paper in addressing these questions is not to design public participation procedures for the NWTS program. Rather, the above are questions that provide a broad framework for developing an understanding of citizen participation in public policy decisions, such as nuclear waste disposal. In this sense, the following discussion is to provide a context and guidance for approaching the problem of organizing and structuring involvement in the NWTS program. Annotated bibliography of 95 references is included

  8. Public consultation in public policy information: a state-of-the-art report

    Energy Technology Data Exchange (ETDEWEB)

    Bishop, A.B.; McKee, M.; Hansen, R.D.


    The purpose of the National Waste Terminal Storage (NWTS) Program is to site, construct and operate nuclear waste repositories at several locations. Recent experience indicates that the public is aware of the problems of nuclear waste disposal, and correspondingly there is public concern about how and where to dispose of nuclear wastes. The selection of sites involves a wide range of considerations including geological, technical and environmental feasibility. In addition to these, it is important that societal acceptance of repository options also be taken into account in moving foward with the NWTS Program. Such an incorporation of social considerations and preferences correspondingly implies the need for public consultation in the site selection process. In exploring the concept and state-or-the-art of public involvement in public policy decision, a number of important questions are relevant: (1) What are the basic objectives of public participation in policy formation and program decisions. (2) Who are the ''publics'' that should be involved and how can they be identified. (3) What information should be communicated between the agency and the publics. (4) What techniques are available to elicit public participation and involvement and what are their capabilities. At the outset, it should be noted that the purpose of this paper in addressing these questions is not to design public participation procedures for the NWTS program. Rather, the above are questions that provide a broad framework for developing an understanding of citizen participation in public policy decisions, such as nuclear waste disposal. In this sense, the following discussion is to provide a context and guidance for approaching the problem of organizing and structuring involvement in the NWTS program. Annotated bibliography of 95 references is included.

  9. How do nurse consultant job characteristics impact on job satisfaction? An Australian quantitative study


    Giles, Michelle; Parker, Vicki; Mitchell, Rebecca; Conway, Jane


    Background There is a direct link between job satisfaction, nurses? job performance and improved patient outcomes. Understanding what job characteristics influence job satisfaction is vital if health organizations are to optimize individual employee satisfaction and performance. This is particularly necessary in the Nurse Consultant role, which is a multifaceted role that has evolved to meet the dynamic and changing needs of health services. This study aims to examine how job characteristics ...

  10. How to support customisation on SaaS: a grounded theory from customisation consultants


    Song, Hui; Chauvel, Franck; Solberg, Arnor; Foyn, Bent; Yates, Antony


    This paper reports the initial result of a qualitative research on how to support customisation of SaaS (Software as a Service). The research follows the grounded theory method, and investigates the expectation of consultants who are specialized in customising enterprise software systems. The resulting theory contributes to the understanding of how customisation on SaaS differs from the traditional one, and provides a high-level guidance for SaaS vendors to prepare effective support for custo...

  11. How head and neck consultants manage patients' emotional distress during cancer follow-up consultations: a multilevel study. (United States)

    Zhou, Yuefang; Humphris, Gerry; Ghazali, Naseem; Friderichs, Simon; Grosset, David; Rogers, Simon N


    Head and neck cancer (HNC) patients suffer substantial emotional problems. This study aimed to explore how utterance-level variables (source, type and timing of emotional cues) and patient-level variables (e.g. age, gender and emotional well-being) relate to consultants' responses (i.e. reducing or providing space) to patient expressions of emotional distress. Forty-three HNC outpatient follow-up consultations were audio recorded and coded, for patients' expressions of emotional distress and consultants' responses, using the Verona Coding Definitions of Emotional Sequence. Multilevel logistic regression modelled the probability of the occurrence of consultant-reduced space response as a function of patient distress cue expression, controlling for consultation and patient-related variables. An average of 3.5 cues/concerns (range 1-20) was identified per consultation where 84 out of 152 total cues/concerns were responded by reducing space. Cue type did not impact on response; likewise for the quality of patient emotional well-being. However, consultants were more likely to reduce space to cues elicited by patients, as opposed to those initiated by themselves. This reduced space response was more pronounced as the consultation continued. However, about 6 min into the consultation, this effect (i.e. tendency to block patients) started to weaken. Head and neck consultants' responses to negative emotions depended on source and timing of patient emotional expressions. The findings are useful for training programme development to encourage consultants to be more flexible and open in the early stages of the consultation.

  12. What is symptom meaning? A framework analysis of communication in palliative care consultations. (United States)

    Estacio, Celina F; Butow, Phyllis N; Lovell, Melanie R; Dong, Skye T; Clayton, Josephine M


    There is a limited understanding of symptom meaning and its significance to clinical practice within symptom experience literature. This study aims to qualitatively explore the ways in which symptom meanings are discussed by patients and responded to by palliative care physicians during consultations. Framework analysis was conducted with 40 palliative care consultation transcripts. 55% of consultations discussed symptom meaning. Six themes regarding patients' symptom meanings emerged while four themes conveyed physicians' responses to these utterances. Key symptom meanings included symptoms representing diminished function and uncertainty about symptom cause or future. Physicians usually gave scientific medical responses concerning symptom cause and treatment, versus reassurance or empathy. This study has provided greater insight into the different symptom meanings that exist for palliative care patients. Physicians' responses highlight their reliance on medical information when patients are distressed. Future studies should explore the impact of different responses on patient outcomes, and health practitioners' views about optimal responses. Physicians could explore symptom meanings with their patients, looking out for those identified here. Apart from information-giving and treatment, active listening to these concerns as they present in consultations may help improve the therapeutic relationship and better guide optimal care. Copyright © 2017. Published by Elsevier B.V.

  13. Moving It Along: A study of healthcare professionals' experience with ethics consultations. (United States)

    Crigger, Nancy; Fox, Maria; Rosell, Tarris; Rojjanasrirat, Wilaiporn


    Ethics consultation is the traditional way of resolving challenging ethical questions raised about patient care in the United States. Little research has been published on the resolution process used during ethics consultations and on how this experience affects healthcare professionals who participate in them. The purpose of this qualitative research was to uncover the basic process that occurs in consultation services through study of the perceptions of healthcare professionals. The researchers in this study used a constructivist grounded theory approach that represents how one group of professionals experienced ethics consultations in their hospital in the United States. The results were sufficient to develop an initial theory that has been named after the core concept: Moving It Along. Three process stages emerged from data interpretation: moral questioning, seeing the big picture, and coming together. It is hoped that this initial work stimulates additional research in describing and understanding the complex social process that occurs for healthcare professionals as they address the difficult moral issues that arise in clinical practice.

  14. Parental knowledge in pediatric otolaryngology surgical consultations: A qualitative content analysis. (United States)

    Gorodzinsky, Ayala Y; Hong, Paul; Chorney, Jill MacLaren


    To understand the source of parents' knowledge prior to and desire for further information following pediatric otolaryngology surgical consultations. Mixed-methods approach using descriptive and qualitative content analysis of interviews with parents following otolaryngology consultations for children under the age of 6 years was performed. The children were being seen for either tonsillitis, obstructive sleep apnea, otitis media, and/or sinusitis/nasal obstruction. Forty-one parents completed a phone interview two weeks following their child's surgical consultation. The majority of parents indicated that their primary care physician referred their child for either: investigation of symptoms (50%), to have a specific discussion about surgery (27.5%), or because other treatment options were no longer working (20%). Many parents (56.5%) indicated that the Internet was their primary source of information prior to the appointment. Most parents (93%) wanted more information; majority of these parents noted that a technology-based mode of delivery of information available prior to the appointment would be most desirable. Desired information was most often regarding the surgical procedure, including risks and benefits, and symptoms of concern prior to surgery. This study provides a description of parental knowledge and information sources prior to their child's surgical consultation and continued desire for information. This information may lead to decreased knowledge barriers and increased communication to facilitate shared decision-making between the provider and parents. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  15. Challenging heteronormativity in the consultation: a focus group study among general practitioners. (United States)

    Westerståhl, Anna; Björkelund, Cecilia


    To reflect on and further understand mechanisms of heteronormativity in the consultation, with special focus on the relative invisibility of lesbian women. Tape-recorded focus group interviews transcribed verbatim and analysed using qualitative methods. General practitioners (GPs) from the city of Göteborg, Sweden, who had formerly answered a postal questionnaire about lesbian women in the consultation, were invited to take part in subsequent focus groups. Ten GPs from the questionnaire who accepted the invitation and volunteered to participate in focus groups. A discourse analytical approach using interaction regarding consensus and disagreement between informants in creating major and minor themes. Consultation skills were forwarded as a major tool in receiving optimal information from patients. However, traditional concepts of family and sexuality restricted information and hampered an accepting attitude. Bringing up issues of sexual identity/orientation was left to the lesbian patient and strongly related to her reason for attending. Consultation skills are a useful but not sufficient means of making lesbian women visible in the doctor-patient relationship. Doctors also need to transcend traditional concepts of family and sexuality and reflect on what is a relevant issue from the patient's perspective.

  16. Key attributes of a modern surgical trainer: perspectives from consultants and trainees in the United kingdom. (United States)

    Nisar, Pasha J; Scott, Humphrey J


    This study identifies key attributes of a modern surgical trainer as defined by individual trainees and consultant training faculty members. Using a collaborative inquiry process, we conducted focus groups and semistructured interviews with 32 trainees and 10 consultant trainers in general surgery. This study was undertaken in a single postgraduate deanery in the United Kingdom. Key trainer attributes were identified and categorized into themes. Key attributes identified by core trainees (CTs) were enthusiasm, giving feedback, setting targets, completing online assessments, and inspiring trainees. From specialty trainees (STs), key attributes were leading in difficult situations, patience, ensuring trainees perform cases, inspiring trainees, and being a role model. Key attributes from consultants were engaging other trainers, awareness of individual needs, ensuring trainees perform cases, discussing problems sympathetically, and patience. Effective communication was the principal trainer theme for CTs and STs identified the principal theme of leadership. These themes were emphasized also by trainers. Trainees and trainers have different beliefs on the attributes a good surgical trainer should possess. These findings may be used to promote understanding between trainees and trainers of the expectations and difficulties faced by surgical consultants. Copyright © 2011 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  17. Deferring the Decision Point: Treatment Assertions in Neurology Outpatient Consultations. (United States)

    Toerien, Merran


    Recommendations can be implied by asserting some generalisation about a treatment's benefit without overtly directing the patient to take it. Focusing on a collection of assertions in UK neurology consultations, this paper shows that these are overwhelmingly receipted as "merely" doing informing and argues that this is made possible by their ambiguous design: their relatively depersonalised formats convey that the neurologist is simply telling the patient what's available, but the link made between the treatment and the patient's condition implies that it will be of benefit. Thus, assertions, while stopping short of telling the patient what to do, are hearable as recommendation relevant. This delicates balance leaves it up to the patient to respond either to the implied or on-record action (recommending vs. informing). When treated as "merely" doing informing, assertions defer the decision point until the neurologist has done something more. Three main interactional functions of this are identified as follows: (i) indicating the existence of a solution to a concern, without making a decision relevant next; (ii) orienting to the patient's right to choose; and (iii) making "cautious" recommendations.

  18. Should consultation recording use be a practice standard? A systematic review of the effectiveness and implementation of consultation recordings. (United States)

    Rieger, Kendra L; Hack, Thomas F; Beaver, Kinta; Schofield, Penelope


    To conduct a systematic review of the effectiveness of consultation recordings and identify factors contributing to their successful implementation in health-care settings. A systematic review was conducted for quantitative studies examining the effectiveness of consultation recordings in health care. Two independent reviewers assessed the relevance and quality of retrieved quantitative studies by using standardized criteria. Study findings were examined to determine consultation recording effectiveness and to identify barriers and facilitators to implementation. A supplementary review of qualitative evidence was performed to further explicate implementation factors. Of the 3373 articles retrieved in the quantitative search, 26 satisfied the standardized inclusion criteria (12 randomized controlled trials, 1 quasi-experiment, and 13 cross-sectional studies). Most patients found consultation recordings beneficial. Statistically significant evidentiary support was found for the beneficial impact of consultation recordings on the following patient reported outcomes: knowledge, perception of being informed, information recall, decision-making factors, anxiety, and depression. Implementation barriers included strength of evidence concerns, patient distress, impact of the recording on consultation quality, clinic procedures, medico-legal issues, and resource costs. Facilitators included comfort with being recorded, clinical champions, legal strategies, efficient recording procedures, and a positive consultation recording experience. Consultation recordings are valuable to patients and positively associated with patient-reported outcomes. Successful integration of consultation recording use into clinical practice requires an administratively supported, systematic approach to addressing implementation factors. Copyright © 2017 John Wiley & Sons, Ltd.

  19. Embedding nursing and therapy consultantship: the case of stroke consultants. (United States)

    Burton, Christopher R; Bennett, Bev; Gibbon, Bernard


    As the basis for the design of career development opportunities for current and aspiring nursing and therapy consultants, we aimed to explore the factors that shape how these roles have embedded in UK stroke services. The non-medical consultant role has been introduced into UK health care services to provide opportunities for experienced practitioners to progress their careers in clinical practice. Whilst there have been evaluations of the impact of the role on service delivery, little attention has been paid to the pathways towards consultantship. An exploratory design, incorporating focus group discussions, was used to address the research questions. Participating consultants, both nurses and allied health professionals, worked in stroke services, although it is anticipated that the results will have wider application. Two focus groups were held with non-medical consultants in stroke from across the UK. Participants had the opportunity to comment on an interim paper prior to publication of the results. Thirteen consultants took part in the study. A lack of consensus about the nature of clinical expertise and a diverse range of pathways towards consultantship were identified. Health care policy had presented the opportunity for consultants to be entrepreneurial in the development of stroke services, although this had limited the scope for the development of professional knowledge. Inflexible programmes to support aspiring consultants may limit the opportunities to develop these entrepreneurial skills. This study challenges health care organizations and the education and research departments that support them to think creatively in the way that the non-medical consultant role is embedded, and that this should draw on the commitment of existing consultants to support succession planning. The identification of those aspects of career pathways that current consultants have found to be helpful will be useful in designing opportunities for aspiring consultants.

  20. Antipsychotic use in nursing homes varies by psychiatric consultant. (United States)

    Tjia, Jennifer; Field, Terry; Lemay, Celeste; Mazor, Kathleen; Pandolfi, Michelle; Spenard, Ann; Ho, Shih-Yieh; Kanaan, Abir; Donovan, Jennifer; Gurwitz, Jerry H; Briesacher, Becky


    The relationship between psychiatric consultation and antipsychotic prescribing in nursing homes (NH) is unknown. To identify the association between psychiatric consultant groups and NH-level antipsychotic prescribing after adjustment for resident case-mix and facility characteristics. Nested cross-sectional study of 60 NHs in a cluster randomized trial. We linked facility leadership surveys to October 2009-September 2010 Minimum Data Set, Nursing Home Compare, the US Census, and pharmacy dispensing data. The main exposure is the psychiatric consultant group and the main outcome is NH-level prevalence of atypical antipsychotic use. We calculated annual means and interquartile ranges of NH-level antipsychotic use for each consultant group and arrayed consultant groups from lowest to highest prevalence. Generalized linear models were used to predict antipsychotic prescribing adjusting for resident case-mix and facility characteristics. Observed versus predicted antipsychotic prescribing levels were compared for each consultant group. Seven psychiatric consultant groups served a range of 3-27 study facilities. Overall mean facility-level antipsychotic prescribing was 19.2%. Mean prevalence of antipsychotic prescribing ranged from 12.2% (SD, 5.8) in the lowest consultant group to 26.4% (SD, 3.6) in the highest group. All facilities served by the highest-ranked consultant group had observed antipsychotic levels exceeding the overall study mean with half exceeding predictions for on-label indications, whereas most facilities served by the lowest-ranked consultant group had observed levels below the overall study and predicted means. Preliminary evidence suggests that psychiatric consultant groups affect NH antipsychotic prescribing independent of resident case-mix and facility characteristics.

  1. Report on AECB consultative document C-70: The use of fault trees in licensing submissions

    International Nuclear Information System (INIS)


    The Atomic Energy Control Board (AECB) has issued Consultative Document C-70, 'The Use of Fault Trees in Licensing Submissions', for public comment. The Advisory Committee on Nuclear Safety (ACNS) has examined this document and ACNS members have met with AECB staff and representatives of the nuclear industry to discuss it. The ACNS presents its comments and recommendations in this report. The consultative document defines a fault tree as a hierarchically-structured graphical representation of system failures and their potential causes. The document then states certain basic characteristics or attributes which fault trees should possess, and certain conditions affecting the use of fault trees. It defines fault tree fundamentals, sets criteria for the application of fault trees to systems and defines ground rules for a fault tree format. Finally, in two appendices, it includes specific rules for fault tree symbols and fault tree description files for computer use. The appendices are referred to in the text as 'acceptable' standards or methods

  2. Prognostic accuracy of antenatal neonatology consultation. (United States)

    Kukora, S; Gollehon, N; Weiner, G; Laventhal, N


    Neonatologists provide antenatal counseling to support shared decision-making for complicated pregnancies. Poor or ambiguous prognostication can lead to inappropriate treatment and parental distress. We sought to evaluate the accuracy of antenatal prognosticaltion. A retrospective cohort was assembled from a prospectively populated database of all outpatient neonatology consultations. On the basis of the written consultation, fetuses were characterized by diagnosis groups (multiple anomalies or genetic disorders, single major anomaly and obstetric complications), assigned to five prognostic categories (I=survivable, IIA=uncertain but likely survivable, II=uncertain, IIB=uncertain but likely non-survivable, III non-survivable) and two final outcome categories (fetal demise/in-hospital neonatal death or survival to hospital discharge). When possible, status at last follow-up was recorded for those discharged from the hospital. Prognostic accuracy was assessed using unweighted, multi-level likelihood ratios (LRs). The final cohort included 143 fetuses/infants distributed nearly evenly among the three diagnosis groups. Over half (64%) were assigned an uncertain prognosis, but most of these could be divided into 'likely survivable' or 'likely non-survivable' subgroups. Overall survival for the entire cohort was 62% (89/143). All but one of the fetuses assigned a non-survivable prognosis suffered fetal demise or died before hospital discharge. The neonatologist's antenatal prognosis accurately predicted the probability of survival by prognosis group (LR I=4.56, LR IIA=10.53, LR II=4.71, LR IIB=0.099, LR III=0.040). The LRs clearly differentiated between fetuses with high and low probability of survival. Eleven fetuses (7.7%) had misalignment between the predicted prognosis and outcome. Five died before discharge despite being given category I or IIA prognoses, whereas six infants with category IIB or III prognoses survived to discharge, though some of these were

  3. Understanding classification

    NARCIS (Netherlands)

    Subianto, M.


    In practical data analysis, the understandability of models plays an important role in their acceptance. In the data mining literature, however, understandability plays is hardly ever mentioned. If it is mentioned, it is interpreted as meaning that the models have to be simple. In this thesis we

  4. Embodied understanding. (United States)

    Johnson, Mark


    Western culture has inherited a view of understanding as an intellectual cognitive operation of grasping of concepts and their relations. However, cognitive science research has shown that this received intellectualist conception is substantially out of touch with how humans actually make and experience meaning. The view emerging from the mind sciences recognizes that understanding is profoundly embodied, insofar as our conceptualization and reasoning recruit sensory, motor, and affective patterns and processes to structure our understanding of, and engagement with, our world. A psychologically realistic account of understanding must begin with the patterns of ongoing interaction between an organism and its physical and cultural environments and must include both our emotional responses to changes in our body and environment, and also the actions by which we continuously transform our experience. Consequently, embodied understanding is not merely a conceptual/propositional activity of thought, but rather constitutes our most basic way of being in, and engaging with, our surroundings in a deep visceral manner.

  5. Consultation: Creating School-Based Interventions. Second Edition. (United States)

    Dinkmeyer, Don, Jr.; Carlson, Jon

    Decades after consultation has become a mandated function of school counselors, consultants still seek effective ways to deliver this essential role. This book, geared towards mental health professionals, provides a set of skills for working with the school-based population. The ideas, based on Adlerian psychology, present a theory of consultation…

  6. Using Learning Principles as a Theoretical Framework for Instructional Consultations (United States)

    DiPietro, Michele; Norman, Marie


    Learning theory provides a powerful framework for analyzing instructional consultations and increasing their effectiveness. In this paper, the authors review the main tenets of learning theory, apply them to consultation scenarios, and present a complex case study to show how they can guide analysis and problem solving around challenging…

  7. Intellectual Humility and Morality as Consultee-Centered Consultation Epistemologies (United States)

    Truscott, Stephen D.; Kearney, Moriah A.; Davis, Don E.; Roach, Andrew T.


    Little research examines how epistemological constructs affect the consultation process in schools. We consider how the epistemological constructs of (a) intellectual humility and (b) moral foundations may moderate the effectiveness of consultee-centered consultation. We define the constructs and provide examples of their potential influences on…

  8. International Consultation and Training on Group Work in South Asia (United States)

    Ibrahim, Farah A.


    This article presents a consultation and training for faculty and graduate students in South Asia under the auspices of the United Nations' Transfer of Knowledge Through Expatriate Nationals (TOKTEN) Program. It describes the development of a consultation relationship and training on group work. Needs assessments focusing on both cultural…

  9. Colonial connections and consulting engineers 1850-1914

    DEFF Research Database (Denmark)

    Andersen, Casper


    The paper analyses colonial connections and networks of British consulting engineers. It unravels how consulting engineers operated within different imperial contexts, including settler colonies, Egypt and Crown colonies in West Africa in particular. The paper also examines the close and at times...

  10. Can audio recording of outpatient consultations improve patient outcome?

    DEFF Research Database (Denmark)

    Wolderslund, Maiken; Kofoed, Poul-Erik; Axboe, Mette

    recording of the dialogue between the patient and the clinician via the telephone in the consultation room. This technique ensures minimal time consumption for clinicians and high sound quality. By dialing their social security number in combination with a PIN, patients can hear their consultation again...

  11. 15 CFR 200.103 - Consulting and advisory services. (United States)


    ... testimony or the production of data, information, or records in such legal proceedings which is governed by..., SERVICES, PROCEDURES, AND FEES § 200.103 Consulting and advisory services. (a) In areas of its special competence, NIST offers consulting and advisory services on various problems related to measurement, e.g...

  12. 21 CFR 860.125 - Consultation with panels. (United States)


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Consultation with panels. 860.125 Section 860.125 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED...) Discussion at a panel meeting. (b) The method of consultation chosen by the Commissioner will depend upon the...

  13. 10 CFR 19.15 - Consultation with workers during inspections. (United States)


    ... 10 Energy 1 2010-01-01 2010-01-01 false Consultation with workers during inspections. 19.15...: INSPECTION AND INVESTIGATIONS § 19.15 Consultation with workers during inspections. (a) Commission inspectors... inspectors deem necessary for the conduct of an effective and thorough inspection. (b) During the course of...

  14. A Critical Review of Videoconferencing Software to Support School Consultation (United States)

    Fischer, Aaron J.; Schultz, Brandon K.; Collier-Meek, Melissa A.; Zoder-Martell, Kimberly A.; Erchul, William P.


    With recent advances in technology, several viable options now exist for school consultants to communicate with teachers via synchronous online videoconferencing (VC) without the need for specialized equipment. Unfortunately, few studies have evaluated the effectiveness of school consultation through VC, so practitioners are provided little…

  15. 29 CFR 1903.10 - Consultation with employees. (United States)


    ... 29 Labor 5 2010-07-01 2010-07-01 false Consultation with employees. 1903.10 Section 1903.10 Labor... INSPECTIONS, CITATIONS AND PROPOSED PENALTIES § 1903.10 Consultation with employees. Compliance Safety and... extent they deem necessary for the conduct of an effective and thorough inspection. During the course of...

  16. 40 CFR 161.40 - Consultation with the Agency. (United States)


    ... 40 Protection of Environment 23 2010-07-01 2010-07-01 false Consultation with the Agency. 161.40 Section 161.40 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) PESTICIDE PROGRAMS DATA REQUIREMENTS FOR REGISTRATION OF ANTIMICROBIAL PESTICIDES General Provisions § 161.40 Consultation...

  17. Consultant choice across decision contexts: are abortion decisions different? (United States)

    Finken, L L; Jacobs, J E


    A survey conducted among college students in the midwestern US indicated that abortion decision-making consultation patterns differ substantially from those associated with other types of decisions. Surveyed were 169 predominantly White, middle-income students (68 males and 101 females) 18-20 years of age recruited from an introductory psychology class. Participants were presented with vignettes that pertained to four types of decisions: abortion (unplanned pregnancy), medical (cancer treatment type), future (career move), and interpersonal (crisis with a friend). For each decision, students were asked who they would consult (specific family members, significant others, friends, various professionals) and the order in which they would consult them. The mean number of consultants selected was 3.72 for abortion, 5.54 for medical, 4.90 for future-oriented, and 2.41 for interpersonal decisions. Significant others were selected most often for all decision scenarios; however, the highest frequency of consultation and lowest mean rank order for the significant other was on the abortion decision. The next most important consultant for abortion decisions was friends, then family members, and, finally, professionals. The only gender difference was a greater tendency for females to consult their mothers. For every category of consultant (except best friend), the pattern differed depending on the type of decision. These findings underscore the importance of considering context and multifaceted approaches in the design of programs aimed at enhancing adolescents' decision-making skills.

  18. 77 FR 18258 - Government-to-Government Telephonic Consultation Meetings (United States)


    ... DEPARTMENT OF THE INTERIOR National Park Service [NPS-WASO-NRNHL-0212-9515; 2280-665] Government-to-Government Telephonic Consultation Meetings AGENCY: National Park Service, Interior. SUMMARY: The National Park Service announces two telephonic government- to-government consultation meetings with Indian...

  19. Consultation in Bullying Prevention: An Elementary School Case Study (United States)

    Morrow, Michael T.; Hooker, Steven D.; Cate, Rebecca Lynne


    This manuscript outlines a consultation with a public elementary school that was aimed at assessing and strengthening the school's antibullying programs. We gathered consultation data through interviews and observations and also reviewed existing program evaluation data. We evaluated these data in light of current research on bullying prevention…

  20. 18 CFR 12.34 - Approval of independent consultant. (United States)


    ... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Approval of independent... COMMISSION, DEPARTMENT OF ENERGY REGULATIONS UNDER THE FEDERAL POWER ACT SAFETY OF WATER POWER PROJECTS AND PROJECT WORKS Inspection by Independent Consultant § 12.34 Approval of independent consultant. At least 60...

  1. 18 CFR 12.37 - Report of the independent consultant. (United States)


    ... independent consultant. 12.37 Section 12.37 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY REGULATIONS UNDER THE FEDERAL POWER ACT SAFETY OF WATER POWER PROJECTS AND PROJECT WORKS Inspection by Independent Consultant § 12.37 Report of the independent...

  2. An Interdisciplinary Mental Health Consultation Team in a Nursing Home. (United States)

    Joseph, Carol; And Others


    Describes the Mental Health Consultation Team at the Portland Veterans Affairs Medical Center nursing home. The team is an interdisciplinary group of mental health professionals and primary care providers. Cooperation among these professionals has decreased the demands for formal psychiatry and psychology consultations while increasing mental…

  3. Delay to orthopedic consultation for isolated limb injury (United States)

    Rouleau, Dominique M.; Feldman, Debbie Ehrmann; Parent, Stefan


    ABSTRACT OBJECTIVE To describe referral mechanisms for referral to orthopedic surgery for isolated limb injuries in a public health care system and to identify factors affecting access. DESIGN Cross-sectional survey. SETTING Orthopedic surgery service in a level 1 trauma centre in Montreal, Que. PARTICIPANTS We conducted a prospective study of 166 consecutive adults (mean age 48 years) referred to orthopedic surgery for isolated limb injuries during a 4-month period. MAIN OUTCOME MEASURES Self-reported data on the nature of the trauma, the elapsed time between injury and orthopedic consultation, the number and type of previous primary care consultations, sociodemographic characteristics, and the level of satisfaction with care. RESULTS Average time between the injury and orthopedic consultation was 89 hours (range 3 to 642), with an average of 68 hours (range 0 to 642) for delay between primary care consultation and orthopedic consultation. A total of 36% of patients with time-sensitive diagnoses had unacceptable delays to orthopedic consultation according to the Quebec Orthopaedic Association guidelines. Lower limb injury, consulting first at another hospital, living far from the trauma centre, patient perception of low severity, and having a soft tissue injury were associated with longer delays. CONCLUSION Identifying gaps and risk factors for slower access might help improve referral mechanisms for orthopedic consultation. PMID:19826162

  4. Effects of a nurse practitioner on a multidisciplinary consultation team

    NARCIS (Netherlands)

    van der Sluis, Corry K.; Datema, Linetta; Saan, Ingrid; Stant, Dennis; Dijkstra, Pieter U.

    Effects of a nurse practitioner on a multidisciplinary consultation team. This paper is a report of a study to evaluate the impact on office hours capacity, patient satisfaction, quality of life and costs of including a nurse practitioner in a multidisciplinary consultation team for patients with

  5. The preoperative cardiology consultation: Indications and risk modification

    NARCIS (Netherlands)

    M.W. de Groot (Mark); A. Spronk (Angela); S.E. Hoeks (Sanne); R.J. Stolker (Robert); F. van Lier (Felix)


    textabstractBackground The cardiologist is regularly consulted preop-eratively by anaesthesiologists. However, insights into the efficiency and usefulness of these consultations are unclear. Methods This is a retrospective study of 24,174 preoperatively screened patients ≥18 years scheduled for

  6. Lag Sequential Analysis: Taking Consultation Communication Research to the Movies. (United States)

    Benes, Kathryn M.; Gutkin, Terry B.; Kramer, Jack J.


    Describes lag-sequential analysis and its unique contributions to research literature, addressing communication processes in school-based consultation. For purposes of demonstrating the application and potential utility of lag-sequential analysis, article analyzes the communication behaviors of two consultants. Considers directions for future…

  7. Trend of newspaper consultation by students of federal University of ...

    African Journals Online (AJOL)

    The research investigated the trend of Newspaper consultation by the students of Federal University of Technology, Owerri. Survey research design was adopted for this Study. Data was obtained from the University Library's Records of users' statistics for Newspaper consultation for ten years, 2004-2013. Questionnaire was ...

  8. A Qualitative Study of Televideo Consultations for COPD Patients

    DEFF Research Database (Denmark)

    Mathar, Helle; Fastholm, Pernille; Sandholm Larsen, Niels


    from hospital with televideo consultations? The study shows that the patients' assessments of the effectiveness and value of the televideo consultations in their everyday lives are based on tough cost-benefit calculation of the extent to which the intervention makes their lives easier or more difficult...

  9. An integrated occupational hygiene consultation model for the catering industry. (United States)

    Lin, Yi-Kuei; Lee, Lien-Hsiung


    Vegetable oil used in food processing, during high-temperature exposure, will generate particulate matter (PM) and polycyclic aromatic hydrocarbons (PAHs), which are carcinogenic chemical compounds, with the potential to cause lung disease for restaurant kitchen staff. This study's design includes a three-stage consultation process with eight major consultation items, in order to build an integrated consultation model for occupational hygiene. This model combines inspection and consultation, targeting Chinese restaurants in the catering industry. Characteristics of the integrated consultation model include cooperation between different government departments and collaboration with nongovernmental, professional consulting organizations. An additional benefit of the model is the building of a good partnership relationship with the Catering Trade Association. The consultation model helps Chinese restaurants attain improvements in their work environments with minimal investment. Postconsultation, results show a 63.35% and 61.98% (P < 0.001) decrease in the mean time-weighted concentration of exposure to PM and PAHs, respectively. The overall regulation compliance rate of Chinese restaurants significantly increased from 34.3% to 89.6%. These results show that the integrated consultation model for occupational hygiene not only helps small and medium enterprises reduce exposure concentrations in the workplace but also has specific potential for successful implementation in Taiwan.

  10. 42 CFR 493.1457 - Standard; Clinical consultant responsibilities. (United States)


    ... HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION LABORATORY REQUIREMENTS Personnel for Nonwaived Testing Laboratories Performing High Complexity Testing § 493.1457 Standard; Clinical consultant... 42 Public Health 5 2010-10-01 2010-10-01 false Standard; Clinical consultant responsibilities. 493...

  11. 10 CFR 51.40 - Consultation with NRC staff. (United States)


    ... 10 Energy 2 2010-01-01 2010-01-01 false Consultation with NRC staff. 51.40 Section 51.40 Energy....40 Consultation with NRC staff. (a) A prospective applicant or petitioner for rulemaking is encouraged to confer with NRC staff as early as possible in its planning process before submitting...

  12. Financial implications for built environment consultants working at ...

    African Journals Online (AJOL)

    Adendorff et al • Financial implications. 133 that should be avoided. One of the pitfalls is pricing – if the pricing is wrong for a particular project, either the consultant or the client may thus be prejudiced (Moss, 2000: 1). Working at risk should however not be confused with a simple deferral of the consultant's fee (or a portion ...

  13. Development of a teledermatopathology consultation system using virtual slides

    Directory of Open Access Journals (Sweden)

    Nakayama Ikunori


    Full Text Available Abstract Background An online consultation system using virtual slides (whole slide images; WSI has been developed for pathological diagnosis, and could help compensate for the shortage of pathologists, especially in the field of dermatopathology and in other fields dealing with difficult cases. This study focused on the performance and future potential of the system. Method In our system, histological specimens on slide glasses are digitalized by a virtual slide instrument, converted into web data, and up-loaded to an open server. Using our own purpose-built online system, we then input patient details such as age, gender, affected region, clinical data, past history and other related items. We next select up to ten consultants. Finally we send an e-mail to all consultants simultaneously through a single command. The consultant receives an e-mail containing an ID and password which is used to access the open server and inspect the images and other data associated with the case. The consultant makes a diagnosis, which is sent to us along with comments. Because this was a pilot study, we also conducted several questionnaires with consultants concerning the quality of images, operability, usability, and other issues. Results We solicited consultations for 36 cases, including cases of tumor, and involving one to eight consultants in the field of dermatopathology. No problems were noted concerning the images or the functioning of the system on the sender or receiver sides. The quickest diagnosis was received only 18 minutes after sending our data. This is much faster than in conventional consultation using glass slides. There were no major problems relating to the diagnosis, although there were some minor differences of opinion between consultants. The results of questionnaires answered by many consultants confirmed the usability of this system for pathological consultation. (16 out of 23 consultants. Conclusion We have developed a novel

  14. Stakeholder consultations regarding centralized power procurement processes in Ontario

    International Nuclear Information System (INIS)


    In 2004, Ontario held 4 Requests for Proposals (RFPs) to encourage the development of new clean renewable combined heat and power generation and the implementation of conservation and demand management programs. Details of a stakeholder consultation related to the RFP process were presented were in this paper. The aim of the consultation was to synthesize stakeholder comments and to provide appropriate recommendations for future RFPs held by the Ontario Power Authority (OPA). The financial burden of bidding was discussed, as well as communications procedures and contract ambiguities. Issues concerning the criteria used for qualifying potential bidders and evaluating project submissions were reviewed. Recommendations for future processes included prequalification, a simplification in collusion requirements, and a fixed time response. It was also recommended that the process should not emphasize financing as lenders do not make firm commitments to bidders prior to a bid being accepted. It was suggested that the amount of bid security should vary with the project size and phase of development, and that the contracts for differences format should be refined to allow participants to propose parameters. Issues concerning audit procedures and performance deviations were reviewed. It was suggested that contract terms should be compatible with gas markets. It was also suggested that the OPA should adopt a more simplified approach to co-generation proposals, where proponents can specify amounts of energy and required prices. The adoption of the Swiss challenge approach of allowing other vendors an opportunity to match or beat terms on an offer was recommended. It was suggested that renewables should be acquired through a targeted and volume limited standard-offer process to be set yearly. Conservation and demand management recommendations were also presented. It was suggested that the OPA should serve as a facilitator of clean development mechanism (CDM) programs. It was

  15. Participation in Written Government Consultations in Denmark and the UK

    DEFF Research Database (Denmark)

    Rasmussen, Anne


    Despite the proliferation of instruments of public consultation in liberal democracies, little is known of how the design and use of these instruments affect stakeholder participation in practice. The article examines participation in written government consultations in an analysis of approximately...... 5,000 responses to consultations in Denmark and the UK in the first half of 2008. It shows that participation is highly conditional upon system-and actor-level characteristics in practice. Our findings indicate that, even if liberal democracies have adopted similar procedures for actor consultation...... in the last decades, the design and application of crucial rules vary considerably between systems. They emphasize how the conduct of consultation is heavily conditioned by the design of these processes, which is in turn constrained by the historical legacy of state-society structures of the system...

  16. Does professional-centred training improve consultation outcomes?

    DEFF Research Database (Denmark)

    Parkin, Tracey; Barnard, K.; Cradock, S.


    complete disagreement occurred between the patient and professional, on decisions made, reduced from 17% at baseline to 11% at follow up. It was concluded that professional-centred training can be effective in improving patients' perceptions of the consultation, and in increasing patient......This study aimed to examine whether professional-centred training improves consultation outcomes. Using a pre- and post-data collection design. Immediately after consultations, professionals and patients completed a consultation review sheet which was coded for the level of agreement on issues...... discussed and decisions made. Patients also completed the Health Care Climate Questionnaire (HCCQ). Pre-training results were fed back to the professionals to provide an objective measure of current practice. Training day one comprised 10 minutes' observation of videoed consultations of each professional...

  17. An Empirical Study of Multidimensional Fidelity of COMPASS Consultation. (United States)

    Wong, Venus; Ruble, Lisa A; McGrew, John H; Yu, Yue


    Consultation is essential to the daily practice of school psychologists (National Association of School Psychologist, 2010). Successful consultation requires fidelity at both the consultant (implementation) and consultee (intervention) levels. We applied a multidimensional, multilevel conception of fidelity (Dunst, Trivette, & Raab, 2013) to a consultative intervention called the Collaborative Model for Promoting Competence and Success (COMPASS) for students with autism. The study provided 3 main findings. First, multidimensional, multilevel fidelity is a stable construct and increases over time with consultation support. Second, mediation analyses revealed that implementation-level fidelity components had distant, indirect effects on student Individualized Education Program (IEP) outcomes. Third, 3 fidelity components correlated with IEP outcomes: teacher coaching responsiveness at the implementation level, and teacher quality of delivery and student responsiveness at the intervention levels. Implications and future directions are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  18. Determinants of Management Innovation in the Ghanaian Construction Consulting Sector

    Directory of Open Access Journals (Sweden)

    De-Graft Owusu-Manu


    Full Text Available Determinants of management innovation (MI within the Ghanaian construction consulting sector are examined. A sample of 70 consulting firms is surveyed using self-administered questionnaires. Data are analysed using descriptive statistics and factor analysis. Findings indicate that determinants of MI were interwoven among seven principal factors viz: community and market demands; financial and business management practices; human resource policies; creativity and organizational strategies; corporate social responsibility; prevailing conditions; and competitive leverage. The study adds to the discourse on evolution of innovation within the global consulting sector generally, while providing reference for practitioners and academics in the field with respect to MI determinants more specifically. It is envisaged that practitioners who adopt these findings in the construction consultancy sector would enhance their ability to provide innovative services to clients. Study recommendations include that future research should explore how innovation is diffused within consulting enterprises’ value chains. Paper Type: Research article

  19. Spirituality and distress in palliative care consultation. (United States)

    Hills, Judith; Paice, Judith A; Cameron, Jacqueline R; Shott, Susan


    One's spirituality or religious beliefs and practices may have a profound impact on how the individual copes with the suffering that so often accompanies advanced disease. Several previous studies suggest that negative religious coping can significantly affect health outcomes. The primary aim of this study was to explore the relationship between spirituality, religious coping, and symptoms of distress among a group of inpatients referred to the palliative care consult service. Pilot study. The study was conducted in a large academic medical center with a comprehensive Palliative Care and Home Hospice Program. (1) National Comprehensive Cancer Network Distress Management Assessment Tool; (2) Pargament Brief Religious Coping Scale (Brief RCOPE); (3) Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp); (4) Puchalski's FICA; and (5) Profile of Mood States-Short Form (POMS-SF). The 31 subjects surveyed experienced moderate distress (5.8 +/- 2.7), major physical and psychosocial symptom burden, along with reduced function and significant caregiving needs. The majority (87.2%) perceived themselves to be at least somewhat spiritual, with 77.4% admitting to being at least somewhat religious. Negative religious coping (i.e., statements regarding punishment or abandonment by God) was positively associated with distress, confusion, depression, and negatively associated with physical and emotional well-being, as well as quality of life. Palliative care clinicians should be alert to symptoms of spiritual distress and intervene accordingly. Future research is needed to identify optimal techniques to address negative religious coping.

  20. Concertation or Consultation. That is the question.

    CERN Multimedia

    Staff Association


    In April 2017 (as reported in Echo No. 268), the Staff Association, when invited to an Enlarged Directorate meeting, stressed that “concertation requires a positive attitude and mutual trust. […] The Staff Association is firmly committed in this respect but does not consider that the concertation process is as effective as we should like”. The continued lack, for the Staff Association, of an effective concertation process led to a revisiting of the situation in June 2017 (Echo No. 271), in an article that stressed the importance of the concertation process at CERN since it was introduced in 1983, the year in which the Standing Concertation Committee (SCC) replaced the Standing Consultation Committee. The importance of concertation was also highlighted by Mr Bernard Dormy, Chair of TREF, in an interview he gave to the Staff Association at the end of January 2018 (Echo No. 284), when he retired from his position as the Chair of the Forum. “To sum it up, I would certainl...

  1. Concertation rather than Consultation or Negotiation!

    CERN Multimedia

    Staff Association


    At CERN, the Concertation between the Management and the Personnel has been in effect since 1983, the year in which the Standing Concertation Committee (SCC) came to replace the Standing Consultation Committee. Since then, the concertation process has been enshrined in the Staff Rules and Regulations, which define its scope of application: “Any proposed measures of a general nature regarding the conditions of employment or association of members of the personnel shall be the subject of discussion within the SCC” (S VII 1.08). More generally, all questions relating to the employment and working conditions of the members of personnel are discussed in the SCC, including in particular issues of remuneration, social protection (CHIS and Pension Fund), career evolution... In Article S VII 1.07 of the Staff Rules and Regulations it is also stated that: “Discussion shall mean a procedure whereby the Director-General and the Staff Association concert together to try to reach a common po...

  2. Department of Training and Consulting - Overview

    International Nuclear Information System (INIS)

    Dobrzynski, L.


    Department of Training and Consulting is regularly serving secondary schools' pupils and teachers, university students and the public. As usual we have been visited by about 7000 visitors, mainly students from secondary schools in Poland. The Department is constantly developing experiments which can be conducted by students of secondary schools and universities, as well as by professionals. At the moment there are about 20 experiments available for the guests of the Department. They cover measurements of the lifetimes, elements of radioprotection, absorption of radiation in various materials, excitation of fluorescence radiation, influence of magnetic field on beta radiation as well as electrons emitted from typical electron gun, Compton scattering and elements of gamma spectroscopy, search for radioactive pollutions etc. In addition the Department was very active during Science Picnic in May and Science Festival in September, when the Department proposed organisation of a '' Day with Radioactivity ''. '' The Day '' consisted of a number of public lectures and demonstrations. In addition two evenings were dedicated to a public debate on energy sources and energy demands and supply in next 50-100 years. One should also mention organisation and leading of the professional course for accelerators' operators, as well as starting a new university course on '' Nuclear Energy and Its Use '' (Cardinal Stefan Wyszynski University, Warsaw). The web side of the Department contains educational materials (part of it can be found on international platform, quizzes and self-teaching materials. (author)

  3. Education, consultation, guidance, students, advisor, teacher

    Directory of Open Access Journals (Sweden)

    M Seyedmajidi


    Full Text Available Introduction: Student counseling and supervision play an important role to overcome learning problems and to achieve educational goals. The present study is intended to investigate viewpoints of students regarding educational guidance and advice studying at Babol University of Medical Sciences. Methods: In this descriptive cross-sectional survey, viewpoints of 480 students were collected by a questionnaire. The validity and reliability of the questionnaire had been approved before. Data were analyzed using SPSS version 17 software. Chi- square and ANOVA tests were administered. Results: 61.2% of all participants were female and 38.8% were males with mean age of 21.3±4.0. 37.2% of these students lacked sufficient knowledge and information on how to request from their advisors for help and guidance. Half of students (50.3% reported attendance of advisors and holding routine consultation is inappropriate. Advisors made more educational files for females compare to males (P=0.001. No difference observed regarding educational disciplines of the advisors regarding students were dissatisfied with help and guidance received from paramedics and dentistry students in most fields (87.3% and 81.5% respectively. Conclusion: It seems that either student has no sufficient information about tasks of advisors and/or advisors may not do their tasks properly. It is recommended the students to be acquainted with advisors’ tasks upon their entrance into the university. Training classes for new academics would be helpful.

  4. Inpatient allergy/immunology consultations in a tertiary care setting. (United States)

    Otto, Hans F; England, Ronald W; Quinn, James M


    Few studies have examined inpatient referral patterns for fellowship training programs and none for allergy/immunology (AI) since 2003. The primary end point was the reason for consultation, and secondary end points included the AI diagnosis made and outcomes. We retrospectively reviewed all inpatient AI consultations from July 1, 2001 through June 30, 2007. These 6 years of data were combined with 14 years of data examining the reason for consult from a previous study. The data were analyzed for trends and changes over the entire 20-year period. A total of 254 AI inpatient consults were reviewed over the 6 years studied. Thirty-six percent (92/254) of inpatient consults were for evaluation of adverse drug reactions (ADRs), 22% (55/254) miscellaneous reasons, 17% (43/254) urticaria/angioedema, 13% (32/254) for possible immunodeficiency, 9% (23/254) for anaphylaxis, and 3% (8/254) for asthma. AI inpatient consults show a significant decline over the recent 6-year period (p = 0.0023) despite stable total hospital admissions since 1998. Over the last 20 years, an 85% decrease (p < 0.00001) in inpatient asthma consults and increases (p < 0.05) in immunodeficiency, rash, and urticaria/angioedema evaluations have been observed. Not following AI recommendations resulted in a 16.6 odds ratio (95% CI, 5.55-49.93) that a patient's clinical status would be worse or unchanged. Inpatient AI consults have declined with associated reduction in asthma inpatient consults. Although ADRs and anaphylaxis consults have been stable, evaluations for immunodeficiency, rash, and urticaria/angioedema have increased. Following inpatient AI recommendations is associated with improved patient outcomes.

  5. Nurse and allied health professional consultants: perceptions and experiences of the role. (United States)

    Stevenson, Kay; Ryan, Sarah; Masterson, Abigail


    To explore the perceptions and experiences of nurse and allied health professional consultants and key stakeholders. Nurse and allied health professional consultants' roles were introduced in the United Kingdom in 1999 with defined role criteria and a remit to improve patient outcomes. Although these roles have now existed for over a decade, there is a lack of research as to whether these roles have achieved their intended impact on clinical care. Through an exploration of the experiences of consultant nurses and allied health professionals and key stakeholders who work with these practitioners, a greater understanding of the consultant role can be achieved. Qualitative. A purposive sample of seven non-medical consultants (five nurses, one physiotherapist and a pharmacist) and eight stakeholders took part in focus group interviews. Each focus group was audio-taped and lasted between 1.5-2 hours. Content analysis was used to interpret the data. Four main themes were identified: (1) Role interpretation--core features include clinical practice, leadership, education and research. Debate surrounded the need to incorporate managerial responsibilities into the role. (2) Role implementation required political skills and emotional intelligence. (3) Role impact especially on clinical practice was a major priority for both groups. (4) Challenges included lack of organisational and administrative support. There was consensus amongst the two groups regarding the value of the role, key role functions and skills and the emerging impact on clinical practice. Both groups were able to identify the clinical impact of the role including helping patients manage chronic pain, reducing the need for follow-up appointments and managing emergency admissions. To capture the clinical diversity of the roles, a variety of evaluation strategies should be implemented. © 2011 Blackwell Publishing Ltd.

  6. Patients' preferences for GP consultation for perceived cancer risk in primary care: a discrete choice experiment. (United States)

    Whitaker, Katriina L; Ghanouni, Alex; Zhou, Yin; Lyratzopoulos, Georgios; Morris, Stephen


    Contacting a doctor for advice when experiencing a potential cancer symptom is an important step in early diagnosis, but barriers to consultation are commonly reported. Understanding barriers to consulting in primary care within the cancer context provides opportunities to improve earlier diagnosis of cancer AIM: To investigate patients' GP consultation preferences when presented with a potential cancer symptom, and to describe whether these preferences are mediated by variable levels of cancer risk. A UK-wide online survey of adults ≥50 years old, using quota sampling to reflect general population characteristics. A discrete choice experiment examined participants' preferences for primary care consultation for three cancer symptom scenarios: risk level not mentioned, risk designated as 'low', or risk designated as 'high'. Scenarios based on length of consultation, time to getting an appointment, convenience, choice of GP, and GP listening skills were presented in a self-completed online questionnaire. A total of 9616 observations were obtained from 601 participants. Participants expressed preferences for doctors with better listening skills, the ability to see a GP of their choice, and shorter waiting times. These findings were the same across risk conditions and demographic groups. Participants were willing to wait an extra 3.5 weeks for an appointment with a doctor with good/very good listening skills (versus very poor listening skills) and an extra week for an appointment with a GP of their choice (versus any GP). Patient decisions about help seeking seem to be particularly influenced by the anticipated listening skills of doctors. Improving doctors' communication skills may in the longer term encourage people to seek prompt medical help when they experience a cancer symptom. © British Journal of General Practice 2017.

  7. Understanding delusions

    Directory of Open Access Journals (Sweden)

    Chandra Kiran


    Full Text Available Delusion has always been a central topic for psychiatric research with regard to etiology, pathogenesis, diagnosis, treatment, and forensic relevance. The various theories and explanations for delusion formation are reviewed. The etiology, classification and management of delusions are briefly discussed. Recent advances in the field are reviewed.

  8. Understanding semantics

    DEFF Research Database (Denmark)

    Thrane, Torben


    Understanding natural language is a cognitive, information-driven process. Discussing some of the consequences of this fact, the paper offers a novel look at the semantic effect of lexical nouns and the identification of reference types....

  9. Understanding Alzheimer's (United States)

    ... Navigation Bar Home Current Issue Past Issues Understanding Alzheimer's Past Issues / Fall 2007 Table of Contents For ... and brain scans. No treatment so far stops Alzheimer's. However, for some in the disease's early and ...

  10. Understanding homelessness


    Somerville, Peter


    This paper reviews the literature on understanding homelessness. It criticizes approaches that ignore, distort or diminish the humanity of homeless people, or else, add little to our understanding of that humanity. In particular, it rejects what it calls “epidemiological” approaches, which deny the possibility of agency for homeless people, insofar as those approaches view the situation of those people largely as a “social fact”, to be explained in terms of causal variables or “risk factors” ...

  11. Canadian National Consultation on Access to Scientific Research Data

    Directory of Open Access Journals (Sweden)

    Michel Sabourin


    Full Text Available In June 2004, an expert Task Force, appointed by the National Research Council Canada and chaired by Dr. David Strong, came together in Ottawa to plan a National Forum as the focus of the National Consultation on Access to Scientific Research Data. The Forum, which was held in November 2004, brought together more than seventy Canadian leaders in scientific research, data management, research administration, intellectual property and other pertinent areas. This article presents a comprehensive review of the issues, and the opportunities and the challenges identified during the Forum. Complex and rich arrays of scientific databases are changing how research is conducted, speeding the discovery and creation of new concepts. Increased access will accelerate such changes even more, creating other new opportunities. With the combination of databases within and among disciplines and countries, fundamental leaps in knowledge will occur that will transform our understanding of life, the world and the universe. The Canadian research community is concerned by the need to take swift action to adapt to the substantial changes required by the scientific enterprise. Because no national data preservation organization exists, may experts believe that a national strategy on data access or policies needs to be developed, and that a "Data Task Force" be created to prepare a full national implementation strategy. Once such a national strategy is broadly supported, it is proposed that a dedicated national infrastructure, tentatively called "Data Canada", be established, to assume overall leadership in the development and execution of a strategic plan.

  12. Balancing Acts: Culture as Commodity Among Business Consultants

    Directory of Open Access Journals (Sweden)

    Elias Mellander


    Full Text Available In this article the authors intend to analyze how the concept of culture is packaged, sold and delivered as a commodity. It is based on an ethnographic study of a Swedish consultancy in the field of cross-cultural communication and the relationship between the company and its clients. The clients were primarily foreign executives working in Sweden or Swedish expatriates, preparing for life abroad. The significance of culture-as-commodity will be explored from the perspective of the company as well as its clients in order to shed light on how the concept of culture can be communicated and what happens to it in the process. The study shows how the company combines theoretical perspectives from anthropology and intercultural communication with the aim to deliver a complex yet accessible understanding of culture to its clients. The analysis shows that these perspectives both clash and synergize, creating contradictions as well as turning culture into an accessible and useful tool for clients. The authors argue that researchers in the field of applied cultural analysis can learn from the example put forth by the balancing act between these two perspectives on culture performed by the company. The authors conclude that although the commodification process reduces and simplifies the meaning(s of culture, the company still manages to put culture on the agenda, demonstrating to its clients how, why, and in what ways it matters to them.

  13. Hybrid forum or network? The social and political construction of an international 'technical consultation': male circumcision and HIV prevention. (United States)

    Giami, Alain; Perrey, Christophe; Mendonça, André Luiz de Oliveira; de Camargo, Kenneth Rochel


    The technical consultation in Montreux, organised by World Health Organization and UNAIDS in 2007, recommended male circumcision as a method for preventing HIV transmission. This consultation came out of a long process of releasing reports and holding international and regional conferences, a process steered by an informal network. This network's relations with other parties is analysed along with its way of working and the exchanges during the technical consultation that led up to the formal adoption of a recommendation. Conducted in relation to the concepts of a 'hybrid forum' and 'network', this article shows that the decision was based on the formation and consolidation of a network of persons. They were active in all phases of this process, ranging from studies of the recommendation's efficacy, feasibility and acceptability to its adoption and implementation. In this sense, this consultation cannot be described as the constitution of a 'hybrid forum', which is characterised by its openness to a debate as well as a plurality of issues formulated by the actors and of resources used by them. On the contrary, little room was allowed for contradictory discussions, as if the decision had already been made before the Montreux consultation.

  14. Understanding MARC: Another Look

    Directory of Open Access Journals (Sweden)

    Roy Chang


    Full Text Available 無MARC format has been widely used and discussed in our profession. However, there appear to have a wide spread misunderstanding of its real structure and attributes. This article discuss the needs for us to understand it a little more. Also, it presents the general misconceptions about MARC, the compatibility of MARC, the structure of MARC, standardization and - data communication, and some major issues related to MARC format. In this library automation age, MARC is a key element in library services, and it deserves us to take another look.

  15. An Exploratory Study of Informal Learning and Team Performance in the Pre-Consulting Phase (United States)

    Sibarani, Roza Marsaulina


    This paper reports the process of informal learning in the pre-consulting phase in management-consulting firms in Indonesia. As the consulting industry significantly grows in Indonesia, more organisations use consultant services to improve their business. Pre-consulting is an important phase to define the right solutions, which involves a lot of…

  16. Department of Training and Consulting - Overview

    International Nuclear Information System (INIS)

    Dobrzynski, L.


    Full text: The Department of Training and Consulting concentrates on the dissemination of knowledge on radiation phenomena: the origins, applications and health effects of ionizing radiation in particular. Its activity is open to the public. However, the main recipients are students of secondary schools and teachers. During about 12 years of such activity the number of visitors has exceeded 60 000 persons, while during last few years the average number of our visitors varies between 6 000 and 7 000 per year, which shows how much this kind of activity is needed. It should be noted that the term 'visitor' is not the most appropriate, because what the 'visitor' actually experiences in the Department is a series of lectures with demonstrations, visits to the MARIA reactor or regular experimenting in a specially designed Laboratory of Atomic and Nuclear Physics for schools, teachers and university students. The Department organized two permanent exhibitions. One is connected with the nuclear waste treatment and storage, another one displays a large model. 4x4x4 m. of a nuclear reactor of the WWER-type which was about to be installed at Zarnowiec about 20 years ago. The Department is equally active during annual Picnics and Festivals of Science in Warsaw and other Polish towns. Our staff is often asked to deliver lectures outside the Institute for Nuclear Studies, and participates in discussions on problems of teaching, in addition, the Department leads, together with the Institute of Physics of the Polish Academy of Sciences, Warsaw, the annual competition, named '' Physical Paths '', for high-school students. The competition is arranged in three categories: research, demonstration of physical phenomena, and essays on physics and its relation to civilization. This competition particularly stimulates small educational centers in Poland. This year, 2010, the competition was organized for the fifth time. The Department of Training and Consulting arranges regular courses

  17. History Making: The Historian as Consultant

    Directory of Open Access Journals (Sweden)

    Jorma Kalela


    Full Text Available History is not just a genre of knowledge but also a basic feature of human life. Accounting for the past, or creating histories, to quote David Thelen, is ‘as natural a part of life as eating or breathing’. Casual references to what has taken place make up the vast majority of these accounts. But there are also a great number of deliberately created expositions of the past. They are produced in every field of society and by a wide variety of actors, from private persons to, for example, politicians and various media. The totality of them can be called everyday history. These accounts of the past serve present purposes – histories have innumerable functions and are of countless types. Divergent accounts also influence each other, and my suggestion is that their interaction be called the never-ending social process of history-making. History making, in other words, is not the preserve of academically-trained historians. They are experts but not outside observers. Scholarly historians are inescapably involved in the social process of history making. Their work goes beyond prevailing histories: they seek interpretations that make better sense of the past than the existing ones. Embedded in this effort is another constructivist function: they demonstrate ways to think about the past and how to use it. When demonstrating ‘that’s not how it was’, historians at the same display ‘how the presentation should have been constructed’. Even if they don’t think of themselves as consultants on history making they act in this capacity.

  18. Interventions before consultations for helping patients address their information needs. (United States)

    Kinnersley, P; Edwards, A; Hood, K; Cadbury, N; Ryan, R; Prout, H; Owen, D; Macbeth, F; Butow, P; Butler, C


    Patients often do not get the information they require from doctors and nurses. To address this problem, interventions directed at patients to help them gather information in their healthcare consultations have been proposed and tested. To assess the effects on patients, clinicians and the healthcare system of interventions which are delivered before consultations, and which have been designed to help patients (and/or their representatives) address their information needs within consultations. We searched: the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library (issue 3 2006); MEDLINE (1966 to September 2006); EMBASE (1980 to September 2006); PsycINFO (1985 to September 2006); and other databases, with no language restriction. We also searched reference lists of articles and related reviews, and handsearched Patient Education and Counseling (1986 to September 2006). Randomised controlled trials of interventions before consultations designed to encourage question asking and information gathering by the patient. Two researchers assessed the search output independently to identify potentially-relevant studies, selected studies for inclusion, and extracted data. We conducted a narrative synthesis of the included trials, and meta-analyses of five outcomes. We identified 33 randomised controlled trials, from 6 countries and in a range of settings. A total of 8244 patients was randomised and entered into studies. The most common interventions were question checklists and patient coaching. Most interventions were delivered immediately before the consultations.Commonly-occurring outcomes were: question asking, patient participation, patient anxiety, knowledge, satisfaction and consultation length. A minority of studies showed positive effects for these outcomes. Meta-analyses, however, showed small and statistically significant increases for question asking (standardised mean difference (SMD) 0.27 (95% confidence interval (CI) 0.19 to 0.36)) and

  19. Applying research to practice: generalist and specialist (visual ergonomics) consultancy. (United States)

    Long, Jennifer; Long, Airdrie


    Ergonomics is a holistic discipline encompassing a wide range of special interest groups. The role of an ergonomics consultant is to provide integrated solutions to improve comfort, safety and productivity. In Australia, there are two types of consultants--generalists and specialists. Both have training in ergonomics but specialist knowledge may be the result of previous education or work experience. This paper presents three projects illustrating generalist and specialist (visual ergonomics) consultancy: development of a vision screening protocol, solving visual discomfort in an office environment and solving postural discomfort in heavy industry. These case studies demonstrate how multiple ergonomics consultants may work together to solve ergonomics problems. It also describes some of the challenges for consultants, for those engaging their services and for the ergonomics profession, e.g. recognizing the boundaries of expertise, sharing information with business competitors, the costs-benefits of engaging multiple consultants and the risk of fragmentation of ergonomics knowledge and solutions. Since ergonomics problems are often multifaceted, ergonomics consultants should have a solid grounding in all domains of ergonomics, even if they ultimately only practice in one specialty or domain. This will benefit the profession and ensure that ergonomics remains a holistic discipline.

  20. Interpreted consultations as 'business as usual'? An analysis of organisational routines in general practices. (United States)

    Greenhalgh, Trisha; Voisey, Christopher; Robb, Nadia


    UK general practices operate in an environment of high linguistic diversity, because of recent large-scale immigration and of the NHS's commitment to provide a professional interpreter to any patient if needed. Much activity in general practice is co-ordinated and patterned into organisational routines (defined as repeated patterns of interdependent actions, involving multiple actors, bound by rules and customs) that tend to be stable and to persist. If we want to understand how general practices are responding to pressures to develop new routines, such as interpreted consultations, we need to understand how existing organisational routines change. This will then help us to address a second question, which is how the interpreted consultation itself is being enacted and changing as it becomes routinised (or not) in everyday general practice. In seeking answers to these two questions, we undertook a qualitative study of narratives of interpreted primary care consultations in three London boroughs with large minority ethnic populations. In 69 individual interviews and two focus groups, we sought accounts of interpreted consultations from service users, professional interpreters, family member interpreters, general practitioners, practice nurses, receptionists, and practice managers. We asked participants to tell us both positive and negative stories of their experiences. We analysed these data by searching for instances of concepts relating to the organisational routine, the meaning of the interpreted consultation to the practice, and the sociology of medical work. Our findings identified a number of general properties of the interpreted consultation as an organisational routine, including the wide variation in the form of adoption, the stability of the routine, the adaptability of the routine, and the strength of the routine. Our second key finding was that this variation could be partly explained by characteristics of the practice as an organisation, especially