WorldWideScience

Sample records for unit setting role

  1. Instruction Set Architectures for Quantum Processing Units

    OpenAIRE

    Britt, Keith A.; Humble, Travis S.

    2017-01-01

    Progress in quantum computing hardware raises questions about how these devices can be controlled, programmed, and integrated with existing computational workflows. We briefly describe several prominent quantum computational models, their associated quantum processing units (QPUs), and the adoption of these devices as accelerators within high-performance computing systems. Emphasizing the interface to the QPU, we analyze instruction set architectures based on reduced and complex instruction s...

  2. Role strain among male RNs in the critical care setting: Perceptions of an unfriendly workplace.

    Science.gov (United States)

    Carte, Nicholas S; Williams, Collette

    2017-12-01

    Traditionally, nursing has been a female-dominated profession. Men employed as registered nurses have been in the minority and little is known about the experiences of this demographic. The purpose of this descriptive, quantitative study was to understand the relationship between the variables of demographics and causes of role strain among male nurses in critical care settings. The Sherrod Role Strain Scale assesses role strain within the context of role conflict, role overload, role ambiguity and role incongruity. Data analysis of the results included descriptive and inferential statistics. Inferential statistics involved the use of repeated measures ANOVA testing for significant difference in the causes of role strain between male nurses employed in critical care settings and a post hoc comparison of specific demographic data using multivariate analyses of variance (MANOVAs). Data from 37 male nurses in critical care settings from the northeast of the United States were used to calculate descriptive statistics standard deviation, mean of the data analysis and results of the repeated ANOVA and the post hoc secondary MANOVA analysis. The descriptive data showed that all participants worked full-time. There was an even split from those participants who worked day shift (46%) vs. night shift (43%), most the participants indicated they had 15 years or more experience as an registered nurse (54%). Significant findings of this study include two causes of role strain in male nurses employed in critical care settings which are: role ambiguity and role overload based on ethnicity. Consistent with previous research findings, the results of this study suggest that male registered nurses employed in critical care settings do experience role strain. The two main causes of role strain in male nurses are role ambiguity and role overload. Copyright © 2017. Published by Elsevier Ltd.

  3. Role of Social Protection Unit District Cilacap

    Directory of Open Access Journals (Sweden)

    Gunawan

    2015-12-01

    Full Text Available Implementation of security and peace, order and protection of the people especially those who are within the settlement is the duty and responsibility of member units of community protection (Satlinmas, and what happens when members Satlinmas in carrying out its duties and functions not supported by the human resources of adequate quality and quantity , so the expectations and desires of the community to get security and peace, order and public protection are not met in full and result in (Satlinmas presence cannot be felt by the community. The method used in this study using qualitative research with descriptive analysis, the data obtained through documentation, observation, and interviews, sample locations were selected based on purposive sample of Cilacap, Cilacap is a district that has accommodated the institutional Linmas the organizational structure of Civil Service Police Unit and a barometer for other regions in the implementation of the enforcement of local regulations. The purpose of the study wanted to know how far Satlinmas can act in accordance with its duties and functions. Research results that Satlinmas role in organizing disaster management, the handling of security, peace and order, protection of the public at the district level are generally already be implemented, but at the neighbourhood level and harmonious citizens tasks and functions are yet to be implemented optimally.

  4. 75 FR 10345 - Pricing for 2010 United States Mint America the Beautiful Quarters Proof Set, etc.

    Science.gov (United States)

    2010-03-05

    ... DEPARTMENT OF THE TREASURY United States Mint Pricing for 2010 United States Mint America the Beautiful Quarters Proof Set, etc. AGENCY: United States Mint, Department of the Treasury. ACTION: Notice. SUMMARY: The United States Mint is announcing the prices of the 2010 United States Mint America the...

  5. Setting Sight on Role Playing: To Accommodate or to Repudiate?

    Directory of Open Access Journals (Sweden)

    Ika Apriani Fata

    2016-11-01

    Full Text Available To set sight on role play by means to look at EFL teacher’s experience and students’ perspectives of role play (RP technique enactment in teaching speaking by using qualitative design. This research was a qualitative study. It was discharged at a Senior high school in Banda Aceh, Indonesia. It provided work for the instrument of observation sheet, field notes and interview guide, and also questionnaire. The methodology designated the combination of four mountainsides to expose in-depth the urgency of role play in which applied since 1936. The result of interview was exposed that the English teacher claimed that role play was a technique applied to promote speaking and it was corroborated by the result of field note. Likewise, regarding students’ perspective depicted that the students indeed agreed on themselves of the usefulness of role play to enhance their speaking skill and motivation. Thus, Students asserted that the learning was more fun and enjoyable through role play itself. It is merely found in this research study that role playing can accommodate students’ need and teacher’s side in English language teaching. Nevertheless, this article applies a small subject as the participant. Therefore, the researchers recommended to have a deep look at reasoning students’ point of view in terms of role play technique implementation in non-English class. And see ascertains how beneficial it is in terms of role play (RP in a large classroom.

  6. Management of starvation in a Role 1 setting.

    Science.gov (United States)

    Jeffery, S M T; Freshwater, D A

    2012-01-01

    Historical reports from war and natural disasters first identified the dangers of reintroducing food after a period of starvation or malnutrition. The development of advanced nutritional support for hospitalised patients gave rise to the concept of refeeding syndrome, further highlighting the problems and leading to the development of guidelines and protocols for managing malnutrition. In this paper we present a case of starvation in the maritime setting and review the pathophysiology of starvation and refeeding. We discuss the problems associated with managing acute starvation in a Role 1 setting without access to higher medical care, and present guidance for its management.

  7. Social Work Student and Practitioner Roles in Integrated Care Settings.

    Science.gov (United States)

    Fraher, Erin P; Richman, Erica Lynn; Zerden, Lisa de Saxe; Lombardi, Brianna

    2018-06-01

    Social workers are increasingly being deployed in integrated medical and behavioral healthcare settings but information about the roles they fill in these settings is not well understood. This study sought to identify the functions that social workers perform in integrated settings and identify where they acquired the necessary skills to perform them. Master of social work students (n=21) and their field supervisors (n=21) who were part of a Health Resources and Services Administration-funded program to train and expand the behavioral health workforce in integrated settings were asked how often they engaged in 28 functions, where they learned to perform those functions, and the degree to which their roles overlapped with others on the healthcare team. The most frequent functions included employing cultural competency, documenting in the electronic health record, addressing patient social determinants of health, and participating in team-based care. Respondents were least likely to engage in case conferences; use Screening, Brief Intervention and Referral to Treatment; use stepped care to determine necessary level of treatment; conduct functional assessments of daily living skills; use behavioral activation; and use problem-solving therapy. A total of 80% of respondents reported that their roles occasionally, often, very often, or always overlapped with others on the healthcare team. Students reported learning the majority of skills (76%) in their Master of Social Work programs. Supervisors attributed the majority (65%) of their skill development to on-the-job training. Study findings suggest the need to redesign education, regulatory, and payment to better support the deployment of social workers in integrated care settings. This article is part of a supplement entitled The Behavioral Health Workforce: Planning, Practice, and Preparation, which is sponsored by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services

  8. Valuing the Leadership Role of University Unit Coordinators

    Science.gov (United States)

    Pepper, Coral; Roberts, Susan

    2016-01-01

    In this paper we describe the experiences of 64 unit coordinators across 15 Australian universities, gathered during 2011/2012 as part of an Office for Learning and Teaching (OLT) project. Our intention was to gain insight into how unit coordinators (academics who coordinate a discrete unit of study) perceive their role as leaders of learning in…

  9. 76 FR 15047 - Pricing for 2010 United States Mint America the Beautiful Quarters Silver Proof SetTM

    Science.gov (United States)

    2011-03-18

    ... DEPARTMENT OF THE TREASURY United States Mint Pricing for 2010 United States Mint America the Beautiful Quarters Silver Proof Set\\TM\\, etc. ACTION: Pricing for 2010 United States Mint America the Beautiful Quarters Silver Proof Set TM ; 2010 United States Mint Silver Proof Set TM ; 2011 United States...

  10. Dosimetric accuracy at low monitor unit setting in electron beams at different dose rates

    International Nuclear Information System (INIS)

    Ravikumar, M.; Ravichandran, R.; Supe, Sanjay S.; Sharma, Anil K.

    1999-01-01

    As electron beam with low monitor unit (LMU) settings are used in some dosimetric studies, better understanding of accuracy in dose delivery at LMU setting is necessary. The dose measurements were carried out with 0.6 cm 3 farmer type ion chamber at d max in a polystyrene phantom. Measurements at different MUs show that the dose linearity ratio (DLR) increases as the MU setting decreases below 20 MU and DLRs are found to increase when the incident electron beams have higher energies. The increase in DLR is minimum for low dose rate setting for all five electron beam energies (6, 9, 12, 16 and 20 MeV). As the variation in dose delivery is machine-specific, a detailed study should be conducted before the low MU setting is implemented. Since errors in dose delivery are high at higher dose rates, low dose rate may be better at low MU unit setting. (author)

  11. Simulation of the behaviour of a set of Cu/sub 2/S-CdS unit photocells

    Energy Technology Data Exchange (ETDEWEB)

    Jacquemin, J L; Bordure, G

    1982-03-01

    With the help of a general simulation program (the Spice II program from the University of California, Berkeley), adapted to photocell modelling, we studied the behaviour of a large solar photocell consisting of smaller Cu/sub 2/S-CdS unit solar cells in parallel. In particular we examined a theoretical set of photocells identical with the best cell made in the laboratory, a set of 30 real photocells characterized individually and the effect of introducing low efficiency cells. We indicate the role of each parameter characterizing the photocells in order to improve the behaviour of photovoltaic panels of larger dimensions.

  12. The Black Male Urban Barbershop as a Sex-Role Socialization Setting.

    Science.gov (United States)

    Franklin, Clyde W., II

    1985-01-01

    Participant observation found that the barbershop studies perpetuated sex-role stereotypes, encouraged sexist attitudes toward women and, in general, was a sex-role socialization setting that promoted sex-role inequality. (GC)

  13. Assessing students in community settings: the role of peer evaluation

    NARCIS (Netherlands)

    H.G. Schmidt (Henk); D.H.J.M. Dolmans (Diana); A.A. Abdel-Hameed (Ahmed); M.E.M. Mohi Eldin (Magzoub)

    1998-01-01

    textabstractThe assessment of students in community settings faces unique difficulties. Since students are usually posted in small groups in different community settings and since the learning (largely) takes place outside the classroom, assessing student performance becomes an intrinsically complex

  14. Inflammation and the neurovascular unit in the setting of focal cerebral ischemia.

    Science.gov (United States)

    del Zoppo, G J

    2009-02-06

    Responses to focal cerebral ischemia by neurons and adjacent microvessels are rapid, simultaneous, and topographically related. Recent observations indicate the simultaneous appearance of proteases by components of nearby microvessels that are also expressed by neurons in the ischemic territory, implying that the events could be coordinated. The structural relationship of neurons to their microvascular supply, the direct functional participation of glial cells, and the observation of a highly ordered microvessel-neuron response to ischemia suggest that these elements are arranged in and behave in a unitary fashion, the neurovascular unit. Their roles as a unit in the stimulation of cellular inflammation and the generation of inflammatory mediators during focal cerebral ischemia have not been explored yet. However, components of the neurovascular unit both generate and respond to these influences under the conditions of ischemia. Here we briefly explore the potential inter-relationships of the components of the neurovascular unit with respect to their potential roles in ischemia-induced inflammatory responses.

  15. 78 FR 70414 - Pricing for the 2013 United States Mint Limited Edition Silver Proof SetTM

    Science.gov (United States)

    2013-11-25

    ... DEPARTMENT OF THE TREASURY United States Mint Pricing for the 2013 United States Mint Limited Edition Silver Proof Set TM AGENCY: United States Mint, Department of the Treasury. ACTION: Notice. SUMMARY: The United States Mint is announcing a price of $139.95 for the 2013 United States Mint Limited...

  16. The role of experience curves for setting MEPS for appliances

    International Nuclear Information System (INIS)

    Siderius, Hans-Paul

    2013-01-01

    Minimum efficiency performance standards (MEPS) are an important policy instrument to raise the efficiency of products. In most schemes the concept of life cycle costs (LCC) is used to guide setting the MEPS levels. Although a large body of literature shows that product cost is decreasing with increasing cumulative production, the experience curve, this is currently not used for setting MEPS. This article shows how to integrate the concept of the experience curve into LCC calculations for setting MEPS in the European Union and applies this to household laundry driers, refrigerator-freezers and televisions. The results indicate that for driers and refrigerator-freezers at least twice the energy savings compared to the current approach can be achieved. These products also show that energy label classes can successfully be used for setting MEPS. For televisions an experience curve is provided, showing a learning rate of 29%. However, television prices do not show a relation with energy efficiency but are to a large extent determined by the time the product is placed on the market. This suggests to policy makers that for televisions and other products with a short (re)design and market cycle timing is more important than the MEPS levels itself. - Highlights: • We integrate experience curves into life cycle cost calculations for MEPS. • For driers and refrigerators this results in at least twice the energy savings. • For flat panel televisions an experience curve is provided

  17. The Role of Construct Maps in Standard Setting

    Science.gov (United States)

    Kane, Michael T.; Tannenbaum, Richard J.

    2013-01-01

    The authors observe in this commentary that construct maps can help standard-setting panels to make realistic and internally consistent recommendations for performance-level descriptions (PLDs) and cut-scores, but the benefits may not be realized if policymakers do not fully understand the rationale for the recommendations provided by the…

  18. Malnutrition in healthcare settings and the role of gastrostomy feeding.

    Science.gov (United States)

    Kurien, Matthew; Williams, Jake; Sanders, David S

    2017-08-01

    Malnutrition can adversely affect physical and psychological function, influencing both morbidity and mortality. Despite the prevalence of malnutrition and its associated health and economic costs, malnutrition remains under-detected and under-treated in differing healthcare settings. For a subgroup of malnourished individuals, a gastrostomy (a feeding tube placed directly into the stomach) may be required to provide long-term nutritional support. In this review we explore the spectrum and consequences of malnutrition in differing healthcare settings. We then specifically review gastrostomies as a method of providing nutritional support. The review highlights the origins of gastrostomies, and discusses how endoscopic and radiological advances have culminated in an increased demand and placement of gastrostomy feeding tubes. Several studies have raised concerns about the benefits derived following this intervention and also about the patients selected to undergo this procedure. These studies are discussed in detail in this review, alongside suggestions for future research to help better delineate those who will benefit most from this intervention, and improve understanding about how gastrostomies influence nutritional outcomes.

  19. Intonational meaning in institutional settings: the role of syntagmatic relations

    Science.gov (United States)

    Wichmann, Anne

    2010-12-01

    This paper addresses the power of intonation to convey interpersonal or attitudinal meaning. Speakers have been shown to accommodate to each other in the course of conversation, and this convergence may be perceived as a sign of empathy. Accommodation often involves paradigmatic choices—choosing the same words, gestures, regional accent or melodic pattern, but this paper suggests that affective meaning can also be conveyed syntagmatically through the relationship between prosodic features in successive utterances. The paper also addresses the use of prosody in situations of conflict, particularly in institutional settings. The requirement of the more powerful participant to exercise control may conflict with the expression of empathy. Situations are described where divergent rather than convergent behaviour is more successful both in keeping control and in maintaining rapport.

  20. A reliability model of a warm standby configuration with two identical sets of units

    International Nuclear Information System (INIS)

    Huang, Wei; Loman, James; Song, Thomas

    2015-01-01

    This article presents a new reliability model and the development of its analytical solution for a warm standby redundant configuration with units that are originally operated in active mode, and then, upon turn-on of originally standby units, are put into warm standby mode. These units can be used later if a standby- turned into active-unit fails. Numerical results of an example configuration are presented and discussed with comparison to other warm standby configurations, and to Monte Carlo simulation results obtained from BlockSim software. Results show that the Monte Carlo simulation model gives virtually identical reliability value when the simulation uses a high number of replications, confirming the developed model. - Highlights: • A new reliability model is developed for a warm standby redundancy with two sets of identical units. • The units subject to state change from active to standby then back to active mode. • A closed form analytical solution is developed with exponential distribution. • To validate the developed model, a Monte Carlo simulation for an exemplary configuration is performed

  1. Model for Estimating Power and Downtime Effects on Teletherapy Units in Low-Resource Settings

    Directory of Open Access Journals (Sweden)

    Rachel McCarroll

    2017-10-01

    Full Text Available Purpose: More than 6,500 megavoltage teletherapy units are needed worldwide, many in low-resource settings. Cobalt-60 units or linear accelerators (linacs can fill this need. We have evaluated machine performance on the basis of patient throughput to provide insight into machine viability under various conditions in such a way that conclusions can be generalized to a vast array of clinical scenarios. Materials and Methods: Data from patient treatment plans, peer-reviewed studies, and international organizations were combined to assess the relative patient throughput of linacs and cobalt-60 units that deliver radiotherapy with standard techniques under various power and maintenance support conditions. Data concerning the frequency and duration of power outages and downtime characteristics of the machines were used to model teletherapy operation in low-resource settings. Results: Modeled average daily throughput was decreased for linacs because of lack of power infrastructure and for cobalt-60 units because of limited and decaying source strength. For conformal radiotherapy delivered with multileaf collimators, average daily patient throughput over 8 years of operation was equal for cobalt-60 units and linacs when an average of 1.83 hours of power outage occurred per 10-hour working day. Relative to conformal treatments delivered with multileaf collimators on the respective machines, the use of advanced techniques on linacs decreased throughput between 20% and 32% and, for cobalt machines, the need to manually place blocks reduced throughput up to 37%. Conclusion: Our patient throughput data indicate that cobalt-60 units are generally best suited for implementation when machine operation might be 70% or less of total operable time because of power outages or mechanical repair. However, each implementation scenario is unique and requires consideration of all variables affecting implementation.

  2. Predictors of CPAP compliance in different clinical settings: primary care versus sleep unit.

    Science.gov (United States)

    Nadal, Núria; de Batlle, Jordi; Barbé, Ferran; Marsal, Josep Ramon; Sánchez-de-la-Torre, Alicia; Tarraubella, Nuria; Lavega, Merce; Sánchez-de-la-Torre, Manuel

    2018-03-01

    Good adherence to continuous positive airway pressure (CPAP) treatment improves the patient's quality of life and decreases the risk of cardiovascular disease. Previous studies that have analyzed the adherence to CPAP were performed in a sleep unit (SU) setting. The involvement of primary care (PC) in the management of obstructive sleep apnea (OSA) patients receiving CPAP treatment could introduce factors related to the adherence to treatment. The objective was to compare the baseline predictors of CPAP compliance in SU and PC settings. OSA patients treated with CPAP were followed for 6 months in SU or PC setting. We included baseline clinical and anthropometrical variables, the Epworth Sleep Scale (ESS) score, the quality of life index, and the Charlson index. A logistic regression was performed for each group to determine the CPAP compliance predictors. Discrimination and calibration were performed using the area under the curve and Hosmer-Lemeshow tests. We included 191 patients: 91 in the PC group and 100 in the SU group. In 74.9% of the patients, the compliance was ≥ 4 h per day, with 80% compliance in the SU setting and 69.2% compliance in the PC setting (p = 0.087). The predictors of CPAP compliance were different between SU and PC settings. Body mass index, ESS, and CPAP pressure were predictors in the SU setting, and ESS, gender, and waist circumference were predictors in the PC setting. The predictors of adequate CPAP compliance vary between SU and PC settings. Detecting compliance predictors could help in the planning of early interventions to improve CPAP adherence.

  3. Valuing setting-based recreation for selected visitors to national forests in the southern United States.

    Science.gov (United States)

    Sardana, Kavita; Bergstrom, John C; Bowker, J M

    2016-12-01

    In this study we estimate selected visitors' demand and value for recreational trips to settings such as developed vs. undeveloped sites in U.S. national forests in the Southern United States using the travel cost method. The setting-based approach allows for valuation of multi-activity trips to particular settings. The results from an adjusted Poisson lognormal estimator corrected for truncation and endogenous stratification reveal that economic value per trip estimates are higher for wilderness compared to day-use developed settings, overnight-use developed settings, and general forest areas. Estimates of these economic values are important to resource managers because their management decisions and actions typically control recreational settings. For example, managers control developed campground capacity in a national forest, but typically not the number of campers below the capacity constraint and the number and types of activities visitors engage in during a multi-activity trip to a developed campground (within limits since some activities such as discharging a firearm are not permitted in a developed campground). Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Environmental and hydrologic setting of the Ozark Plateaus study unit, Arkansas, Kansas, Missouri, and Oklahoma

    Science.gov (United States)

    Adamski, James C.; Petersen, James C.; Freiwald, David A.; Davis, Jerri V.

    1995-01-01

    The environmental and hydrologic setting of the Ozark Plateaus National Water-Quality Assessment (NAWQA) study unit and the factors that affect water quality are described in this report. The primary natural and cultural features that affect water- quality characteristics and the potential for future water-quality problems are described. These environmental features include climate, physio- graphy, geology, soils, population, land use, water use, and surface- and ground-water flow systems. The study-unit area is approximately 47,600 square miles and includes most of the Ozark Plateaus Province and parts of the adjacent Osage Plains and Mississippi Alluvial Plain in parts of Arkansas, Kansas, Missouri, and Oklahoma. The geology is characterized by basement igneous rocks overlain by a thick sequence of dolomites, limestones, sandstones, and shales of Paleozoic age. Land use in the study unit is predominantly pasture and forest in the southeastern part, and pasture and cropland in the northwestern part. All or part of the White, Neosho-lllinois, Osage, Gasconade, Meramec, St. Francis, and Black River Basins are within the study unit. Streams in the Boston Mountains contain the least mineralized water, and those in the Osage Plains contain the most mineralized water. The study unit contains eight hydrogeologic units including three major aquifers--the Springfield Plateau, Ozark, and St. Francois aquifers. Streams and aquifers in the study unit generally contain calcium or calcium-magnesium bicarbonate waters. Ground- and surface-water interactions are greatest in the Salem and Springfield Plateaus and least in the Boston Mountains and Osage Plains. Geology, land use, and population probably are the most important environmental factors that affect water quality.

  5. The Role of Proprioception in the Sagittal Setting of Anticipatory Postural Adjustments During Gait Initiation

    OpenAIRE

    Pereira Marcelo P.; Pelicioni Paulo H. Silva; Gobbi Lilian T.B.

    2015-01-01

    Purpose. Previous studies have studied the role of proprioception on the setting of anticipatory postural adjustments (APA) during gait initiation. However, these studies did not investigate the role of proprioception in the sagittal APA setting. We aimed to investigate the role of proprioception manipulation to induce APA sagittal adaptations on gait initiation. Methods. Fourteen healthy adults performed gait initiation without, and with, vibration applied before movement onset, and during m...

  6. Role and services of the Nuclear Energy Unit

    International Nuclear Information System (INIS)

    Ahmad Tajuddin bin Ali

    1985-01-01

    This article contains the research and development activities planned to be undertaken, and the services to be provided by the Nuclear Energy Unit. The fields of research have been selected to aid the development in the use of Nuclear Science and Technology, whilst the proposed services are geared towards widening the use to this technology in socio-economic development. Objectives in the research fields have been identified following a number of consultations with IAEA, foreign and local experts, and involved careful study of local requirements. The services provided will cater for all, especially institutions involved in nuclear technology both from the public and private sectors. This effort is in line with the role of the Unit as the national promoter and coordinator in the utilization of nuclear technology in the country

  7. Midwives' experiences of labour care in midwifery units. A qualitative interview study in a Norwegian setting.

    Science.gov (United States)

    Skogheim, Gry; Hanssen, Tove A

    2015-12-01

    In some economically developed countries, women's choice of birth care and birth place is encouraged. The aim of this study was to explore and describe the experiences of midwives who started working in alongside/free-standing midwifery units (AMU/FMU) and their experiences with labour care in this setting. A qualitative explorative design using a phenomenographic approach was used. Semi-structured interviews were conducted with ten strategically sampled midwives working in midwifery units. The analysis revealed the following five categories of experiences noted by the midwives: mixed emotions and de-learning obstetric unit habits, revitalising midwifery philosophy, alertness and preparedness, presence and patience, and coping with time. Starting to work in an AMU/FMU can be a distressing period for a midwife. First, it may require de-learning the medical approach to birth, and, second, it may entail a revitalisation (and re-learning) of birth care that promotes physiological birth. Midwifery, particularly in FMUs, requires an especially careful assessment of the labouring process, the ability to be foresighted, and capability in emergencies. The autonomy of midwives may be constrained also in AMUs/FMUs. However, working in these settings is also viewed as experiencing "the art of midwifery" and enables revitalisation of the midwifery philosophy. Copyright © 2015 Elsevier B.V. All rights reserved.

  8. Experiences of Nigerian Internationally Educated Nurses Transitioning to United States Health Care Settings.

    Science.gov (United States)

    Iheduru-Anderson, Kechinyere C; Wahi, Monika M

    2018-04-01

    Successful transition to practice of internationally educated nurses (IENs) can critically affect quality of care. The aim of this study was to characterize the facilitators and barriers to transition of Nigerian IENs (NIENs) to the United States health care setting. Using a descriptive phenomenology approach, 6 NIENs were interviewed about their transitional experiences in the United States. Thematic methods were used for data analysis. The three major themes identified from the participants' stories were "fear/anger and disappointment" (FAD), "road/journey to success/overcoming challenges" (RJO), and "moving forward" (MF). The FAD theme predominated, including experiences of racism, bullying, and inequality. The RJO theme included resilience, and the MF theme encompassed personal growth. NIENs face personal and organizational barriers to adaptation, especially fear, anger and disappointment. Future research should seek to develop a model for optimal adaptation that focuses on improving both personal and organizational facilitators and decreasing barriers.

  9. Valuing setting-based recreation for selected visitors to national forests in the southern United States

    Science.gov (United States)

    Kavita Sardana; John C. Bergstrom; J. M.  Bowker

    2016-01-01

    In this study we estimate selected visitors’ demand and value for recreational trips to settings such as developed vs. undeveloped sites in U.S. national forests in the Southern United States using the travel cost method. The setting-based approach allows for valuation of multi-activity trips to particular settings. The results from an adjusted Poisson lognormal...

  10. Surgical stress response and the potential role of preoperative glucocorticoids on post-anesthesia care unit recovery

    DEFF Research Database (Denmark)

    Steinthorsdottir, Kristin J; Kehlet, Henrik; Aasvang, Eske K

    2017-01-01

    The immediate postoperative course in the post-anesthesia care unit (PACU) remains a challenge across surgical procedures. Postoperative pain, sedation/cognitive dysfunction, nausea and vomiting (PONV), circulatory and respiratory problems and orthostatic intolerance constitute the bulk of the di......-anesthesia care unit (PACU), but with a scarcity of intervention studies using glucocorticoids to control inflammation. We, therefore, suggest a future research focus on the role of inflammation and effect of glucocorticoids in the PACU setting to improve patient recovery....

  11. Vaginal birth after cesarean: neonatal outcomes and United States birth setting.

    Science.gov (United States)

    Tilden, Ellen L; Cheyney, Melissa; Guise, Jeanne-Marie; Emeis, Cathy; Lapidus, Jodi; Biel, Frances M; Wiedrick, Jack; Snowden, Jonathan M

    2017-04-01

    Women who seek vaginal birth after cesarean delivery may find limited in-hospital options. Increasing numbers of women in the United States are delivering by vaginal birth after cesarean delivery out-of-hospital. Little is known about neonatal outcomes among those who deliver by vaginal birth after cesarean delivery in- vs out-of-hospital. The purpose of this study was to compare neonatal outcomes between women who deliver via vaginal birth after cesarean delivery in-hospital vs out-of-hospital (home and freestanding birth center). We conducted a retrospective cohort study using 2007-2010 linked United States birth and death records to compare singleton, term, vertex, nonanomolous, and liveborn neonates who delivered by vaginal birth after cesarean delivery in- or out-of-hospital. Descriptive statistics and multivariate regression analyses were conducted to estimate unadjusted, absolute, and relative birth-setting risk differences. Analyses were stratified by parity and history of vaginal birth. Sensitivity analyses that involved 3 transfer status scenarios were conducted. Of women in the United States with a history of cesarean delivery (n=1,138,813), only a small proportion delivered by vaginal birth after cesarean delivery with the subsequent pregnancy (n=109,970; 9.65%). The proportion of home vaginal birth after cesarean delivery births increased from 1.78-2.45%. A pattern of increased neonatal morbidity was noted in unadjusted analysis (neonatal seizures, Apgar score birthing their second child by vaginal birth after cesarean delivery in out-of-hospital settings had higher odds of neonatal morbidity and death compared with women of higher parity. Women who had not birthed vaginally prior to out-of-hospital vaginal birth after cesarean delivery had higher odds of neonatal morbidity and mortality compared with women who had birthed vaginally prior to out-of-hospital vaginal birth after cesarean delivery. Sensitivity analyses generated distributions of plausible

  12. A New Model of Delirium Care in the Acute Geriatric Setting: Geriatric Monitoring Unit

    Directory of Open Access Journals (Sweden)

    Chong Mei

    2011-08-01

    Full Text Available Abstract Background Delirium is a common and serious condition, which affects many of our older hospitalised patients. It is an indicator of severe underlying illness and requires early diagnosis and prompt treatment, associated with poor survival, functional outcomes with increased risk of institutionalisation following the delirium episode in the acute care setting. We describe a new model of delirium care in the acute care setting, titled Geriatric Monitoring Unit (GMU where the important concepts of delirium prevention and management are integrated. We hypothesize that patients with delirium admitted to the GMU would have better clinical outcomes with less need for physical and psychotropic restraints compared to usual care. Methods/Design GMU models after the Delirium Room with adoption of core interventions from Hospital Elder Life Program and use of evening bright light therapy to consolidate circadian rhythm and improve sleep in the elderly patients. The novelty of this approach lies in the amalgamation of these interventions in a multi-faceted approach in acute delirium management. GMU development thus consists of key considerations for room design and resource planning, program specific interventions and daily core interventions. Assessments undertaken include baseline demographics, comorbidity scoring, duration and severity of delirium, cognitive, functional measures at baseline, 6 months and 12 months later. Additionally we also analysed the pre and post-GMU implementation knowledge and attitude on delirium care among staff members in the geriatric wards (nurses, doctors and undertook satisfaction surveys for caregivers of patients treated in GMU. Discussion This study protocol describes the conceptualization and implementation of a specialized unit for delirium management. We hypothesize that such a model of care will not only result in better clinical outcomes for the elderly patient with delirium compared to usual geriatric care

  13. A comprehensive dwelling unit choice model accommodating psychological constructs within a search strategy for consideration set formation.

    Science.gov (United States)

    2015-12-01

    This study adopts a dwelling unit level of analysis and considers a probabilistic choice set generation approach for residential choice modeling. In doing so, we accommodate the fact that housing choices involve both characteristics of the dwelling u...

  14. Enhanced Decision Support Systems in Intensive Care Unit Based on Intuitionistic Fuzzy Sets

    Directory of Open Access Journals (Sweden)

    Hanen Jemal

    2017-01-01

    Full Text Available In areas of medical diagnosis and decision-making, several uncertainty and ambiguity shrouded situations are most often imposed. In this regard, one may well assume that intuitionistic fuzzy sets (IFS should stand as a potent technique useful for demystifying associated with the real healthcare decision-making situations. To this end, we are developing a prototype model helpful for detecting the patients risk degree in Intensive Care Unit (ICU. Based on the intuitionistic fuzzy sets, dubbed Medical Intuitionistic Fuzzy Expert Decision Support System (MIFEDSS, the shown work has its origins in the Modified Early Warning Score (MEWS standard. It is worth noting that the proposed prototype effectiveness validation is associated through a real case study test at the Polyclinic ESSALEMA cited in Sfax, Tunisia. This paper does actually provide some practical initial results concerning the system as carried out in real life situations. Indeed, the proposed system turns out to prove that the MIFEDSS does actually display an imposing capability for an established handily ICU related uncertainty issues. The performance of the prototypes is compared with the MEWS standard which exposed that the IFS application appears to perform highly better in deferring accuracy than the expert MEWS score with higher degrees of sensitivity and specificity being recorded.

  15. A Cross-Country Comparison of Virtual Discussion Board Use in United States and Costa Rican Education Settings

    Science.gov (United States)

    Hodge, Kari; Saxon, Terrill F.; Trumble, Jason

    2013-01-01

    The purpose of the current study was to compare the use of virtual discussion boards in various educational settings in the United States and Costa Rica. Participants included professors of education, in-service and pre-service teachers in the United States and Costa Rica where a survey was used that included demographic, knowledge, attitude, and…

  16. Comparisons of auction mechanisms in a multiple unit setting: A consideration for restructuring electric power markets

    Science.gov (United States)

    Bernard, John Charles

    The objective of this study was to compare the performance of five single sided auctions that could be used in restructured electric power markets across different market sizes in a multiple unit setting. Auction selection would profoundly influence an industry over $200 billion in size in the United States, and the consequences of implementing an inappropriate mechanism would be great. Experimental methods were selected to analyze the auctions. Two rounds of experiments were conducted, the first testing the sealed offer last accepted offer (LAO) and first rejected offer (FRO), and the clock English (ENG) and sealed offer English (SOE) in markets of sizes two and six. The FRO, SOE, and ENG used the same pricing rule. Second round testing was on the LAO, FRO, and the nonuniform price multiple unit Vickrey (MUV) in markets of sizes two, four, and six. Experiments lasted 23 and 75 periods for rounds 1 and 2 respectively. Analysis of variance and contrast analysis were used to examine the data. The four performance measures used were price, efficiency, profits per unit, and supply revelation. Five basic principles were also assessed: no sales at losses, all low cost capacity should be offered and sold, no high cost capacity should sell, and the market should clear. It was expected group size and auction type would affect performance. For all performance measures, group size was a significant variable, with smaller groups showing poorer performance. Auction type was significant only for the efficiency performance measure, where clock auctions outperformed the others. Clock auctions also proved superior for the first four principles. The FRO performed poorly in almost all situations, and should not be a preferred mechanism in any market. The ENG was highly efficient, but expensive for the buyer. The SOE appeared superior to the FRO and ENG. The clock improves efficiency over the FRO while less information kept prices under the ENG. The MUV was superior in revealing costs

  17. Simulation of the behaviour of a set of Cu/sub 2/S-CdS unit photocells. [Spice II program

    Energy Technology Data Exchange (ETDEWEB)

    Jacquemin, J L; Bordure, G

    1982-03-01

    With the help of a general simulation program (the Spice II program from the University of California, Berkeley), adapted to photocell modeling, authors studied the behavior of a large solar photocell consisting of smaller Cu/sub 2/S-CdS unit solar cells in parallel, in particular, a theoretical set of photocells identical with the best cell made in the laboratory, a set of 30 real photocells characterized individually and the effect of introducing low efficiency cells. The role of each parameter characterizing the photocells is indicated, in order to improve the behavior of photovoltaic panels of larger dimensions. 2 refs.

  18. Role Strain, Part 2: Perceptions Among Athletic Trainers Employed in the Professional Practice Setting.

    Science.gov (United States)

    Romero, Manuel G; Pitney, William A; Mazerolle, Stephanie M; Brumels, Kirk

    2018-02-01

      Athletic trainers (ATs) employed in the professional sport setting (ATPSSs) demonstrate moderate to high degrees of role strain. The experiences and perceptions of these ATs provide insight regarding the sources of role strain as well as ways to reduce it.   To investigate the perceptions of ATPSSs regarding role strain.   Qualitative study.   From a purposeful sampling of 389 ATs employed in the 5 major sport leagues (Major League Baseball, Major League Soccer, National Basketball Association, National Football League, and National Hockey League), we identified 34 participants willing to participate in phone interviews. Data Collection and Procedures:  Semistructured phone interviews. Inductive data analysis was based on a grounded theory approach. Credibility was addressed with member checks and a peer debriefing.   Three first-order emergent themes materialized from the data: (1) sources of role strain, (2) consequences of role strain, and (3) strategies to alleviate role strain in ATPSSs. Participants described the antecedents of role strain as emerging from the competing expectations of the professional athlete, the organization, and the sport league. Consequences of role strain included effects on direct patient care and work-life imbalance. Improving organizational factors such as inadequate staffing and poor communication within the organization were strategies described by participants for decreasing role strain in the professional sports setting.   Our participants discussed experiencing role strain, which was facilitated by trying to meet the competing demands placed on them with limited time and often with an inadequate support staff. Participant role strain affected health care and contributed to work-life imbalance. Participants described changing the organizational factors that contributed to role strain as a strategy to alleviate the perceived stress.

  19. Patients' perceptions of their roles in goal setting in a spinal cord injury regional rehabilitation program.

    Science.gov (United States)

    Draaistra, Harriett; Singh, Mina D; Ireland, Sandra; Harper, Theresa

    2012-01-01

    Goal setting is a common practice in rehabilitation, yet there is a paucity of literature exploring patients' perceptions of their roles in this process. This study was conducted using a qualitative descriptive methodology to explore patients' perceptions of their roles in setting goals in a spinal cord injury regional rehabilitation program. Imogene King's theory of goal attainment was used to frame the study. Data were collected through interviews and analyzed using a content analysis. The results revealed four themes: Visioning, Redefining, Brainstorming, and Rebuilding Participants (n = 13) envisioned their roles as setting an overarching priority goal, defining detailed rehabilitation goals, sharing knowledge with the team, and rebuilding skills to attain goals. Implications for nursing practice include the need to understand patients' experiences and perceptions, share knowledge, and support effective communication to promote collaborative goal setting. A need to enhance health professionals' education to fully understand factors influencing patients' abilities to set rehabilitation goals, and future research in methods to promote patients' engagement in goal setting was also clearly indicated.

  20. Leader performance evaluations and role congruity expectations in a community college setting

    OpenAIRE

    Trickey, Edward

    2011-01-01

    To investigate the relationships among evaluator attitudes, the role congruity biases many people consciously and unconsciously maintain, evaluation practices, perceptions of leader efficacy and success, and leader persistence in two community college settings, a mixed-methods study was conducted. Leaders are the products of their experiences, environments, the greater society within which they live, their personal attitudes and biases, and the attitudes and role biases of others. Over time, ...

  1. Evaluating the use of the Cleo 90 infusion set for patients on a palliative care unit.

    Science.gov (United States)

    Schneider, Michael; Hoffmann, Martin; Lorenzl, Stefan

    2009-08-01

    Although the use of subcutaneous infusion is common in palliative care, problems can occur. Normally, butterfly needles are used; however, there are occasional issues with patients being able to walk around or with restless patients who suffer from delirium. In these cases, needles often dislocate; therefore, a small observational study was undertaken to evaluate the use of the Cleo 90 infusion set. The use of this needle system has been well established in diabetic patients who require continuous subcutaneous infusion of insulin, but has never been tested in a wider range of patients with other medications. In this 6-month study, 45 patients were identified for subcutaneous infusion and a total of 112 needles were used for this study, since we initially changed each site after 2 days to control the local site for adverse reactions. We have not observed any complications with drug combinations delivered via the attached tube and the needle, and have used up to five different drugs mixed together in a single syringe. Needles could be used for a mean time of 5 +/- 2 days (range 2-12 days). Local site reactions have been observed only with sodium chloride infusions, which were not delivered via a pump system. Reddening and induration of the skin occurred, but they were reversible after removing the needle. As this was a small study in only one unit, without standardization the results can only be observational. However, it has shown, for the first time, that the Cleo 90 needle can be safe and comfortable.

  2. Research on Role Sets and Emotional Relationships in Military Personnel Marriage

    Science.gov (United States)

    Murtazina, Elmira I.; Minullina, Aida F.

    2016-01-01

    An urgent demand of society to conduct effective work with the family substantiates the relevance of the research. The article provides the investigation of role sets and emotional relationships in marriage through the study of military personnel and nonmilitary personnel families. Practical implementation of psychological ideas represents one of…

  3. Innovative partnerships: the clinical nurse leader role in diverse clinical settings.

    Science.gov (United States)

    Lammon, Carol Ann Barnett; Stanton, Marietta P; Blakney, John L

    2010-01-01

    The American Association of Colleges of Nursing in collaboration with leaders in the health care arena has developed a new role in nursing, the clinical nurse leader (CNL). The CNL is a master's-prepared advanced nurse generalist, accountable for providing high-quality, cost-effective care for a cohort of patients in a specific microsystem. Although initial implementation of the CNL has been predominantly in urban acute care settings, the skill set of the CNL role is equally applicable to diverse clinical settings, such as smaller rural hospitals, home-based home care providers, long-term care facilities, schools, Veteran's Administration facilities, and public health settings. This article reports the strategies used and the progress made at The University of Alabama Capstone College of Nursing in the development of innovative partnerships to develop the role of the CNL in diverse clinical settings. With academia and practice working in partnership, the goal of transforming health care and improving patient outcomes can be achieved. Copyright © 2010 Elsevier Inc. All rights reserved.

  4. Characteristics of flattening filter free beams at low monitor unit settings

    Energy Technology Data Exchange (ETDEWEB)

    Akino, Yuichi [Department of Radiology, Osaka University Hospital, Suita, Osaka 565-0871, Japan and Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871 (Japan); Ota, Seiichi; Inoue, Shinichi; Mizuno, Hirokazu [Department of Radiology, Osaka University Hospital, Suita, Osaka 565-0871 (Japan); Sumida, Iori; Yoshioka, Yasuo; Ogawa, Kazuhiko [Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871 (Japan); Isohashi, Fumiaki [Oncology Center, Osaka University Hospital, Suita, Osaka 565-0871 (Japan)

    2013-11-15

    Purpose: Newer linear accelerators (linacs) have been equipped to deliver flattening filter free (FFF) beams. When FFF beams are used for step-and-shoot intensity-modulated radiotherapy (IMRT), the stability of delivery of small numbers of monitor units (MU) is important. The authors developed automatic measurement techniques to evaluate the stability of the dose profile, dose linearity, and consistency. Here, the authors report the performance of the Artiste™ accelerator (Siemens, Erlangen, Germany) in delivering low-MU FFF beams.Methods: A 6 MV flattened beam (6X) with 300 MU/min dose rate and FFF beams of 7 (7XU) and 11 MV (11XU), each with a 500 MU/min dose rate, were measured at 1, 2, 3, 5, 8, 10, and 20 MU settings. For the 2000 MU/min dose rate, the 7 (7XUH) and 11 MV (11XUH) beams were set at 10, 15, 20, 25, and 30 MU because of the limits of the minimum MU settings. Beams with 20 × 20 and 10 × 10 cm{sup 2} field sizes were alternately measured ten times in intensity modulated (IM) mode, with which Siemens linacs regulate beam delivery for step-and-shoot IMRT. The in- and crossplane beam profiles were measured using a Profiler™ Model 1170 (Sun Nuclear Corporation, Melbourne, FL) in multiframe mode. The frames of 20 × 20 cm{sup 2} beams were identified at the off-axis profile. The 6X beam profile was normalized at the central axis. The 7 and 11 MV FFF beam profiles were rescaled to set the dose at the central axis at 145% and 170%, respectively. Point doses were also measured using a Farmer-type ionization chamber and water-equivalent solid phantom to evaluate the linearity and consistency of low-MU beam delivery. The values displayed on the electrometer were recognized with a USB-type camera and read with open-source optical character recognition software.Results: The symmetry measurements of the 6X, 7XU, and 11XU beam profiles were better than 2% for beams ≥2 MU and improved with increasing MU. The variations in flatness of FFF beams ≥2 MU were

  5. Characteristics of flattening filter free beams at low monitor unit settings

    International Nuclear Information System (INIS)

    Akino, Yuichi; Ota, Seiichi; Inoue, Shinichi; Mizuno, Hirokazu; Sumida, Iori; Yoshioka, Yasuo; Ogawa, Kazuhiko; Isohashi, Fumiaki

    2013-01-01

    Purpose: Newer linear accelerators (linacs) have been equipped to deliver flattening filter free (FFF) beams. When FFF beams are used for step-and-shoot intensity-modulated radiotherapy (IMRT), the stability of delivery of small numbers of monitor units (MU) is important. The authors developed automatic measurement techniques to evaluate the stability of the dose profile, dose linearity, and consistency. Here, the authors report the performance of the Artiste™ accelerator (Siemens, Erlangen, Germany) in delivering low-MU FFF beams.Methods: A 6 MV flattened beam (6X) with 300 MU/min dose rate and FFF beams of 7 (7XU) and 11 MV (11XU), each with a 500 MU/min dose rate, were measured at 1, 2, 3, 5, 8, 10, and 20 MU settings. For the 2000 MU/min dose rate, the 7 (7XUH) and 11 MV (11XUH) beams were set at 10, 15, 20, 25, and 30 MU because of the limits of the minimum MU settings. Beams with 20 × 20 and 10 × 10 cm 2 field sizes were alternately measured ten times in intensity modulated (IM) mode, with which Siemens linacs regulate beam delivery for step-and-shoot IMRT. The in- and crossplane beam profiles were measured using a Profiler™ Model 1170 (Sun Nuclear Corporation, Melbourne, FL) in multiframe mode. The frames of 20 × 20 cm 2 beams were identified at the off-axis profile. The 6X beam profile was normalized at the central axis. The 7 and 11 MV FFF beam profiles were rescaled to set the dose at the central axis at 145% and 170%, respectively. Point doses were also measured using a Farmer-type ionization chamber and water-equivalent solid phantom to evaluate the linearity and consistency of low-MU beam delivery. The values displayed on the electrometer were recognized with a USB-type camera and read with open-source optical character recognition software.Results: The symmetry measurements of the 6X, 7XU, and 11XU beam profiles were better than 2% for beams ≥2 MU and improved with increasing MU. The variations in flatness of FFF beams ≥2 MU were ±5%. The

  6. Productivity Effects of United States Multinational Enterprises : The Roles of Market Orientation and Regional Integration

    NARCIS (Netherlands)

    Smeets, Roger; Wei, Yingqi

    2010-01-01

    Smeets R. and Wei Y. Productivity effects of United States multinational enterprises: the roles of market orientation and regional integration, Regional Studies. This paper considers the role of market orientation and regional integration in foreign direct investment (FDI) productivity effects.

  7. On the role of phraseological units in nowadays English periodicals

    Directory of Open Access Journals (Sweden)

    Osipova I. A.

    2016-09-01

    Full Text Available the current study is aimed at functional analysis of phraseological units in today’s English periodicals. An everlasting interest of contemporary researches to the above mentioned object of studies stems from the thesis that phraseological units are a potent linguistic means to convey emotional potential and vivid images of texts belonging to the publicistic genre.

  8. EPA's Role in the United Nations Economic and Social Council

    Science.gov (United States)

    The United Nations Economic and Social Council (ECOSOC) considers the world’s economic, social, and environmental challenges. ECOSOC is composed of subsidiary bodies, including the recently concluded Commission on Sustainable Development (CSD).

  9. Developing the Role of a Health Information Professional in a Clinical Research Setting

    Directory of Open Access Journals (Sweden)

    Helen M. Seeley

    2010-06-01

    Full Text Available Objective ‐ This paper examines the role of a health information professional in a large multidisciplinary project to improve services for head injury.Methods ‐ An action research approach was taken, with the information professional acting as co‐ordinator. Change management processes were guided by theory and evidence. The health information professional was responsible for an ongoing literature review on knowledge management (clinical and political issues, data collection and analysis (from patient records, collating and comparing data (to help develop standards, and devising appropriate dissemination strategies.Results ‐ Important elements of the health information management role proved to be 1 co‐ordination; 2 setting up mechanisms for collaborative learning through information sharing; and 3 using the theoretical frameworks (identified from the literature review to help guide implementation. The role that emerged here has some similarities to the informationist role that stresses domain knowledge, continuous learning and working in context (embedding. This project also emphasised the importance of co‐ordination, and the ability to work across traditional library information analysis (research literature discovery and appraisal and information analysis of patient data sets (the information management role.Conclusion ‐ Experience with this project indicates that health information professionals will need to be prepared to work with patient record data and synthesis of that data, design systems to co‐ordinate patient data collection, as well as critically appraise external evidence.

  10. Ageing prisoners' health care: analysing the legal settings in Europe and the United States.

    Science.gov (United States)

    Bretschneider, Wiebke; Elger, Bernice; Wangmo, Tenzin

    2013-01-01

    Relatively little is known about the current health care situation and the legal rights of ageing prisoners worldwide. To date, only a few studies have investigated their rights to health care. However, elderly prisoners need special attention. The aim of this article is to critically review the health care situation of older prisoners by analysing the relevant national and international legal frameworks with a particular focus on Switzerland, England and Wales, and the United States (U.S.). Publications on legal frameworks were searched using Web of Science, PubMed, MEDLINE, HeinOnline, and the National Criminal Justice Reference Service. Searches utilizing combinations of keywords relating to ageing prisoners were performed. Relevant reports and policy documents were obtained in order to understand the legal settings in Switzerland, England and Wales, and the U.S. All articles, reports, and policy documents published in English and German between 1774 to June 2012 were included for analysis. Using a comparative approach, an outline was completed to distinguish positive policies in this area. Regulatory approaches were investigated through evaluations of soft laws applicable in Europe and U.S. Supreme Court judgements. Even though several documents could be interpreted as guaranteeing adequate health care for ageing prisoners, there is no specific regulation that addresses this issue completely. The Vienna International Plan of Action on Ageing contributes the most by providing an in-depth analysis of the health care needs of older persons. Still, critical analysis of retrieved documents reveals the lack of specific legislation regarding the health care for ageing prisoners. No consistent regulation delineates the provision of health care for ageing prisoners. Neither national nor international institutions have enforceable laws that secure the precarious situation of older adults in prisons. To initiate a change, this work presents critical issues that must be

  11. Price Setting Transactions and the Role of Denominating Currency in FX Markets

    OpenAIRE

    Friberg, Richard; Wilander, Fredrik

    2007-01-01

    This report, commissioned by Sveriges Riksbank, examines the role of currency denomination in international trade transactions. It is divided in two parts. The first part consists of a survey of the price setting and payment practices of a large sample of Swedish exporting firms. The second part analyzes payments data from the Swedish settlement reports from 1999-2002. We examine whether invoicing patterns of Swedish and European companies changed following the creation of the EMU and how the...

  12. On Fréchet theorem in the set of measure preserving functions over the unit interval

    Directory of Open Access Journals (Sweden)

    So-Hsiang Chou

    1990-01-01

    Full Text Available In this paper, we study the Fréchet theorem in the set of measure preserving functions over the unit interval and show that any measure preserving function on [0,1] can be approximated by a sequence of measure preserving piecewise linear continuous functions almost everywhere. Some application is included.

  13. The Cultural Influence in Accounting Standard Setting: A Comparative Analysis of the United States, Canada, and England.

    Science.gov (United States)

    Bloom, Robert; And Others

    A study of the processes for establishing the principles and policies of measurement and disclosure in preparing financial reports examines differences in these processes in the United States, Canada, and England. Information was drawn from international accounting literature on standard setting. The differences and similarities in the…

  14. From agenda-setting to implementation: The role of multisectoral partnerships in addressing urban climate risks

    Science.gov (United States)

    Surminski, Swenja; Leck, Hayley

    2017-10-01

    Multisectoral partnerships (MSPs) form an increasingly popular and important part of the global climate and disaster risk governance landscape, but the literature offers little critical investigation of this phenomenon. In particular it remains unclear how MSPs can support the transition from agenda setting to implementation in response to multiple current and future pressures threatening the resilience of cities. Through the lens of the London Climate Change Partnership (LCCP) and drawing from other MSP examples, this paper investigates the scope for MSPs to enhance climate adaptation in an urban context. Our paper has two main aims: to expand understanding of the role of MSPs in the adaptation decision process in the context of the wider governance literature, and to shed some light on the complexities of transitioning through that process. To clarify the role of a MSP we propose a distinction between "first generation" and "second generation" MSPs, illustrating the progression from agenda-setting to implementation: "first generation" MSPs are focused on agenda setting and knowledge sharing in order to support decision makers, while "second generation" MSPs are aimed at implementing solutions. We consider this distinction from the perspective of the individual members and their perceptions, motivations, and expectations. We find that the dynamic nature of urban adaptation with a shifting focus from initial agenda setting toward the implementation of actions presents challenges for existing MSPs, particularly such long-established ones like the LCCP. Our investigation shows that "first generation" MSPs can play important roles in agenda setting, but finds little evidence of "second generation" MSPs achieving implementation.

  15. The Role of eHealth in Optimizing Preventive Care in the Primary Care Setting.

    Science.gov (United States)

    Carey, Mariko; Noble, Natasha; Mansfield, Elise; Waller, Amy; Henskens, Frans; Sanson-Fisher, Rob

    2015-05-22

    Modifiable health risk behaviors such as smoking, overweight and obesity, risky alcohol consumption, physical inactivity, and poor nutrition contribute to a substantial proportion of the world's morbidity and mortality burden. General practitioners (GPs) play a key role in identifying and managing modifiable health risk behaviors. However, these are often underdetected and undermanaged in the primary care setting. We describe the potential of eHealth to help patients and GPs to overcome some of the barriers to managing health risk behaviors. In particular, we discuss (1) the role of eHealth in facilitating routine collection of patient-reported data on lifestyle risk factors, and (2) the role of eHealth in improving clinical management of identified risk factors through provision of tailored feedback, point-of-care reminders, tailored educational materials, and referral to online self-management programs. Strategies to harness the capacity of the eHealth medium, including the use of dynamic features and tailoring to help end users engage with, understand, and apply information need to be considered and maximized. Finally, the potential challenges in implementing eHealth solutions in the primary care setting are discussed. In conclusion, there is significant potential for innovative eHealth solutions to make a contribution to improving preventive care in the primary care setting. However, attention to issues such as data security and designing eHealth interfaces that maximize engagement from end users will be important to moving this field forward.

  16. The Role of Proprioception in the Sagittal Setting of Anticipatory Postural Adjustments During Gait Initiation

    Directory of Open Access Journals (Sweden)

    Pereira Marcelo P.

    2015-12-01

    Full Text Available Purpose. Previous studies have studied the role of proprioception on the setting of anticipatory postural adjustments (APA during gait initiation. However, these studies did not investigate the role of proprioception in the sagittal APA setting. We aimed to investigate the role of proprioception manipulation to induce APA sagittal adaptations on gait initiation. Methods. Fourteen healthy adults performed gait initiation without, and with, vibration applied before movement onset, and during movement. In addition, the effects of two different vibration frequencies (80 and 120Hz were tested. Vibration was applied bilaterally on the tibialis anterior, rectus femoris and trapezius superior. The first step characteristics, ground reaction forces and CoP behaviour were assessed. Results. Vibration improved gait initiation performance regardless of the moment it was applied. CoP velocity during the initial phase of APA was increased by vibration only when it was applied before movement. When vibration was applied to disturb the movement, no effects on the CoP behaviour were observed. Manipulation of vibration frequency had no effects. Conclusions. Rather than proprioception manipulation, the results suggest that post-vibratory effects and attentional mechanisms were responsible for our results. Taken together, the results show that sagittal APA setting is robust to proprioception manipulation.

  17. The ASN imposes on EDF complementary requirements for the setting of the hard-core unit

    International Nuclear Information System (INIS)

    Anon.

    2014-01-01

    In January 2014, the ASN (French Authority for Nuclear Safety) published a list of 19 decisions concerning the implementation of a 'post-Fukushima' hard-core unit in each EDF nuclear power plant. The purpose of the hard-core unit is to have structures and equipment able to resist very extreme events and able to assure the vital functions necessary for the reactor safety. The 19 decisions detail the rules for the design of the hard-core unit. For example the hard-core unit will have to resist earthquakes for which the probability of occurrence is about 1 every 20.000 years while the probability taking into account for the design of the reactor is only 1 every 1000 or 10.000 years

  18. Detrital zircon provenance of the Hartselle Sandstone Unit, Southeastern USA: Insights into sediment source, paleogeography, and setting

    Science.gov (United States)

    Harthy, M. A.; Gifford, J.

    2017-12-01

    The Hartselle sandstone is an excellent example of an Oil sand, a resource rich in bitumen. The unit is a light-colored thick-bedded to massive quartzose sandstone, that is widespread across an area from Georgia in the east to Mississippi in the west, and south from Alabama to Kentucky as a northern border. Formation thickness ranges from 0 to more than 150 feet. The unit has been stratigraphically dated to the Middle-Upper Mississippian age. One hypothesis suggests that the sandstone unit formed from the geological remains of barrier islands located in the ocean between Gondwana and Laurentia. The Hartselle is thought to have formed by the movement waves and currents along the shoreline, which carried sand and concentrated it into a set of northwest to southeast trending barrier islands. Transgression-regression events shifted the islands back and forth in relation to the position of the shoreline, leading to the large areal extent of the unit. However, the current data are not enough to explain the geographical position of the Hartselle sandstone unit as it is not running parallel to the ancient shoreline. Another mystery is the source of the sand, some believing the source was from the south (Gondwana) and others that erosion was from the north (Laurentia). Detrital zircon provenance analysis will address the uncertainty in sediment source. We will compare zircon U-Pb age spectra to possible Laurentian and Gondwanan source areas to discriminate between these possibilities. In addition, the age of the youngest detrital zircon population will provide additional constraints on the maximum age of deposition for the unit. These detrital ages will also help us to understand the tectonic setting at the time of Hartselle deposition. Lastly, we aim to explain the widespread nature of the unit and the processes involved in the formation of the Hartselle sandstone. When taken together, these interpretations will illuminate the age, depositional and tectonic setting of a

  19. The Present and Future State of Blended Learning in Workplace Learning Settings in the United States

    Science.gov (United States)

    Bonk, Curtis J.; Kim, Kyong-Jee; Oh, Eun Jung; Teng, Ya-Ting; Son, Su Jin

    2007-01-01

    This paper reports survey findings related to the present and future state of blended learning in workplace learning settings across the U.S. Surveyed in this study are 118 practitioners in corporate training or elearning in various workplace settings. The findings reveal interesting perceptions by respondents regarding the benefits of and…

  20. The role of anaesthetists in paediatric intensive care units

    African Journals Online (AJOL)

    Adele

    to various surgical and critical care disciplines, the usefulness of a paediatric intensive care unit (PICU) rotation was investigated. A brief overview of the experiences of anaesthetic registrars at a. South African teaching hospital rotating through a PICU is pre- sented, as well as the potential advantages for both trainees and.

  1. Navigating Motherhood and the Role of the Head Athletic Trainer in the Collegiate Setting

    Science.gov (United States)

    Mazerolle, Stephanie M.; Eason, Christianne M.

    2016-01-01

    Context:  Motherhood has been identified as a barrier to the head athletic trainer (AT) position. Role models have been cited as a possible facilitator for increasing the number of women who pursue and maintain this role in the collegiate setting. Objective:  To examine the experiences of female ATs balancing motherhood and head AT positions in the National Collegiate Athletic Association Division II and III and National Association of Intercollegiate Athletics settings. Design:  Qualitative study. Setting:  National Collegiate Athletic Association Divisions II and III and National Association of Intercollegiate Athletics. Patients or Other Participants:  A total of 22 female head ATs (average age = 40 ± 8 years) who were married with children completed our study. Our participants had been certified for 15.5 ± 7.5 years and in their current positions as head ATs for 9 ± 8 years. Data Collection and Analysis:  We conducted online interviews with all participants. Participants journaled their reflections on a series of open-ended questions pertaining to their experiences as head ATs. Data were analyzed following a general inductive approach. Credibility was confirmed through peer review and researcher triangulation. Results:  We identified 3 major contributors to work-life conflict. Two speak to organizational influences on conflict: work demands and time of year. The role of motherhood, which was more of a personal contributor, also precipitated conflict for our ATs. Four themes emerged as work-life balance facilitators: planning, attitude and perspective, support networks, and workplace integration. Support was defined at both the personal and professional levels. Conclusions:  In terms of the organization, our participants juggled long work hours, travel, and administrative tasks. Individually and socioculturally, they overcame their guilt and their need to be present and an active part of the parenting process. These mothers demonstrated the

  2. Transportable GPU (General Processor Units) chip set technology for standard computer architectures

    Science.gov (United States)

    Fosdick, R. E.; Denison, H. C.

    1982-11-01

    The USAFR-developed GPU Chip Set has been utilized by Tracor to implement both USAF and Navy Standard 16-Bit Airborne Computer Architectures. Both configurations are currently being delivered into DOD full-scale development programs. Leadless Hermetic Chip Carrier packaging has facilitated implementation of both architectures on single 41/2 x 5 substrates. The CMOS and CMOS/SOS implementations of the GPU Chip Set have allowed both CPU implementations to use less than 3 watts of power each. Recent efforts by Tracor for USAF have included the definition of a next-generation GPU Chip Set that will retain the application-proven architecture of the current chip set while offering the added cost advantages of transportability across ISO-CMOS and CMOS/SOS processes and across numerous semiconductor manufacturers using a newly-defined set of common design rules. The Enhanced GPU Chip Set will increase speed by an approximate factor of 3 while significantly reducing chip counts and costs of standard CPU implementations.

  3. Roles of Carbohydrate Supply and Ethylene,Polyamines in Maize Kernel Set

    Institute of Scientific and Technical Information of China (English)

    Han-Yu Feng; Zhi-Min Wang; Fan-Na Kong; Min-Jie Zhang; Shun-Li Zhou

    2011-01-01

    Glucose appears to have an antagonistic relationship with ethylene and ethylene and polyaminesappear to play antagonistic roles in the abortion of seeds and fruits.Moreover,ethylene,spermidine,and spermine share a common biosynthetic precursor.The synchronous changes of them and therelationships with kernel set are currently unclear.Here,we stimulated maize(Zea mays L.)apical kernelset and studied their changes at 4,8,12,and 16 d after pollination(DAP).The status of the apicalkernels changed from abortion to set,showing a pattern similar to that of the middle kernels,withslow decrease in glucose and rapid decline in ethylene production,and a sharp increase in spermidineand spermine after four DAP.Synchronous changes in ethylene and spermidine were also observed.However,the ethylene production decreased slowly in the aborted apical kernels,the glucose andpolyamines concentrations were lower.Ethephon application did not block the change from abortion toset for the setting apical kernels.These data indicate that the developmental change may be accompaniedby an inhibition of adequate glucose to ethylene synthesis and subsequent promotion of spermidine andspermine synthesis,and adequate carbohydrate supply may play a key role in the developmental process.

  4. The role of heat pipes in intensified unit operations

    International Nuclear Information System (INIS)

    Reay, David; Harvey, Adam

    2013-01-01

    Heat pipes are heat transfer devices that rely, most commonly, on the evaporation and condensation of a working fluid contained within them, with passive pumping of the condensate back to the evaporator. They are sometimes referred to as ‘thermal superconductors’ because of their exceptionally high effective thermal conductivity (substantially higher than any metal). This, together with several other characteristics make them attractive to a range of intensified unit operations, particularly reactors. The majority of modern computers deploy heat pipes for cooling of the CPU. The application areas of heat pipes come within a number of broad groups, each of which describes a property of the heat pipe. The ones particularly relevant to chemical reactors are: i. Separation of heat source and sink. ii. Temperature flattening, or isothermalisation. iii. Temperature control. Chemical reactors, as a heat pipe application area, highlight the benefits of the heat pipe based on isothermalisation/temperature flattening device and on being a highly effective heat transfer unit. Temperature control, done passively, is also of relevance. Heat pipe technology offers a number of potential benefits to reactor performance and operation. The aim of increased yield of high purity, high added value chemicals means less waste and higher profitability. Other intensified unit operations, such as those employing sorption processes, can also profit from heat pipe technology. This paper describes several variants of heat pipe and the opportunities for their use in intensified plant, and will give some current examples. -- Highlights: ► Heat pipes – thermal superconductors – can lead to improved chemical reactor performance. ► Isothermalisation within a reactor vessel is an ideal application. ► The variable conductance heat pipe can control reaction temperatures within close limits. ► Heat pipes can be beneficial in intensified reactors

  5. Navigating Motherhood and the Role of the Head Athletic Trainer in the Collegiate Setting.

    Science.gov (United States)

    Mazerolle, Stephanie M; Eason, Christianne M

    2016-07-01

    Motherhood has been identified as a barrier to the head athletic trainer (AT) position. Role models have been cited as a possible facilitator for increasing the number of women who pursue and maintain this role in the collegiate setting. To examine the experiences of female ATs balancing motherhood and head AT positions in the National Collegiate Athletic Association Division II and III and National Association of Intercollegiate Athletics settings. Qualitative study. National Collegiate Athletic Association Divisions II and III and National Association of Intercollegiate Athletics. A total of 22 female head ATs (average age = 40 ± 8 years) who were married with children completed our study. Our participants had been certified for 15.5 ± 7.5 years and in their current positions as head ATs for 9 ± 8 years. We conducted online interviews with all participants. Participants journaled their reflections on a series of open-ended questions pertaining to their experiences as head ATs. Data were analyzed following a general inductive approach. Credibility was confirmed through peer review and researcher triangulation. We identified 3 major contributors to work-life conflict. Two speak to organizational influences on conflict: work demands and time of year. The role of motherhood, which was more of a personal contributor, also precipitated conflict for our ATs. Four themes emerged as work-life balance facilitators: planning, attitude and perspective, support networks, and workplace integration. Support was defined at both the personal and professional levels. In terms of the organization, our participants juggled long work hours, travel, and administrative tasks. Individually and socioculturally, they overcame their guilt and their need to be present and an active part of the parenting process. These mothers demonstrated the ability to cope with their demanding roles as both moms and head ATs.

  6. Sets in Excess Demand in Ascending Auctions with Unit-Demand Bidders

    NARCIS (Netherlands)

    Andersson, T.D.; Andersson, C.; Talman, A.J.J.

    2010-01-01

    This paper analyzes the problem of selling a number of indivisible items to a set of unitdemand bidders. An ascending auction mechanism called the Excess Demand Ascending Auction (EDAA) is defined. The main results demonstrate that EDAA terminates in a finite number of iterations and that the exact

  7. Informational Element of Power: The Role of Public Diplomacy in United States-Cuba Policy Implementation

    National Research Council Canada - National Science Library

    Andujar, Roberto C

    2005-01-01

    THESIS: The United States should reassess its Public Diplomacy strategy toward Cuba and the key role that Public Diplomacy plays in preparing the Cuban people to transition to a free and democratic state. RATIONALE...

  8. What is the role of general internists in the tertiary or academic setting?

    Science.gov (United States)

    Tanriover, Mine Durusu; Rigby, Shirley; van Hulsteijn, L Harry; Ferreira, Faustino; Oliveira, Narcisso; Schumm-Draeger, Petra-Maria; Weidanz, Frauke; Kramer, Mark H H

    2015-01-01

    The changing demography of European populations mandates a vital role for internists in caring for patients in each level of healthcare. Internists in the tertiary or academic setting are highly ranked in terms of their responsibilities: they are clinicians, educators, researchers, role models, mentors and administrators. Contrary to the highly focused approach of sub-specialties, general internists working in academic settings can ensure that coordinated care is delivered in the most cost-conscious and efficient way. Moreover, internal medicine is one of the most appropriate specialties in which to teach clinical reasoning skills, decision-making and analytical thinking, as well as evidence based, patient oriented medicine. Internists deal with challenging patients of the new millennium with a high burden of chronic diseases and polypharmacy; practice personalised medicine with a wide scientific background and so they are the perfect fit to establish and implement new tools for scientific research. In conclusion, internal medicine is developing a new identity as a specialty in its own right. The European Federation of Internal Medicine supports the concept of academic internists and calls upon the member countries to construct academic (general) internal medicine departments in their respective countries. As 'internal medicine is the cornerstone of every national healthcare system', academic (general) internal medicine should strive to be the cornerstone of every integrated, patient-centred, modern medical care and training system. Copyright © 2014 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  9. Paediatric cardiac intensive care unit: current setting and organization in 2010.

    Science.gov (United States)

    Fraisse, Alain; Le Bel, Stéphane; Mas, Bertrand; Macrae, Duncan

    2010-10-01

    Over recent decades, specialized paediatric cardiac intensive care has emerged as a central component in the management of critically ill, neonatal, paediatric and adult patients with congenital and acquired heart disease. The majority of high-volume centres (dealing with over 300 surgical cases per year) have dedicated paediatric cardiac intensive care units, with the smallest programmes more likely to care for paediatric cardiac patients in mixed paediatric or adult intensive care units. Specialized nursing staff are also a crucial presence at the patient's bedside for quality of care. A paediatric cardiac intensive care programme should have patients (preoperative and postoperative) grouped together geographically, and should provide proximity to the operating theatre, catheterization laboratory and radiology department, as well as to the regular ward. Age-appropriate medical equipment must be provided. An optimal strategy for running a paediatric cardiac intensive care programme should include: multidisciplinary collaboration and involvement with paediatric cardiology, anaesthesia, cardiac surgery and many other subspecialties; a risk-stratification strategy for quantifying perioperative risk; a personalized patient approach; and anticipatory care. Finally, progressive withdrawal from heavy paediatric cardiac intensive care management should be institutionalized. Although the countries of the European Union do not share any common legislation on the structure and organization of paediatric intensive care or paediatric cardiac intensive care, any paediatric cardiac surgery programme in France that is agreed by the French Health Ministry must perform at least '150 major procedures per year in children' and must provide a 'specialized paediatric intensive care unit'. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  10. Data acquisition for a patient-directed intervention protocol in the dynamic intensive care unit setting.

    Science.gov (United States)

    Chlan, Linda; Patterson, Robert P; Heiderscheit, Annie

    2011-07-01

    Methods to easily, accurately, and efficiently obtain data in an ICU-based clinical trial can be challenging in this high-tech setting. Patient medical status and the dynamic nature of this clinical setting further complicate data collection. The purpose of this paper is to describe the modifications of commercially available headphones and the application of a data logging device to capture frequency and length of protocol use (music listening or headphones only for noise cancellation) without burdening participants or busy ICU nurses. With the automatic capture of protocol use by research participants, there have been no instances of lost data for this clinical trial. Copyright © 2011 Elsevier Inc. All rights reserved.

  11. A Commentary on "The Role of the Unit in Physics and Psychometrics" by Stephen Humphry

    Science.gov (United States)

    Andrich, David

    2011-01-01

    This commentary examines the role of the unit from the perspective of the definition of measurement in physics as the ratio of two magnitudes, one of which is defined as the unit; it is an important and timely contribution to measurement in the social sciences. There are many different points that could be commented upon, but the author will…

  12. Emergency diesel generating sets for the 900 MW PWR units operation and maintenance policy

    International Nuclear Information System (INIS)

    Guillon, A.; Lallier, M.

    1986-01-01

    In order to improve the reliability of the emergency diesel generating EDF has taken steps to ensure that: - sets are only started up when they are really needed, in order to reduce the thermal cycles and the mechanical stresses associated with start-up. - the maintenance policy is adapted to the conditions of use, by including the notion of a start-up being equivalent to a predetermined number of hours of operation. (authors)

  13. Emergency diesel generating sets for the 900 MW PWR units operation and maintenance policy

    Energy Technology Data Exchange (ETDEWEB)

    Guillon, A.; Lallier, M. [Electricite de France - EDF, Service de la Production Thermique, 3 rue de Messine, 75384 Paris Cedex 08 (France)

    1986-02-15

    In order to improve the reliability of the emergency diesel generating EDF has taken steps to ensure that: - sets are only started up when they are really needed, in order to reduce the thermal cycles and the mechanical stresses associated with start-up. - the maintenance policy is adapted to the conditions of use, by including the notion of a start-up being equivalent to a predetermined number of hours of operation. (authors)

  14. An inventory of United States and Canadian growth record sets: preliminary report.

    Science.gov (United States)

    Hunter, W S; Baumrind, S; Moyers, R E

    1993-06-01

    A listing and description of longitudinal craniofacial growth record sets currently extant on the North American continent is provided. An argument is made for the preservation of these resources and for the generation of a pooled or shared image base of duplicate craniofacial physical records. This is a preliminary report and is assumed to be incomplete. In an effort to improve our accuracy and completeness, we invite corrections and additions.

  15. An Investigation of Mathematical Knowledge Related to Mathematics Teachers' Basic Concepts in Sets Unit

    Directory of Open Access Journals (Sweden)

    Nurullah YAZICI

    2017-05-01

    Full Text Available This research was conducted in order to examine the subject matter of Mathematics teachers in the context of "Mathematical Knowledge For Teaching" (MKT model of "Basic Concepts in Sets" which is the first topic of the 9th class "Sets". The study group, which is one of the qualitative research methods, used the case study design, constitutes 5 mathematics teachers who work in different education levels (primary and secondary education in the academic year of 2015-2016. Open-ended questions and semi-structured interview form developed by the researcher were used for data collection. A descriptive analysis technique was used to analyze the data obtained through interviews. While analyzing the data, teacher and student textbooks, which were prepared by the Ministry of National Education for the purpose of teaching in 2015-2016 academic year, were taken as a reference. According to the research findings, it was determined that the teachers had deficiencies in the subject field of "Basic Concepts in the Sets" and had superficial knowledge rather than in depth knowledge.

  16. Relationships of demographic background and practice setting among practicing physician assistants in the United States.

    Science.gov (United States)

    Muma, Richard D; Kelley, Justin; Lies, Shawn

    2010-01-01

    it is assumed that minority health care providers continue to work in primary care and in underserved areas in higher proportions than their nonminority counterparts, regardless of changing workforce practice patterns. The primary purpose of this study was to determine whether this assumption still holds true among US physician assistants (PAs) in light of recent PA specialization. This assumption is important as there is continuing evidence that a similar background between providers and patients can be beneficial to the provider-patient relationship and to patient outcomes. A secondary purpose was to determine the relationships between various demographic variables (eg, race) and current practice specialty and population served among all PAs. this cross-sectional study measured demographic and practice setting survey data. A random sample of 10,500 PAs was surveyed. the main finding was that minority PAs were more likely to care for the underserved (31.9% vs. 19.3%) and to work in primary care practices (38.8% vs. 29.3%) than were nonminorities. A significant relationship was also found between serving underserved populations and nonmarried status, as well as age over 39 (these groups were more likely to serve this population, p time of high school graduation was significantly related to caring for underserved individuals (p Minority PAs were more likely to care for the underserved and work in primary care settings. Certain other demographic variables among all respondents were also significantly related to service to the underserved and work in primary care settings.

  17. SU-F-T-78: Minimum Data Set of Measurements for TG 71 Based Electron Monitor-Unit Calculations

    International Nuclear Information System (INIS)

    Xu, H; Guerrero, M; Prado, K; Yi, B

    2016-01-01

    Purpose: Building up a TG-71 based electron monitor-unit (MU) calculation protocol usually involves massive measurements. This work investigates a minimum data set of measurements and its calculation accuracy and measurement time. Methods: For 6, 9, 12, 16, and 20 MeV of our Varian Clinac-Series linear accelerators, the complete measurements were performed at different depth using 5 square applicators (6, 10, 15, 20 and 25 cm) with different cutouts (2, 3, 4, 6, 10, 15 and 20 cm up to applicator size) for 5 different SSD’s. For each energy, there were 8 PDD scans and 150 point measurements for applicator factors, cutout factors and effective SSDs that were then converted to air-gap factors for SSD 99–110cm. The dependence of each dosimetric quantity on field size and SSD was examined to determine the minimum data set of measurements as a subset of the complete measurements. The “missing” data excluded in the minimum data set were approximated by linear or polynomial fitting functions based on the included data. The total measurement time and the calculated electron MU using the minimum and the complete data sets were compared. Results: The minimum data set includes 4 or 5 PDD’s and 51 to 66 point measurements for each electron energy, and more PDD’s and fewer point measurements are generally needed as energy increases. Using only <50% of complete measurement time, the minimum data set generates acceptable MU calculation results compared to those with the complete data set. The PDD difference is within 1 mm and the calculated MU difference is less than 1.5%. Conclusion: Data set measurement for TG-71 electron MU calculations can be minimized based on the knowledge of how each dosimetric quantity depends on various setup parameters. The suggested minimum data set allows acceptable MU calculation accuracy and shortens measurement time by a few hours.

  18. SU-F-T-78: Minimum Data Set of Measurements for TG 71 Based Electron Monitor-Unit Calculations

    Energy Technology Data Exchange (ETDEWEB)

    Xu, H; Guerrero, M; Prado, K; Yi, B [University of Maryland School of Medicine, Baltimore, MD (United States)

    2016-06-15

    Purpose: Building up a TG-71 based electron monitor-unit (MU) calculation protocol usually involves massive measurements. This work investigates a minimum data set of measurements and its calculation accuracy and measurement time. Methods: For 6, 9, 12, 16, and 20 MeV of our Varian Clinac-Series linear accelerators, the complete measurements were performed at different depth using 5 square applicators (6, 10, 15, 20 and 25 cm) with different cutouts (2, 3, 4, 6, 10, 15 and 20 cm up to applicator size) for 5 different SSD’s. For each energy, there were 8 PDD scans and 150 point measurements for applicator factors, cutout factors and effective SSDs that were then converted to air-gap factors for SSD 99–110cm. The dependence of each dosimetric quantity on field size and SSD was examined to determine the minimum data set of measurements as a subset of the complete measurements. The “missing” data excluded in the minimum data set were approximated by linear or polynomial fitting functions based on the included data. The total measurement time and the calculated electron MU using the minimum and the complete data sets were compared. Results: The minimum data set includes 4 or 5 PDD’s and 51 to 66 point measurements for each electron energy, and more PDD’s and fewer point measurements are generally needed as energy increases. Using only <50% of complete measurement time, the minimum data set generates acceptable MU calculation results compared to those with the complete data set. The PDD difference is within 1 mm and the calculated MU difference is less than 1.5%. Conclusion: Data set measurement for TG-71 electron MU calculations can be minimized based on the knowledge of how each dosimetric quantity depends on various setup parameters. The suggested minimum data set allows acceptable MU calculation accuracy and shortens measurement time by a few hours.

  19. THE ROLE OF FOLLICULAR UNIT GRAFTING IN TREATMENT ALOPECIA

    Directory of Open Access Journals (Sweden)

    Duhita Ayuningtyas

    2013-07-01

    Full Text Available Normal 0 false false false EN-US X-NONE X-NONE Alopecia is usually treatable and self-limited, but it may be permanent. Careful diagnosis of the type of hair loss will aid in selecting effective treatment. Many drugs used to treat alopecia, but in many people not satisfied with the result. One of the treatment currently used to treat alopecia is hair transplantation with follicular unit grafting (FUG. The advantages of hair transplantation is to create a natural appearance, one that mimics natural hair growth both in terms of numbers and pattern /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;}

  20. Science Roles and Interactions in Adaptive Management of Large River Restoration Projects, Midwest United States

    Science.gov (United States)

    Jacobson, R. B.; Galat, D. L.; Smith, C. B.

    2010-12-01

    Most large-river restoration projects include formal or informal implementations of adaptive management strategies which acknowledge uncertainty and use scientific inquiry to learn and refine management options. Although the central role of science in reducing uncertainty is acknowledged in such projects, specific roles and interactions can vary widely, including how science relates to decision-making within the governance of these projects. Our objective is to present some structured generalizations about science roles and interactions as developed from the authors’ experiences in adaptive management of large river restoration in the Midwest United States. Scientific information may be introduced into decision making by scientists acting in any of the three roles common to adaptive management -- action agency representative, stakeholder, or science provider. We have observed that confusion and gridlock can arise when it is unclear if a scientist is acting as an advocate for a stakeholder or management position, or instead as an independent, “honest broker” of science. Although both advocacy and independence are proper and expected in public decision making, it is useful when scientists unambiguously identify their role. While complete scientific independence may be illusory, transparency and peer review can promote the ideal. Transparency comes from setting clear directions and objectives at the decision-making level and defining at the outset how learning will help assess progress and inform decisions. Independent peer reviews of proposals, study plans, and publications serve as a powerful tool to advance scientific independence, even if funding sources present a potential conflict of interest. Selection of experts for scientific advice and review often requires consideration of the balance between benefits of the “outside” expert (independent, knowledgeable but with little specific understanding of the river system), compared to those provided by the

  1. Patterns of opioid initiation at first visits for pain in United States primary care settings.

    Science.gov (United States)

    Mundkur, Mallika L; Rough, Kathryn; Huybrechts, Krista F; Levin, Raisa; Gagne, Joshua J; Desai, Rishi J; Patorno, Elisabetta; Choudhry, Niteesh K; Bateman, Brian T

    2018-05-01

    The primary objective of this study was to characterize variation in patterns of opioid prescribing within primary care settings at first visits for pain, and to describe variation by condition, geography, and patient characteristics. 2014 healthcare utilization data from Optum's Clinformatics™ DataMart were used to evaluate individuals 18 years or older with an initial presentation to primary care for 1 of 10 common pain conditions. The main outcomes assessed were (1) the proportion of first visits for pain associated with an opioid prescription fill and (2) the proportion of opioid prescriptions with >7 days' supply. We identified 205 560 individuals who met inclusion criteria; 9.1% of all visits were associated with an opioid fill, ranging from 4.1% (headache) to 28.2% (dental pain). Approximately half (46%) of all opioid prescriptions supplied more than 7 days, and 10% of prescriptions supplied ≥30 days. We observed a 4-fold variation in rates of opioid initiation by state, with highest rates of prescribing in Alabama (16.6%) and lowest rates in New York (3.7%). In 2014, nearly half of all patients filling opioid prescriptions received more than 7 days' of opioids in an initial prescription. Policies limiting initial supplies have the potential to substantially impact opioid prescribing in the primary care setting. Copyright © 2017 John Wiley & Sons, Ltd.

  2. Nurse managers' decision-making in daily unit operation in peri-operative settings: a cross-sectional descriptive study.

    Science.gov (United States)

    Siirala, Eriikka; Peltonen, Laura-Maria; Lundgrén-Laine, Heljä; Salanterä, Sanna; Junttila, Kristiina

    2016-09-01

    To describe the tactical and the operational decisions made by nurse managers when managing the daily unit operation in peri-operative settings. Management is challenging as situations change rapidly and decisions are constantly made. Understanding decision-making in this complex environment helps to develop decision support systems to support nurse managers' operative and tactical decision-making. Descriptive cross-sectional design. Data were collected from 20 nurse managers with the think-aloud method during the busiest working hours and analysed using thematic content analysis. Nurse managers made over 700 decisions; either ad hoc (n = 289), near future (n = 268) or long-term (n = 187) by nature. Decisions were often made simultaneously with many interruptions. Ad hoc decisions covered staff allocation, ensuring adequate staff, rescheduling surgical procedures, confirmation tangible resources and following-up the daily unit operation. Decisions in the near future were: planning of surgical procedures and tangible resources, and planning staff allocation. Long-term decisions were: human recourses, nursing development, supplies and equipment, and finances in the unit. Decision-making was vulnerable to interruptions, which sometimes complicated the managing tasks. The results can be used when planning decision support systems and when defining the nurse managers' tasks in peri-operative settings. © 2016 John Wiley & Sons Ltd.

  3. Sex role ideology among East Asian immigrants in the United States.

    Science.gov (United States)

    Barry, Declan T; Beitel, Mark

    2006-10-01

    Although sex role ideology (i.e., beliefs about the proper roles for men and women) is linked with self-definition and male-female interactions, researchers have rarely examined such beliefs among U.S. immigrants. This study examined the cultural (ethnic identity, self-construal) and demographic (gender, age, years in United States) correlates of sex role ideology among 170 (88 male, 82 female) East Asian immigrants using psychometrically established measures. Male participants who endorsed ethnic identity and interdependent self-construal were more likely to report traditional sex roles; female participants who lived for a longer period of time in the United States and who endorsed independent self-construal were more likely to report sex role equality. Clinicians should consider assessing sex role ideology to reduce the likelihood of stereotyping their immigrant clients. (c) 2007 APA, all rights reserved

  4. [Need for the role of the patient's family members at the intensive care unit].

    Science.gov (United States)

    Aliberch Raurell, A M; Miquel Aymar, I M

    2015-01-01

    To know the current status for the role of family members in the intensive care unit and its evolution, analyzing areas for improvement and learning about the nursing role. This work is a literature review. The selected articles included two of the key words in their title. Articles before year 2000 were excluded, except some work of great interest. Family members lose their role and suffer a crisis when one of them is at the intensive care unit. Their normal role into the family changes or disappears. Obtaining a participation role increases satisfaction and decreases anxiety in relatives. Nursing professionals are essential in addressing this need. Solving the need for this role decreases anxiety and stress on relatives and patients. Their implication on the patient process enhances and helps professionals to know the patient's background. Copyright © 2014 Elsevier España, S.L.U. y SEEIUC. All rights reserved.

  5. Geologic Setting and Hydrogeologic Units of the Columbia Plateau Regional Aquifer System, Washington, Oregon, and Idaho

    Science.gov (United States)

    Kahle, Sue C.; Olsen, Theresa D.; Morgan, David S.

    2009-01-01

    geologic mapping and well information and to develop a digital, three-dimensional hydrogeologic model that could be used as the basis of a groundwater-flow model. This report describes the principal geologic and hydrogeologic units of the CPRAS and geologic map and well data that were compiled as part of the study. The report also describes simplified regional hydrogeologic sections and unit extent maps that were used to conceptualize the framework prior to development of the digital 3-dimensional framework model.

  6. Predicting race performance in triathlon: the role of perfectionism, achievement goals, and personal goal setting.

    Science.gov (United States)

    Stoeber, Joachim; Uphill, Mark A; Hotham, Sarah

    2009-04-01

    The question of how perfectionism affects performance is highly debated. Because empirical studies examining perfectionism and competitive sport performance are missing, the present research investigated how perfectionism affected race performance and what role athletes' goals played in this relationship in two prospective studies with competitive triathletes (Study 1: N = 112; Study 2: N = 321). Regression analyses showed that perfectionistic personal standards, high performance-approach goals, low performance-avoidance goals, and high personal goals predicted race performance beyond athletes' performance level. Moreover, the contrast between performance-avoidance and performance-approach goals mediated the relationship between perfectionistic personal standards and performance, whereas personal goal setting mediated the relationship between performance-approach goals and performance. The findings indicate that perfectionistic personal standards do not undermine competitive performance, but are associated with goals that help athletes achieve their best possible performance.

  7. The Role of Nuclear Receptor-Binding SET Domain Family Histone Lysine Methyltransferases in Cancer.

    Science.gov (United States)

    Bennett, Richard L; Swaroop, Alok; Troche, Catalina; Licht, Jonathan D

    2017-06-01

    The nuclear receptor-binding SET Domain (NSD) family of histone H3 lysine 36 methyltransferases is comprised of NSD1, NSD2 (MMSET/WHSC1), and NSD3 (WHSC1L1). These enzymes recognize and catalyze methylation of histone lysine marks to regulate chromatin integrity and gene expression. The growing number of reports demonstrating that alterations or translocations of these genes fundamentally affect cell growth and differentiation leading to developmental defects illustrates the importance of this family. In addition, overexpression, gain of function somatic mutations, and translocations of NSDs are associated with human cancer and can trigger cellular transformation in model systems. Here we review the functions of NSD family members and the accumulating evidence that these proteins play key roles in tumorigenesis. Because epigenetic therapy is an important emerging anticancer strategy, understanding the function of NSD family members may lead to the development of novel therapies. Copyright © 2017 Cold Spring Harbor Laboratory Press; all rights reserved.

  8. Continuous Learning Graphical Knowledge Unit for Cluster Identification in High Density Data Sets

    Directory of Open Access Journals (Sweden)

    K.K.L.B. Adikaram

    2016-12-01

    Full Text Available Big data are visually cluttered by overlapping data points. Rather than removing, reducing or reformulating overlap, we propose a simple, effective and powerful technique for density cluster generation and visualization, where point marker (graphical symbol of a data point overlap is exploited in an additive fashion in order to obtain bitmap data summaries in which clusters can be identified visually, aided by automatically generated contour lines. In the proposed method, the plotting area is a bitmap and the marker is a shape of more than one pixel. As the markers overlap, the red, green and blue (RGB colour values of pixels in the shared region are added. Thus, a pixel of a 24-bit RGB bitmap can code up to 224 (over 1.6 million overlaps. A higher number of overlaps at the same location makes the colour of this area identical, which can be identified by the naked eye. A bitmap is a matrix of colour values that can be represented as integers. The proposed method updates this matrix while adding new points. Thus, this matrix can be considered as an up-to-time knowledge unit of processed data. Results show cluster generation, cluster identification, missing and out-of-range data visualization, and outlier detection capability of the newly proposed method.

  9. Consideration Sets and Their Role in Modelling Doctor Recommendations About Contraceptives.

    Science.gov (United States)

    Fiebig, Denzil G; Viney, Rosalie; Knox, Stephanie; Haas, Marion; Street, Deborah J; Hole, Arne R; Weisberg, Edith; Bateson, Deborah

    2017-01-01

    Decisions about prescribed contraception are typically the result of a consultation between a woman and her doctor. In order to better understand contraceptive choice within this environment, stated preference methods are utilized to ask doctors about what contraceptive options they would discuss with different types of women. The role of doctors is to confine their discussion to a subset of products that best match their patient. This subset of options forms the consideration set from which the ultimate recommendation is made. Given the existence of consideration sets we address the issue of how to model appropriately the ultimate recommendations. The estimated models enable us to characterize doctor recommendations and how they vary with patient attributes and to highlight where recommendations are clear and when they are uncertain. The results also indicate systematic variation in recommendations across different types of doctors, and in particular we observe that some doctors are reluctant to embrace new products and instead recommend those that are more familiar. Such effects are one possible explanation for the relatively low uptake of more cost effective longer acting reversible contraceptives and indicate that further education and training of doctors may be warranted. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  10. Leaf transpiration plays a role in phosphorus acquisition among a large set of chickpea genotypes.

    Science.gov (United States)

    Pang, Jiayin; Zhao, Hongxia; Bansal, Ruchi; Bohuon, Emilien; Lambers, Hans; Ryan, Megan H; Siddique, Kadambot H M

    2018-01-09

    Low availability of inorganic phosphorus (P) is considered a major constraint for crop productivity worldwide. A unique set of 266 chickpea (Cicer arietinum L.) genotypes, originating from 29 countries and with diverse genetic background, were used to study P-use efficiency. Plants were grown in pots containing sterilized river sand supplied with P at a rate of 10 μg P g -1 soil as FePO 4 , a poorly soluble form of P. The results showed large genotypic variation in plant growth, shoot P content, physiological P-use efficiency, and P-utilization efficiency in response to low P supply. Further investigation of a subset of 100 chickpea genotypes with contrasting growth performance showed significant differences in photosynthetic rate and photosynthetic P-use efficiency. A positive correlation was found between leaf P concentration and transpiration rate of the young fully expanded leaves. For the first time, our study has suggested a role of leaf transpiration in P acquisition, consistent with transpiration-driven mass flow in chickpea grown in low-P sandy soils. The identification of 6 genotypes with high plant growth, P-acquisition, and P-utilization efficiency suggests that the chickpea reference set can be used in breeding programmes to improve both P-acquisition and P-utilization efficiency under low-P conditions. © 2018 John Wiley & Sons Ltd.

  11. Migraine-preventive prescription patterns by physician specialty in ambulatory care settings in the United States.

    Science.gov (United States)

    Takaki, Hiroko; Onozuka, Daisuke; Hagihara, Akihito

    2018-03-01

    Many adults with migraine who require preventive therapy are often not prescribed the proper medications. The most likely reason is that primary care physicians are unacquainted with preventive medications for migraine. The present study assessed the migraine-preventive prescription patterns in office visits using data from the National Ambulatory Medical Care Survey from 2006 to 2009 in the United States. Patients who were 18 years or older and diagnosed with migraine were included in the analysis. In accordance with the recommendations of the headache guidelines, we included beta-blockers, antidepressants, triptans for short-term prevention of menstrual migraine, and other triptans for acute treatment. Weighted visits of adults with migraine prescribed with preventive medication ranged from 32.8% in 2006 to 38.6% in 2009. Visits to primary care physicians accounted for 72.6% of the analyzed adult migraine visits. Anticonvulsants (odds ratio [OR] 0.29, 95% confidence interval [CI] 0.14-0.57, p  < 0.001) and triptans for menstrual migraine (OR 0.50, 95% CI 0.28-0.91, p  = 0.025) were less frequently prescribed by primary care physicians compared with specialty care physicians, such as neurologists and psychiatrists. There were no significant differences in the prescription patterns of antidepressants and beta-blockers between primary and specialty care physicians. Beta-blockers were prescribed to patients with comorbidity of hypertension, and antidepressants were used by patients with comorbidity of depression. There are differences in the prescription patterns of certain type of preventive medications between primary care physicians and specialty care physicians.

  12. Migraine-preventive prescription patterns by physician specialty in ambulatory care settings in the United States

    Directory of Open Access Journals (Sweden)

    Hiroko Takaki

    2018-03-01

    Full Text Available Many adults with migraine who require preventive therapy are often not prescribed the proper medications. The most likely reason is that primary care physicians are unacquainted with preventive medications for migraine. The present study assessed the migraine-preventive prescription patterns in office visits using data from the National Ambulatory Medical Care Survey from 2006 to 2009 in the United States. Patients who were 18 years or older and diagnosed with migraine were included in the analysis. In accordance with the recommendations of the headache guidelines, we included beta-blockers, antidepressants, triptans for short-term prevention of menstrual migraine, and other triptans for acute treatment. Weighted visits of adults with migraine prescribed with preventive medication ranged from 32.8% in 2006 to 38.6% in 2009. Visits to primary care physicians accounted for 72.6% of the analyzed adult migraine visits. Anticonvulsants (odds ratio [OR] 0.29, 95% confidence interval [CI] 0.14–0.57, p < 0.001 and triptans for menstrual migraine (OR 0.50, 95% CI 0.28–0.91, p = 0.025 were less frequently prescribed by primary care physicians compared with specialty care physicians, such as neurologists and psychiatrists. There were no significant differences in the prescription patterns of antidepressants and beta-blockers between primary and specialty care physicians. Beta-blockers were prescribed to patients with comorbidity of hypertension, and antidepressants were used by patients with comorbidity of depression. There are differences in the prescription patterns of certain type of preventive medications between primary care physicians and specialty care physicians.

  13. Tattoos and body piercings in the United States: a national data set.

    Science.gov (United States)

    Laumann, Anne E; Derick, Amy J

    2006-09-01

    Little is known about the prevalence and consequences of body art application. Our aim was to provide US tattooing and body piercing prevalence, societal distribution, and medical and social consequence data. Random digit dialing technology was used to obtain a national probability sample of 253 women and 247 men who were 18 to 50 years of age. Of our respondents, 24% had tattoos and 14% had body piercings. Tattooing was equally common in both sexes, but body piercing was more common among women. Other associations were a lack of religious affiliation, extended jail time, previous drinking, and recreational drug use. Local medical complications, including broken teeth, were present in one third of those with body piercings. The prevalence of jewelry allergy increased with the number of piercings. Of those with tattoos, 17% were considering removal but none had had a tattoo removed. This was a self-reported data set with a 33% response rate. Tattooing and body piercing are associated with risk-taking activities. Body piercing has a high incidence of medical complications.

  14. Role of medial cortical, hippocampal and striatal interactions during cognitive set-shifting.

    Science.gov (United States)

    Graham, Steven; Phua, Elaine; Soon, Chun Siong; Oh, Tomasina; Au, Chris; Shuter, Borys; Wang, Shih-Chang; Yeh, Ing Berne

    2009-05-01

    To date, few studies have examined the functional connectivity of brain regions involved in complex executive function tasks, such as cognitive set-shifting. In this study, eighteen healthy volunteers performed a cognitive set-shifting task modified from the Wisconsin card sort test while undergoing functional magnetic resonance imaging. These modifications allowed better disambiguation between cognitive processes and revealed several novel findings: 1) peak activation in the caudate nuclei in the first instance of negative feedback signaling a shift in rule, 2) lowest caudate activation once the rule had been identified, 3) peak hippocampal activation once the identity of the rule had been established, and 4) decreased hippocampal activation during the generation of new rule candidates. This pattern of activation across cognitive set-shifting events suggests that the caudate nuclei play a role in response generation when the identity of the new rule is unknown. In contrast, the reciprocal pattern of hippocampal activation suggests that the hippocampi help consolidate knowledge about the correct stimulus-stimulus associations, associations that become inappropriate once the rule has changed. Functional connectivity analysis using Granger Causality Mapping revealed that caudate and hippocampal regions interacted indirectly via a circuit involving the medial orbitofrontal and posterior cingulate regions, which are known to bias attention towards stimuli based on expectations built up from task-related feedback. Taken together, the evidence suggests that these medial regions may mediate striato-hippocampal interactions and hence affect goal-directed attentional transitions from a response strategy based on stimulus-reward heuristics (caudate-dependent) to one based on stimulus-stimulus associations (hippocampus-dependent).

  15. Operable Unit 3-13, Group 3, Other Surface Soils Remediation Sets 4-6 (Phase II) Waste Management Plan

    International Nuclear Information System (INIS)

    G. L. Schwendiman

    2006-01-01

    This Waste Management Plan describes waste management and waste minimization activities for Group 3, Other Surface Soils Remediation Sets 4-6 (Phase II) at the Idaho Nuclear Technology and Engineering Center located within the Idaho National Laboratory. The waste management activities described in this plan support the selected response action presented in the Final Record of Decision for Idaho Nuclear Technology and Engineering Center, Operable Unit 3-13. This plan identifies the waste streams that will be generated during implementation of the remedial action and presents plans for waste minimization, waste management strategies, and waste disposition

  16. Competing perspectives during organizational socialization on the role of certified athletic trainers in high school settings.

    Science.gov (United States)

    Mensch, James; Crews, Candice; Mitchell, Murray

    2005-01-01

    When certified athletic trainers (ATCs) enter a workplace, their potential for professional effectiveness is affected by a number of factors, including the individual's ability to put acquired knowledge, skills, and attitudes into practice. This ability may be influenced by the preconceived attitudes and expectations of athletes, athletes' parents, athletic directors, physical therapists, physicians, and coaches. To examine the perspectives of high school coaches and ATCs toward the ATC's role in the high school setting by looking at 3 questions: (1) What are coaches' expectations of ATCs during different phases of a sport season? (2) What do ATCs perceive their role to be during different phases of a season? and (3) How do coaches' expectations compare with ATCs' expectations? Qualitative research design involving semistructured interviews. High schools. Twenty high school varsity basketball coaches from 10 high schools in 2 states and the ATCs assigned to these teams. For the coaches, 12 questions focused on 3 specific areas: (1) the athletic training services they received as high school basketball coaches, (2) each coach's expectations of the ATC with whom he or she was working during various phases of the season, and (3) coaches' levels of satisfaction with the athletic training services provided to their team. For the ATCs, 17 questions focused on 3 areas: (1) the ATC's background, (2) the ATC's perceived duties at different phases of the basketball season and his or her relationship with the coach, and (3) other school factors that enhanced or interfered with the ATC's ability to perform duties. Three themes emerged. Coaches had limited knowledge and understanding of ATCs' qualifications, training, professional preparation, and previous experience. Coaches simply expected ATCs to be available to complement their roles. Positive communication was identified as a critical component to a good coach-ATC relationship. Although all participants valued good

  17. Parameters in fractional laser assisted delivery of topical anesthetics: Role of laser type and laser settings.

    Science.gov (United States)

    Meesters, Arne A; Nieboer, Marilin J; Kezic, Sanja; de Rie, Menno A; Wolkerstorfer, Albert

    2018-05-07

    Efficacy of topical anesthetics can be enhanced by pretreatment of the skin with ablative fractional lasers. However, little is known about the role of parameters such as laser modality and laser density settings in this technique. Aims of this study were to compare the efficacy of pretreatment with two different ablative fractional laser modalities, a CO 2 laser and an Er:YAG laser, and to assess the role of laser density in ablative fractional laser assisted topical anesthesia. In each of 15 healthy subjects, four 10 × 10 mm test regions on the back were randomized to pretreatment (70-75 μm ablation depth) with CO 2 laser at 5% density, CO 2 laser at 15% density, Er:YAG laser at 5% density or Er:YAG laser at 15% density. Articaine hydrochloride 40 mg/ml + epinephrine 10 μg/ml solution was applied under occlusion to all four test regions. After 15 minutes, a pass with the CO 2 laser (1,500 μm ablation depth) was administered as pain stimulus to each test region. A reference pain stimulus was given on unanesthetized skin. The main outcome parameter, pain, was scored on a 0-10 visual analogue scale (VAS) after each pain stimulus. Median VAS scores were 1.50 [CO 2 5%], 0.50 [CO 2 15%], 1.50 [Er:YAG 5%], 0.43 [Er:YAG 15%], and 4.50 [unanesthetized reference]. VAS scores for all pretreated test regions were significantly lower compared to the untreated reference region (P laser pretreated regions. However, VAS scores were significantly lower at 15% density compared to 5% density for both for the CO 2 laser (P laser (P laser was considered slightly more painful than pretreatment with Er:YAG laser by the subjects. Fractional laser assisted topical anesthesia is effective even with very low energy settings and an occlusion time of only 15 minutes. Both the CO 2 laser and the Er:YAG laser can be used to assist topical anesthesia although the CO 2 laser pretreatment is experienced as more painful. In our study settings, using articaine

  18. Emergency medicine and internal medicine trainees’ smartphone use in clinical settings in the United States

    Directory of Open Access Journals (Sweden)

    Sonja E. Raaum

    2015-10-01

    Full Text Available Purpose: Smartphone technology offers a multitude of applications (apps that provide a wide range of functions for healthcare professionals. Medical trainees are early adopters of this technology, but how they use smartphones in clinical care remains unclear. Our objective was to further characterize smartphone use by medical trainees at two United States academic institutions, as well as their prior training in the clinical use of smartphones. Methods: In 2014, we surveyed 347 internal medicine and emergency medicine resident physicians at the University of Utah and Brigham and Women’s Hospital about their smartphone use and prior training experiences. Scores (0%–100% were calculated to assess the frequency of their use of general features (email, text and patient-specific apps, and the results were compared according to resident level and program using the Mann-Whitney U-test. Results: A total of 184 residents responded (response rate, 53.0%. The average score for using general features, 14.4/20 (72.2% was significantly higher than the average score for using patient-specific features and apps, 14.1/44 (33.0%, P<0.001. The average scores for the use of general features, were significantly higher for year 3–4 residents, 15.0/20 (75.1% than year 1–2 residents, 14.1/20 (70.5%, P=0.035, and for internal medicine residents, 14.9/20 (74.6% in comparison to emergency medicine residents, 12.9/20 (64.3%, P= 0.001. The average score reflecting the use of patient-specific apps was significantly higher for year 3–4 residents, 16.1/44 (36.5% than for year 1–2 residents, 13.7/44 (31.1%; P=0.044. Only 21.7% of respondents had received prior training in clinical smartphone use. Conclusion: Residents used smartphones for general features more frequently than for patient-specific features, but patient-specific use increased with training. Few residents have received prior training in the clinical use of smartphones.

  19. Family members' informal roles in end-of-life decision making in adult intensive care units.

    Science.gov (United States)

    Quinn, Jill R; Schmitt, Madeline; Baggs, Judith Gedney; Norton, Sally A; Dombeck, Mary T; Sellers, Craig R

    2012-01-01

    To support the process of effective family decision making, it is important to recognize and understand informal roles that various family members may play in the end-of-life decision-making process. To describe some informal roles consistently enacted by family members involved in the process of end-of-life decision making in intensive care units. Ethnographic study. Data were collected via participant observation with field notes and semistructured interviews on 4 intensive care units in an academic health center in the mid-Atlantic United States from 2001 to 2004. The units studied were a medical, a surgical, a burn and trauma, and a cardiovascular intensive care unit. Health care clinicians, patients, and family members. Informal roles for family members consistently observed were primary caregiver, primary decision maker, family spokesperson, out-of-towner, patient's wishes expert, protector, vulnerable member, and health care expert. The identified informal roles were part of families' decision-making processes, and each role was part of a potentially complicated family dynamic for end-of-life decision making within the family system and between the family and health care domains. These informal roles reflect the diverse responses to demands for family decision making in what is usually a novel and stressful situation. Identification and description of these informal roles of family members can help clinicians recognize and understand the functions of these roles in families' decision making at the end of life and guide development of strategies to support and facilitate increased effectiveness of family discussions and decision-making processes.

  20. Perspectives on the Role of Fospropofol in the Monitored Anesthesia Care Setting

    Directory of Open Access Journals (Sweden)

    Joseph V. Pergolizzi

    2011-01-01

    Full Text Available Monitored anesthesia care (MAC is a safe, effective, and appropriate form of anesthesia for many minor surgical procedures. The proliferation of outpatient procedures has heightened interest in MAC sedation agents. Among the most commonly used MAC sedation agents today are benzodiazepines, including midazolam, and propofol. Recently approved in the United States is fospropofol, a prodrug of propofol which hydrolyzes in the body by alkaline phosphatase to liberate propofol. Propofol liberated from fospropofol has unique pharmacological properties, but recently retracted pharmacokinetic (PK and pharmacodynamic (PD evaluations make it difficult to formulate clear conclusions with respect to fospropofol's PK/PD properties. In safety and efficacy clinical studies, fospropofol demonstrated dose-dependent sedation with good rates of success at doses of 6.5 mg/kg along with good levels of patient and physician acceptance. Fospropofol has been associated with less pain at injection site than propofol. The most commonly reported side effects with fospropofol are paresthesia and pruritus. Fospropofol is a promising new sedation agent that appears to be well suited for MAC sedation, but further studies are needed to better understand its PK/PD properties as well its appropriate clinical role in outpatient procedures.

  1. The roles and functions of occupational health nurses in Brazil and in the United States.

    Science.gov (United States)

    Marziale, Maria Helena Palucci; Hong, Oi Saeng; Morris, Judy A; Rocha, Fernanda Ludmilla Rossi

    2010-01-01

    Cross-sectional exploratory research developed to outline the roles and functions of occupational health nurses (OHNs) in Brazil and compare them with those in the United States. The sample consisted of 154 Brazilian occupational health nurses. First, the instrument Job Analysis Survey of Occupational Health Nursing Practice was translated into Portuguese, followed by data collection and data analysis, comparing the results of the proposed study in Brazil with the findings of a job delineation study conducted in the United States. It was found that most were women, white, between 41 and 50 years of age and working primarily at hospitals or medical centers as clinicians and managers/administrators. Besides, it was found that most Brazilian OHNs spend more time in managerial roles, followed by consultant and educator responsibilities while, in the United States, OHNs spend significantly more time in education/advisory roles.

  2. Work-Family Conflict, Resources, and Role Set Density: Assessing Their Effects on Distress among Working Mothers

    Science.gov (United States)

    Kulik, Liat; Liberman, Gabriel

    2013-01-01

    We explored the relationships between the experience of work-family conflict and levels of distress in the family and at work among a sample of 227 Israeli working mothers. We also examined how role set density (RSD, the number of roles they perform) and personal and environmental resources are related to the women's experience of distress.…

  3. Methicillin Resistant Staphylococcus aureus Transmission in a Ghanaian Burn Unit: The Importance of Active Surveillance in Resource-Limited Settings

    Directory of Open Access Journals (Sweden)

    Nana Ama Amissah

    2017-10-01

    Full Text Available Objectives:Staphylococcus aureus infections in burn patients can lead to serious complications and death. The frequency of S. aureus infection is high in low- and middle-income countries presumably due to limited resources, misuse of antibiotics and poor infection control. The objective of the present study was to apply population genomics to precisely define, for the first time, the transmission of antibiotic resistant S. aureus in a resource-limited setting in sub-Saharan Africa.Methods:Staphylococcus aureus surveillance was performed amongst burn patients and healthcare workers during a 7-months survey within the burn unit of the Korle Bu Teaching Hospital in Ghana.Results: Sixty-six S. aureus isolates (59 colonizing and 7 clinical were obtained from 31 patients and 10 healthcare workers. Twenty-one of these isolates were ST250-IV methicillin-resistant S. aureus (MRSA. Notably, 25 (81% of the 31 patients carried or were infected with S. aureus within 24 h of admission. Genome comparisons revealed six distinct S. aureus clones circulating in the burn unit, and demonstrated multiple transmission events between patients and healthcare workers. Further, the collected S. aureus isolates exhibited a wide range of genotypic resistances to antibiotics, including trimethoprim (21%, aminoglycosides (33%, oxacillin (33%, chloramphenicol (50%, tetracycline (59% and fluoroquinolones (100%.Conclusion: Population genomics uncovered multiple transmission events of S. aureus, especially MRSA, within the investigated burn unit. Our findings highlight lapses in infection control and prevention, and underscore the great importance of active surveillance to protect burn victims against multi-drug resistant pathogens in resource-limited settings.

  4. Methicillin Resistant Staphylococcus aureus Transmission in a Ghanaian Burn Unit: The Importance of Active Surveillance in Resource-Limited Settings.

    Science.gov (United States)

    Amissah, Nana Ama; Buultjens, Andrew H; Ablordey, Anthony; van Dam, Lieke; Opoku-Ware, Ampomah; Baines, Sarah L; Bulach, Dieter; Tetteh, Caitlin S; Prah, Isaac; van der Werf, Tjip S; Friedrich, Alexander W; Seemann, Torsten; van Dijl, Jan Maarten; Stienstra, Ymkje; Stinear, Timothy P; Rossen, John W

    2017-01-01

    Objectives: Staphylococcus aureus infections in burn patients can lead to serious complications and death. The frequency of S. aureus infection is high in low- and middle-income countries presumably due to limited resources, misuse of antibiotics and poor infection control. The objective of the present study was to apply population genomics to precisely define, for the first time, the transmission of antibiotic resistant S. aureus in a resource-limited setting in sub-Saharan Africa. Methods: Staphylococcus aureus surveillance was performed amongst burn patients and healthcare workers during a 7-months survey within the burn unit of the Korle Bu Teaching Hospital in Ghana. Results: Sixty-six S. aureus isolates (59 colonizing and 7 clinical) were obtained from 31 patients and 10 healthcare workers. Twenty-one of these isolates were ST250-IV methicillin-resistant S. aureus (MRSA). Notably, 25 (81%) of the 31 patients carried or were infected with S. aureus within 24 h of admission. Genome comparisons revealed six distinct S. aureus clones circulating in the burn unit, and demonstrated multiple transmission events between patients and healthcare workers. Further, the collected S. aureus isolates exhibited a wide range of genotypic resistances to antibiotics, including trimethoprim (21%), aminoglycosides (33%), oxacillin (33%), chloramphenicol (50%), tetracycline (59%) and fluoroquinolones (100%). Conclusion: Population genomics uncovered multiple transmission events of S. aureus , especially MRSA, within the investigated burn unit. Our findings highlight lapses in infection control and prevention, and underscore the great importance of active surveillance to protect burn victims against multi-drug resistant pathogens in resource-limited settings.

  5. The Role of Equivalence and Order Relations in the Development and Coordination of the Concepts of Unit Size and Number of Units in Selected Conservation Type Measurement Problems.

    Science.gov (United States)

    Carpenter, Thomas P.

    The major purpose of this study was 1) to investigate the development of the concept of a unit of measure and the coordination of unit size and the number of units 2) to relate this development to the development of conservation and 3) to determine the role of equivalence and nonequivalence relations in certain conservation and measurement…

  6. The Role of Cognitive Factors in Predicting Balance and Fall Risk in a Neuro-Rehabilitation Setting.

    Science.gov (United States)

    Saverino, A; Waller, D; Rantell, K; Parry, R; Moriarty, A; Playford, E D

    2016-01-01

    There is a consistent body of evidence supporting the role of cognitive functions, particularly executive function, in the elderly and in neurological conditions which become more frequent with ageing. The aim of our study was to assess the role of different domains of cognitive functions to predict balance and fall risk in a sample of adults with various neurological conditions in a rehabilitation setting. This was a prospective, cohort study conducted in a single centre in the UK. 114 participants consecutively admitted to a Neuro-Rehabilitation Unit were prospectively assessed for fall accidents. Baseline assessment included a measure of balance (Berg Balance Scale) and a battery of standard cognitive tests measuring executive function, speed of information processing, verbal and visual memory, visual perception and intellectual function. The outcomes of interest were the risk of becoming a faller, balance and fall rate. Two tests of executive function were significantly associated with fall risk, the Stroop Colour Word Test (IRR 1.01, 95% CI 1.00-1.03) and the number of errors on part B of the Trail Making Test (IRR 1.23, 95% CI 1.03-1.49). Composite scores of executive function, speed of information processing and visual memory domains resulted in 2 to 3 times increased likelihood of having better balance (OR 2.74 95% CI 1.08 to 6.94, OR 2.72 95% CI 1.16 to 6.36 and OR 2.44 95% CI 1.11 to 5.35 respectively). Our results show that specific subcomponents of executive functions are able to predict fall risk, while a more global cognitive dysfunction is associated with poorer balance.

  7. The Role of Cognitive Factors in Predicting Balance and Fall Risk in a Neuro-Rehabilitation Setting.

    Directory of Open Access Journals (Sweden)

    A Saverino

    Full Text Available There is a consistent body of evidence supporting the role of cognitive functions, particularly executive function, in the elderly and in neurological conditions which become more frequent with ageing. The aim of our study was to assess the role of different domains of cognitive functions to predict balance and fall risk in a sample of adults with various neurological conditions in a rehabilitation setting.This was a prospective, cohort study conducted in a single centre in the UK. 114 participants consecutively admitted to a Neuro-Rehabilitation Unit were prospectively assessed for fall accidents. Baseline assessment included a measure of balance (Berg Balance Scale and a battery of standard cognitive tests measuring executive function, speed of information processing, verbal and visual memory, visual perception and intellectual function. The outcomes of interest were the risk of becoming a faller, balance and fall rate.Two tests of executive function were significantly associated with fall risk, the Stroop Colour Word Test (IRR 1.01, 95% CI 1.00-1.03 and the number of errors on part B of the Trail Making Test (IRR 1.23, 95% CI 1.03-1.49. Composite scores of executive function, speed of information processing and visual memory domains resulted in 2 to 3 times increased likelihood of having better balance (OR 2.74 95% CI 1.08 to 6.94, OR 2.72 95% CI 1.16 to 6.36 and OR 2.44 95% CI 1.11 to 5.35 respectively.Our results show that specific subcomponents of executive functions are able to predict fall risk, while a more global cognitive dysfunction is associated with poorer balance.

  8. Neural set point for the control of arterial pressure: role of the nucleus tractus solitarius

    Directory of Open Access Journals (Sweden)

    Valentinuzzi Max E

    2010-01-01

    the baroreflex would stabilize the short term pressure value to the prevailing carotid MAP. The discharge rates of rostral neural projections to the NTS would function as the set point of the closed and open loops of cardiovascular control. No doubt, then, the RNS play a functional role not only under steady-state conditions, but also in different behaviors and pathologies.

  9. Implementing standardized, inter-unit communication in an international setting: handoff of patients from emergency medicine to internal medicine.

    Science.gov (United States)

    Balhara, Kamna S; Peterson, Susan M; Elabd, Mohamed Moheb; Regan, Linda; Anton, Xavier; Al-Natour, Basil Ali; Hsieh, Yu-Hsiang; Scheulen, James; Stewart de Ramirez, Sarah A

    2018-04-01

    Standardized handoffs may reduce communication errors, but research on handoff in community and international settings is lacking. Our study at a community hospital in the United Arab Emirates characterizes existing handoff practices for admitted patients from emergency medicine (EM) to internal medicine (IM), develops a standardized handoff tool, and assesses its impact on communication and physician perceptions. EM physicians completed a survey regarding handoff practices and expectations. Trained observers utilized a checklist based on the Systems Engineering Initiative for Patient Safety model to observe 40 handoffs. EM and IM physicians collaboratively developed a written tool encouraging bedside handoff of admitted patients. After the intervention, surveys of EM physicians and 40 observations were subsequently repeated. 77.5% of initial observed handoffs occurred face-to-face, with 42.5% at bedside, and in four different languages. Most survey respondents considered face-to-face handoff ideal. Respondents noted 9-13 patients suffering harm due to handoff in the prior month. After handoff tool implementation, 97.5% of observed handoffs occurred face-to-face (versus 77.5%, p = 0.014), with 82.5% at bedside (versus 42.5%, p face-to-face and bedside handoff, positively impacted workflow, and increased perceptions of safety by EM physicians in an international, non-academic setting. Our three-step approach can be applied towards developing standardized, context-specific inter-specialty handoff in a variety of settings.

  10. In Silico Testing of an Artificial-Intelligence-Based Artificial Pancreas Designed for Use in the Intensive Care Unit Setting.

    Science.gov (United States)

    DeJournett, Leon; DeJournett, Jeremy

    2016-11-01

    Effective glucose control in the intensive care unit (ICU) setting has the potential to decrease morbidity and mortality rates which should in turn lead to decreased health care expenditures. Current ICU-based glucose controllers are mathematically derived, and tend to be based on proportional integral derivative (PID) or model predictive control (MPC). Artificial intelligence (AI)-based closed loop glucose controllers may have the ability to achieve control that improves on the results achieved by either PID or MPC controllers. We conducted an in silico analysis of an AI-based glucose controller designed for use in the ICU setting. This controller was tested using a mathematical model of the ICU patient's glucose-insulin system. A total of 126 000 unique 5-day simulations were carried out, resulting in 107 million glucose values for analysis. For the 7 control ranges tested, with a sensor error of ±10%, the following average results were achieved: (1) time in control range, 94.2%, (2) time in range 70-140 mg/dl, 97.8%, (3) time in hyperglycemic range (>140 mg/dl), 2.1%, and (4) time in hypoglycemic range (artificial pancreas system for use in the ICU setting. © 2016 Diabetes Technology Society.

  11. The impact of the board's strategy-setting role on board-management relations and hospital performance.

    Science.gov (United States)

    Büchner, Vera Antonia; Schreyögg, Jonas; Schultz, Carsten

    2014-01-01

    The appropriate governance of hospitals largely depends on effective cooperation between governing boards and hospital management. Governing boards play an important role in strategy-setting as part of their support for hospital management. However, in certain situations, this active strategic role may also generate discord within this relationship. The objective of this study is to investigate the impact of the roles, attributes, and processes of governing boards on hospital performance. We examine the impact of the governing board's strategy-setting role on board-management collaboration quality and on financial performance while also analyzing the interaction effects of board diversity and board activity level. The data are derived from a survey that was sent simultaneously to German hospitals and their associated governing board, combined with objective performance information from annual financial statements and quality reports. We use a structural equation modeling approach to test the model. The results indicate that different board characteristics have a significant impact on hospital performance (R = .37). The strategy-setting role and board-management collaboration quality have a positive effect on hospital performance, whereas the impact of strategy-setting on collaboration quality is negative. We find that the positive effect of strategy-setting on performance increases with decreasing board diversity. When board members have more homogeneous backgrounds and exhibit higher board activity levels, the negative effect of the strategy-setting on collaboration quality also increases. Active strategy-setting by a governing board may generally improve hospital performance. Diverse members of governing boards should be involved in strategy-setting for hospitals. However, high board-management collaboration quality may be compromised if managerial autonomy is too highly restricted. Consequently, hospitals should support board-management collaboration about

  12. Gender, sex role ideology, and self-esteem among East Asian immigrants in the United States.

    Science.gov (United States)

    Barry, Declan T; Bernard, Matthew J; Beitel, Mark

    2006-09-01

    This study examined the relationship between gender, sex role ideology, and self-esteem among 170 (88 male, 82 female) East Asian immigrants in the United States. Participants were administered a battery of psychometrically established measures. Men and women did not differ on personal or collective self-esteem (CSE). Women who endorsed traditional sex roles were significantly more likely to report higher private, identity, and total CSE. Personal self-esteem was a significant independent predictor of traditional sex role for women. Participants who endorsed sex role equality were significantly more likely to report public, membership, and total CSE. Sex role equality was associated with enhanced private CSE for men and attenuated personal self-esteem for women. These findings point to the importance of assessing multiple facets of self-esteem, which appear to be differentially associated with sex role ideology for men and women.

  13. Fairer to Fathers: The Role of Schools in Nurturing Positive Fatherhood--A United Kingdom Perspective

    Science.gov (United States)

    Carpenter, Barry

    2007-01-01

    Fatherhood in this 21st century is changing. There is wider societal recognition that, for the sake of our children, we need to value fathers and the contribution they make to family life. In the United Kingdom, various initiatives are actively supporting "Dads" in their role. For fathers of children with disabilities, there are even…

  14. Role of oral care to prevent VAP in mechanically ventilated Intensive Care Unit patients

    Directory of Open Access Journals (Sweden)

    A Gupta

    2016-01-01

    Full Text Available Ventilator associated pneumonia (VAP is the most common nosocomial infection in Intensive Care Unit. One major factor causing VAP is the aspiration of oral colonization because of poor oral care practices. We feel the role of simple measure like oral care is neglected, despite the ample evidence of it being instrumental in preventing VAP.

  15. Role of oral care to prevent VAP in mechanically ventilated Intensive Care Unit patients.

    Science.gov (United States)

    Gupta, A; Gupta, A; Singh, T K; Saxsena, A

    2016-01-01

    Ventilator associated pneumonia (VAP) is the most common nosocomial infection in Intensive Care Unit. One major factor causing VAP is the aspiration of oral colonization because of poor oral care practices. We feel the role of simple measure like oral care is neglected, despite the ample evidence of it being instrumental in preventing VAP.

  16. Role of oral care to prevent VAP in mechanically ventilated Intensive Care Unit patients

    OpenAIRE

    A Gupta; A Gupta; T K Singh; A Saxsena

    2016-01-01

    Ventilator associated pneumonia (VAP) is the most common nosocomial infection in Intensive Care Unit. One major factor causing VAP is the aspiration of oral colonization because of poor oral care practices. We feel the role of simple measure like oral care is neglected, despite the ample evidence of it being instrumental in preventing VAP.

  17. The Role of an Academic Development Unit in Supporting Institutional VET Learning and Teaching Change Management

    Science.gov (United States)

    Fotinatos, Nina

    2016-01-01

    The aim of this paper is to examine the role and impact of a central academic development unit (ADU) within an institutional strategic and operational change management project. The primary goal of this project was to improve vocational education and training (VET) learning and teaching practice in an Australian dual-sector regional university.…

  18. Assessment of Orthographical Processing in Spanish Children with Dyslexia: The Role of Lexical and Sublexical Units

    Science.gov (United States)

    Rodrigo, Mercedes; Jimenez, Juan E.; Garcia, Eduardo; Diaz, Alicia; Ortiz, M. Rosario; Guzman, Remedios; Hernandez-Valle, Isabel; Estevez, Adelina; Hernandez, Sergio

    2004-01-01

    Introduction: The aim of this study was to examine the role of multiletter units, such as the morpheme and whole word, in accessing the lexicon, in Spanish children with dyslexia. Method: A sample of 60 participants were selected and organised i n three different groups: 1) an experimental group of 18 reading-disabled children, (2) a control group…

  19. A Multi-Objective Unit Commitment Model for Setting Carbon Tax to Reduce CO2 Emission: Thailand's Electricity Generation Case

    Directory of Open Access Journals (Sweden)

    Nuchjarin Intalar

    2015-07-01

    Full Text Available Carbon tax policy is a cost-effective instrument for emission reduction. However, setting the carbon tax is one of the challenging task for policy makers as it will lead to higher price of emission-intensive sources especially the utility price. In a large-scale power generation system, minimizing the operational cost and the environmental impact are conflicting objectives and it is difficult to find the compromise solution. This paper proposes a methodology of finding a feasible carbon tax rate on strategic level using the operational unit commitment model. We present a multi-objective mixed integer linear programming model to solve the unit commitment problem and consider the environmental impacts. The methodology of analyzing of the effect of carbon tax rates on the power generation, operating cost, and CO2 emission is also provided. The trade-off relationship between total operating cost and total CO2 emission is presented in the Pareto-optimal curve to analyze the feasible carbon tax rate that is influencing on electricity operating cost. The significant outcome of this paper is a modeling framework for the policy makers to determine the possible carbon tax that can be imposed on the electricity generation.

  20. Articulating the Role of the Development Specialist in Large Organisational Settings.

    Science.gov (United States)

    Dennis, Dell

    1997-01-01

    Workplace educators play a more holistic role of development specialists who plan, implement, and manage human resource development. This role requires skills in communication, employee relations, program development, change agency, and budget management. (SK)

  1. The Role of Cognitive Factors in Predicting Balance and Fall Risk in a Neuro-Rehabilitation Setting

    OpenAIRE

    Saverino, A.; Waller, D.; Rantell, K.; Parry, R.; Moriarty, A.; Playford, E. D.

    2016-01-01

    Introduction\\ud \\ud There is a consistent body of evidence supporting the role of cognitive functions, particularly executive function, in the elderly and in neurological conditions which become more frequent with ageing. The aim of our study was to assess the role of different domains of cognitive functions to predict balance and fall risk in a sample of adults with various neurological conditions in a rehabilitation setting.\\ud \\ud Methods\\ud \\ud This was a prospective, cohort study conduct...

  2. Mobile Unit and Its Role in the Case of Nuclear Emergencies

    International Nuclear Information System (INIS)

    Franic, Z.

    1998-01-01

    Emergency response mobile units play a significant role in the case of nuclear emergencies. The functioning and practice of such teams depend on the nature and phase of the nuclear emergency. In the acute phase, several teams with good navigational and communication abilities performing simple measurements can provide essential data for characterization of plume location and its magnitude. Therefore, such activities are complemental with the network of telemetric radiation monitors. However, in the late phase of an accident, in order to gather reliable data needed for utilization of remedial and recovery measures, a better equipped mobile units are necessary. (author)

  3. Is there a role of palliative care in the neonatal intensive care unit in India?

    Directory of Open Access Journals (Sweden)

    Manjiri P Dighe

    2011-01-01

    Full Text Available Recent advances in medical care have improved the survival of newborn babies born with various problems. Despite this death in the neonatal intensive care unit (NICU is an inevitable reality. For babies who are not going to "get better," the health care team still has a duty to alleviate the physical suffering of the baby and to support the family. Palliative care is a multidisciplinary approach to relieve the physical, psycho social, and spiritual suffering of patients and their families. Palliative care provision in the Indian NICU settings is almost nonexistent at present. In this paper we attempt to "build a case" for palliative care in the Indian NICU setting.

  4. The role of Health Impact Assessment in the setting of air quality standards: An Australian perspective

    Energy Technology Data Exchange (ETDEWEB)

    Spickett, Jeffery, E-mail: J.Spickett@curtin.edu.au [WHO Collaborating Centre for Environmental Health Impact Assessment (Australia); Faculty of Health Sciences, School of Public Health, Curtin University, Perth, Western Australia (Australia); Katscherian, Dianne [WHO Collaborating Centre for Environmental Health Impact Assessment (Australia); Faculty of Health Sciences, School of Public Health, Curtin University, Perth, Western Australia (Australia); Harris, Patrick [CHETRE — UNSW Research Centre for Primary Health Care and Equity, University of New South Wales (Australia)

    2013-11-15

    The approaches used for setting or reviewing air quality standards vary from country to country. The purpose of this research was to consider the potential to improve decision-making through integration of HIA into the processes to review and set air quality standards used in Australia. To assess the value of HIA in this policy process, its strengths and weaknesses were evaluated aligned with review of international processes for setting air quality standards. Air quality standard setting programmes elsewhere have either used HIA or have amalgamated and incorporated factors normally found within HIA frameworks. They clearly demonstrate the value of a formalised HIA process for setting air quality standards in Australia. The following elements should be taken into consideration when using HIA in standard setting. (a) The adequacy of a mainly technical approach in current standard setting procedures to consider social determinants of health. (b) The importance of risk assessment criteria and information within the HIA process. The assessment of risk should consider equity, the distribution of variations in air quality in different locations and the potential impacts on health. (c) The uncertainties in extrapolating evidence from one population to another or to subpopulations, especially the more vulnerable, due to differing environmental factors and population variables. (d) The significance of communication with all potential stakeholders on issues associated with the management of air quality. In Australia there is also an opportunity for HIA to be used in conjunction with the NEPM to develop local air quality standard measures. The outcomes of this research indicated that the use of HIA for air quality standard setting at the national and local levels would prove advantageous. -- Highlights: • Health Impact Assessment framework has been applied to a policy development process. • HIA process was evaluated for application in air quality standard setting.

  5. Using CollaboRATE, a brief patient-reported measure of shared decision making: Results from three clinical settings in the United States.

    Science.gov (United States)

    Forcino, Rachel C; Barr, Paul J; O'Malley, A James; Arend, Roger; Castaldo, Molly G; Ozanne, Elissa M; Percac-Lima, Sanja; Stults, Cheryl D; Tai-Seale, Ming; Thompson, Rachel; Elwyn, Glyn

    2018-02-01

    CollaboRATE is a brief patient survey focused on shared decision making. This paper aims to (i) provide insight on facilitators and challenges to implementing a real-time patient survey and (ii) evaluate CollaboRATE scores and response rates across multiple clinical settings with varied patient populations. All adult patients at three United States primary care practices were eligible to complete CollaboRATE post-visit. To inform key learnings, we aggregated all mentions of unanticipated decisions, problems and administration errors from field notes and email communications. Mixed-effects logistic regression evaluated the impact of site, clinician, patient age and patient gender on the CollaboRATE score. While CollaboRATE score increased only slightly with increasing patient age (OR 1.018, 95% CI 1.014-1.021), female patient gender was associated with significantly higher CollaboRATE scores (OR 1.224, 95% CI 1.073-1.397). Clinician also predicts CollaboRATE score (random effect variance 0.146). Site-specific factors such as clinical workflow and checkout procedures play a key role in successful in-clinic implementation and are significantly related to CollaboRATE scores, with Site 3 scoring significantly higher than Site 1 (OR 1.759, 95% CI 1.216 to 2.545) or Site 2 (z=-2.71, 95% CI -1.114 to -0.178). This study demonstrates that CollaboRATE can be used in diverse primary care settings. A clinic's workflow plays a crucial role in implementation. Patient experience measurement risks becoming a burden to both patients and administrators. Episodic use of short measurement tools could reduce this burden. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

  6. Early and total neonatal mortality in relation to birth setting in the United States, 2006-2009.

    Science.gov (United States)

    Grünebaum, Amos; McCullough, Laurence B; Sapra, Katherine J; Brent, Robert L; Levene, Malcolm I; Arabin, Birgit; Chervenak, Frank A

    2014-10-01

    We examined neonatal mortality in relation to birth settings and birth attendants in the United States from 2006 through 2009. Data from the Centers for Disease Control and Prevention-linked birth and infant death dataset in the United States from 2006 through 2009 were used to assess early and total neonatal mortality for singleton, vertex, and term births without congenital malformations delivered by midwives and physicians in the hospital and midwives and others out of the hospital. Deliveries by hospital midwives served as the reference. Midwife home births had a significantly higher total neonatal mortality risk than deliveries by hospital midwives (1.26 per 1000 births; relative risk [RR], 3.87 vs 0.32 per 1000; P home births of 41 weeks or longer (1.84 per 1000; RR, 6.76 vs 0.27 per 1000; P home births of women with a first birth (2.19 per 1000; RR, 6.74 vs 0.33 per 1000; P home births, neonatal mortality for first births was twice that of subsequent births (2.19 vs 0.96 per 1000; P home births compared with midwife hospital births was 9.32 per 10,000 births, and the excess early neonatal mortality was 7.89 per 10,000 births. Our study shows a significantly increased total and early neonatal mortality for home births and even higher risks for women of 41 weeks or longer and women having a first birth. These significantly increased risks of neonatal mortality in home births must be disclosed by all obstetric practitioners to all pregnant women who express an interest in such births. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. The Roles of Feature-Specific Task Set and Bottom-Up Salience in Attentional Capture: An ERP Study

    Science.gov (United States)

    Eimer, Martin; Kiss, Monika; Press, Clare; Sauter, Disa

    2009-01-01

    We investigated the roles of top-down task set and bottom-up stimulus salience for feature-specific attentional capture. Spatially nonpredictive cues preceded search arrays that included a color-defined target. For target-color singleton cues, behavioral spatial cueing effects were accompanied by cue-induced N2pc components, indicative of…

  8. The role of consumer satisfaction, consideration set size, variety seeking and convenience orientation in explaining seafood consumption in Vietnam

    OpenAIRE

    Ninh, Thi Kim Anh

    2010-01-01

    The study examines the relationship betweens convenience food and seafood consumption in Vietnam through a replication and an extension of studies of Rortveit and Olsen (2007; 2009). The main purpose of this study is to give an understanding of the role of consumers’ satisfaction, consideration set size, variety seeking, and convenience in explaining seafood consumption behavior in Vietnam.

  9. Spatial and temporal patterns of plantation forests in the United States since the 1930s: an annual and gridded data set for regional Earth system modeling

    Science.gov (United States)

    Chen, Guangsheng; Pan, Shufen; Hayes, Daniel J.; Tian, Hanqin

    2017-08-01

    Plantation forest area in the conterminous United States (CONUS) ranked second among the world's nations in the land area apportioned to forest plantation. As compared to the naturally regenerated forests, plantation forests demonstrate significant differences in biophysical characteristics, and biogeochemical and hydrological cycles as a result of more intensive management practices. Inventory data have been reported for multiple time periods on plot, state, and regional scales across the CONUS, but the requisite annual and spatially explicit plantation data set over a long-term period for analysis of the role of plantation management on regional or national scales is lacking. Through synthesis of multiple inventory data sources, this study developed methods to spatialize the time series plantation forest and tree species distribution data for the CONUS over the 1928-2012 time period. According to this new data set, plantation forest area increased from near zero in the 1930s to 268.27 thousand km2 in 2012, accounting for 8.65 % of the total forestland area in the CONUS. Regionally, the South contained the highest proportion of plantation forests, accounting for about 19.34 % of total forestland area in 2012. This time series and gridded data set developed here can be readily applied in regional Earth system modeling frameworks for assessing the impacts of plantation management practices on forest productivity, carbon and nitrogen stocks, and greenhouse gases (e.g., CO2, CH4, and N2O) and water fluxes on regional or national scales. The gridded plantation distribution and tree species maps, and the interpolated state-level annual tree planting area and plantation area during 1928-2012, are available from PANGAEA.873558" target="_blank">https://doi.org/10.1594/PANGAEA.873558.

  10. The simplifying role of pure and stable sets in induced possibilities and necessities

    International Nuclear Information System (INIS)

    Tsiporkova, E.

    1996-01-01

    The behaviour of upper and lower (conditional) possibilities and necessities induced by a multivalued mapping is investigated in case pure and stable sets with respect to this multivalued mapping are involved. It is obtained that the upper and lower possibilities (resp. necessities) and the upper and lower conditional possibilities (resp. necessities) of a pure set with respect to the original (non-restricted) mapping coincide. Simplified expressions for the lower conditional possibilities and necessities induced by a multivalued mapping are established in case of a restricting set that is pure with respect to this multivalued mapping. Moreover, if the multivalued mapping involved is non-void and surjective then the interaction of stable sets with the upper and lower (conditional) possibilities and necessities is also studied

  11. Vitamin D Deficiency and Its Determinants in Adults: A Sample from Community-Based Settings in the United Arab Emirates

    Science.gov (United States)

    Eldeirawi, Kamal; Harfil, Sondos; Fakhry, Randa

    2017-01-01

    Background. Vitamin D deficiency (VDD) is a public health concern in adults worldwide. This study aims to explore the extent of VDD and its associated factors among adults in the United Arab Emirates (UAE). Subjects and Methods. Quantitative, cross-sectional research was used to assess VDD and its associated factors in 216 adults recruited from randomly selected community-based healthcare settings over a six-month period. Recent values of vitamin D and glycated hemoglobin (HbA1c) were abstracted from medical records, followed by interviews with participants to obtain information on factors related to VDD and other covariates and to measure their heights and weights. Results. A total of 74% of participants demonstrated VDD (vitamin D serum level ≤ 30 nmol/L). Emirati participants had higher odds of having VDD compared to non-Emiratis (OR: 2.95; 95% CI: 1.58–5.52), with also significantly increased odds of the condition appearing in older, less educated, and employed adults. Diabetes type 2 (HbA1c ≥ 6.5%), depression, and obesity were significantly associated with an increased likelihood of VDD after accounting for other covariates. Conclusion. VDD is a significant problem for UAE adults and requires attention by public health policy makers. Diabetes, obesity, and depression need to be considered when screening for vitamin D. PMID:28352281

  12. Clinical nurse leader and clinical nurse specialist role delineation in the acute care setting.

    Science.gov (United States)

    Thompson, Patricia; Lulham, Kevin

    2007-10-01

    More than 90 members of the American Association of Colleges of Nursing and 190 practice sites have partnered to develop the clinical nurse leader (CNL) role. The partnership has created synergy between education and practice and nurtured innovation and diffusion of learning on a national basis. In this ongoing department, the editor, Jolene Tornabeni, MA, RN, FAAN, FACHE, showcases a variety of nurse leaders who discuss their new patient care delivery models in preparation for the CNL role and CNLs who highlight partnerships with their clinical colleagues to improve patient care. In this article, the authors explore differences and similarities between the CNL and the clinical nurse specialist roles, describing the working strategies between a CNL and clinical nurse specialist, and role delineations that have resulted from their cooperation, collaboration, and planning.

  13. A description of the roles, activities, and skills of clinical nurse specialists in the United States.

    Science.gov (United States)

    Scott, R A

    1999-07-01

    Clinical nurse specialists (CNSs) frequently adapt to meet the challenging and changing needs of patients, families, nurses, physicians, and institutions, thus creating an advance practice role that is problematic in definition and description. The two dilemmas associated with CNSs have been role confusion and ambiguity, and the inability to explicate CNSs' value in economic terms. The purpose of this study was to describe the roles, activities, skills, and the cost-saving and revenue-generating activities of Master's-prepared nurses who function in traditional CNS roles in the United States. A descriptive research design was employed, using Role Theory as a framework to guide the study. The tool used to measure CNS practice included a 68-item instrument. It was pretested and used in two pilot studies. Content validity was supported by three experienced CNSs who were, at the time, in a doctoral nursing program. Instrument reliability was 0.89. Surveys were mailed to all individuals who subscribed (n = 2379) to the Clinical Nurse Specialist Journal. From the convenience sample, 724 CNSs participated, providing a margin of error of +/- 4 percentage points with a 99% confidence level. Regarding the five role components, CNSs reported (listed from most frequently to least frequently) spending time in the role of expert practitioner, educator, consultant, administrator, and researcher. Most of the activities listed in each of the roles were typical of CNS practice. Of the advanced practice roles, the two with the most surprising results were the expert practitioner and administrator roles. The results indicated a trend toward performing advanced skills that have been in the past considered solely medical practice and toward increasing administrative responsibilities. A small number of CNSs were able to identify cost-saving and revenue-generating activities, including the monetary value of the activity.

  14. Family perceptions of intensive care unit nurses’ roles: a Greek perspective

    Directory of Open Access Journals (Sweden)

    Maria Malliarou

    2014-01-01

    Full Text Available This study was done in order to examine the role of the nurse in families with critically ill patients as perceived by family members. A descriptive design was conducted with 93 family members aged 18-53 years from a 6-bed intensive care unit in a Greek Hospital. An anonymous self-completed questionnaire recording demographic data and the questionnaire Family members perception of nurses behavioral role expectation/enactment scale of Hickey and Lewandowski was used. Parametric statistic tests were used to examine the research questions. Intensive care unit (ICU patients’ family members expect nurses to make them feel they can ask whatever they want whenever they want, placing great emphasis on communicating with one another and on participating in decision making to the progress of patient care. The age seems to correlate with the expectation from nurse to meet the role of training on how to handle the patient. Nurses did well with regard to meeting family members’ expectations. Most family members assessed positively the role of ICU nurse confirming the need for communication, and clear support of families.

  15. [Work setting, satisfaction and burnout of the nurses in critical care units and hospitalization units. RN4CAST-Spain project].

    Science.gov (United States)

    Fuentelsaz-Gallego, C; Moreno-Casbas, T; Gómez-García, T; González-María, E

    2013-01-01

    To know if there are differences between the critical care units and the medical-surgical care units regarding the perception of the nurses working in National Health System hospitals about their work environment, burnout level and job satisfaction. A cross-sectional study was conducted with 6,417 nurses from the medical-surgical care units and with 1,122 nurses from critical care units of 59 Spanish hospitals with more than 150 beds. Socio-demographic, job satisfaction, perception of work environment (Practice Environment Scale of the Nursing Work Index [PES-NWI questionnaire]) and burnout measured with the Maslach Burnout Inventory (MBI) data were collected. The PES-NWI showed differences in 4 out of its 5 factors. It showed better values in medical-surgical units in all the factors, except for Staffing and resource adequacy (P<.001), where critical care units showed a mean level of agreement of 2.41 versus 2.19 for the medical-surgical units. Regarding burnout, this was higher in the medical-surgical care units (P=.039) where 23% (952) of the nurses had high levels. Job satisfaction was lower in the critical care units (P=.044) with 70% (578) of nurses being very or strongly satisfied. The opinion of the nurses, working in critical care units about their hospital is unfavorable. They showed lower levels of burnout than those working in medical-surgical units. Copyright © 2013 Elsevier España, S.L. y SEEIUC. All rights reserved.

  16. The Possible Role of Intuition in the Child's Epistemic Beliefs in the Piagetian Data Set

    Science.gov (United States)

    Bickart, John

    2013-01-01

    U.S. schools teach predominately to the analytical, left-brain, which has foundations in behaviorism, and uses a mechanistic paradigm that influences epistemic beliefs of how learning takes place. This result is that learning is impeded. Using discourse analysis of a set of Piagetian children, this study re-analyzed Piaget's work. This study found…

  17. Leading Teams of Higher Education Administrators: Integrating Goal Setting, Team Role, and Team Life Cycle Theories

    Science.gov (United States)

    Posthuma, Richard; Al-Riyami, Said

    2012-01-01

    Leaders of higher education institutions can create top management teams of academic administrators to guide and improve their organizations. This study illustrates how the leadership of top management teams can be accomplished successfully through a combination of goal setting (Doran, 1981; Locke & Latham, 1990), understanding of team roles…

  18. The role of policy actors and contextual factors in policy agenda setting and formulation

    NARCIS (Netherlands)

    Koduah, Augustina; Dijk, van Han; Agyepong, Irene Akua

    2015-01-01

    Background: Development of health policy is a complex process that does not necessarily follow a particular format and a predictable trajectory. Therefore, agenda setting and selecting of alternatives are critical processes of policy development and can give insights into how and why policies are

  19. Creating Discursive Order at the End of Life: The Role of Genres in Palliative Care Settings

    Science.gov (United States)

    Schryer, Catherine; McDougall, Allan; Tait, Glendon R.; Lingard, Lorelei

    2012-01-01

    This article investigates an emerging practice in palliative care: dignity therapy. Dignity therapy is a psychotherapeutic intervention that its proponents assert has clinically significant positive impacts on dying patients. Dignity therapy consists of a physician asking a patient a set of questions about his or her life and returning to the…

  20. Combining the role of convenience and consideration set size in explaining fish consumption in Norway.

    Science.gov (United States)

    Rortveit, Asbjorn Warvik; Olsen, Svein Ottar

    2009-04-01

    The purpose of this study is to explore how convenience orientation, perceived product inconvenience and consideration set size are related to attitudes towards fish and fish consumption. The authors present a structural equation model (SEM) based on the integration of two previous studies. The results of a SEM analysis using Lisrel 8.72 on data from a Norwegian consumer survey (n=1630) suggest that convenience orientation and perceived product inconvenience have a negative effect on both consideration set size and consumption frequency. Attitude towards fish has the greatest impact on consumption frequency. The results also indicate that perceived product inconvenience is a key variable since it has a significant impact on attitude, and on consideration set size and consumption frequency. Further, the analyses confirm earlier findings suggesting that the effect of convenience orientation on consumption is partially mediated through perceived product inconvenience. The study also confirms earlier findings suggesting that the consideration set size affects consumption frequency. Practical implications drawn from this research are that the seafood industry would benefit from developing and positioning products that change beliefs about fish as an inconvenient product. Future research for other food categories should be done to enhance the external validity.

  1. Student Self-Determination: A Preliminary Investigation of the Role of Participation in Inclusive Settings

    Science.gov (United States)

    Hughes, Carolyn; Cosgriff, Joseph C.; Agran, Martin; Washington, Barbara H.

    2013-01-01

    Little is known about the effects of participation in inclusive settings on student self-determination. In this exploratory study, we examined the association between students' inclusive school and community activities and the self-determination skills of active involvement in IEP activities and use of selected self-determination strategies.…

  2. Sharing Attention and Activities among Toddlers: The Spatial Dimension of the Setting and the Educator's Role

    Science.gov (United States)

    Musatti, Tullia; Mayer, Susanna

    2011-01-01

    The study proposes an analysis of the processes through which the material and symbolic features of the setting and the activities of the educators interact to determine the children's experience in an early educational centre. This analysis is of particular interest with regard to both educational practice and understanding developmental…

  3. Auditory proactive interference in monkeys: the roles of stimulus set size and intertrial interval.

    Science.gov (United States)

    Bigelow, James; Poremba, Amy

    2013-09-01

    We conducted two experiments to examine the influences of stimulus set size (the number of stimuli that are used throughout the session) and intertrial interval (ITI, the elapsed time between trials) in auditory short-term memory in monkeys. We used an auditory delayed matching-to-sample task wherein the animals had to indicate whether two sounds separated by a 5-s retention interval were the same (match trials) or different (nonmatch trials). In Experiment 1, we randomly assigned stimulus set sizes of 2, 4, 8, 16, 32, 64, or 192 (trial-unique) for each session of 128 trials. Consistent with previous visual studies, overall accuracy was consistently lower when smaller stimulus set sizes were used. Further analyses revealed that these effects were primarily caused by an increase in incorrect "same" responses on nonmatch trials. In Experiment 2, we held the stimulus set size constant at four for each session and alternately set the ITI at 5, 10, or 20 s. Overall accuracy improved when the ITI was increased from 5 to 10 s, but it was the same across the 10- and 20-s conditions. As in Experiment 1, the overall decrease in accuracy during the 5-s condition was caused by a greater number of false "match" responses on nonmatch trials. Taken together, Experiments 1 and 2 showed that auditory short-term memory in monkeys is highly susceptible to proactive interference caused by stimulus repetition. Additional analyses of the data from Experiment 1 suggested that monkeys may make same-different judgments on the basis of a familiarity criterion that is adjusted by error-related feedback.

  4. Exploring the Role and Skill Set of Physiotherapy Clinical Educators in Work-Integrated Learning

    Science.gov (United States)

    Edgar, Susan; Connaughton, Joanne

    2014-01-01

    Clinical educators are under increasing pressures in the workplace to provide quality education of healthcare students within varying supervision frameworks. Along with facilitating the teaching of clinical skills, clinical educators play a support role for students and so require more than expert clinical abilities in their vital position linking…

  5. Heroes of Resiliency and Reciprocity: Teachers' Supporting Role for Reconceptualizing Superhero Play in Early Childhood Settings

    Science.gov (United States)

    Harris, Kathleen I.

    2016-01-01

    Superhero play is a specialised form of fantasy play with considerable appeal to young children. During superhero play, children have opportunities to pretend and often to play different types of roles within a safe and caring environment. When guided appropriately in an early childhood classroom, superhero play gives young children opportunities…

  6. The Work-Family Support Roles of Child Care Providers across Settings

    Science.gov (United States)

    Bromer, Juliet; Henly, Julia R.

    2009-01-01

    This paper presents a qualitative investigation of the work-family support roles of a sample of 29 child care providers serving low-income families in the Chicago area (16 family, friend, and neighbor providers (FFN), 7 licensed family child care providers (FCC), and 6 center-based teachers). Providers report offering low-income parents…

  7. Work-Identity in Ethnographic Research: Developing Field Roles in a Demanding Workplace Setting

    Directory of Open Access Journals (Sweden)

    Gunilla Jansson PhD

    2013-02-01

    Full Text Available In this article we problematize our field roles as two linguistic ethnographers who aim to study the communication and documentation practices drawn upon by care workers in elderly care facilities in Sweden. Our field roles are discussed in relation to the complex nature of care workers' knowledge and competence, which results from three different aspects of their work-identities: institutional, professional, and individual. As researchers, we found ourselves in constant dialogue with the research participants, and our field roles were continuously shaped and reshaped according to the individuals and the situations in which we became involved. Even aspects of our own identities taken into the field, such as our background and personal qualities, proved to be important in establishing good relations with the care staff. Coming closer to the participants' professional identity proved to be of utmost importance for interpreting their choices and decisions in the workplace. Identity negotiation is presented here as a constructive way of discussing ethnographic field roles in the research field.

  8. Causal asymmetry across cultures: Assigning causal roles in symmetric physical settings

    Directory of Open Access Journals (Sweden)

    Andrea eBender

    2011-09-01

    Full Text Available In the cognitive sciences, causal cognition in the physical domain has featured as a core research topic, but the impact of culture has been rarely ever explored. One case in point for a topic on which this neglect is pronounced is the pervasive tendency of people to consider one of two (equally important entities as more important for bringing about an effect. In order to scrutinize how robust such tendencies are across cultures, we asked German and Tongan participants to assign prime causality in nine symmetric settings. For most settings, strong asymmetries in both cultures were found, but not always in the same direction, depending on the task content. This indicates that causal asymmetries, while indeed being a robust phenomenon across cultures, are also subject to culture-specific concepts. Moreover, the asymmetries were found to be modulated by figure-ground relations, but not by marking agency.

  9. THE ROLE OF PRAGMATICS IN UNDERSTANDING HUMAN COMMUNICATION IN AN INSTITUTIONAL SETTING

    OpenAIRE

    Hussain AL SHAROUFI

    2013-01-01

    This study tries to show the importance of pragmatics in understanding human communication in an institutional setting. Speakers and listeners are actively involved in a negotiating process that leads to creating a cycle of actively changing contexts in which speech acts win their legitimacy of being real doers of action in real-time situations. Particular cultural repertoires in human societies facilitate language with a wealth of contextual resources that can help anchor meaning by favourin...

  10. Social work role in developing and managing employee assistance programs in health care settings.

    Science.gov (United States)

    Foster, Z; Hirsch, S; Zaske, K

    1991-01-01

    The hospital setting presents special needs for an Employee Assistance Program and special complications for sponsorship, development, and maintenance. What has been learned, how certain problems can be solved or avoided, how responsibility and accountability can be negotiated are presented by a team that has successfully established such a program at a large metropolitan medical center. In addition to successes, some unsolved problems are identified for further study.

  11. [Priority setting of health interventions. Review of criteria, approaches and role of assessment agencies].

    Science.gov (United States)

    Varela-Lema, Leonor; Atienza-Merino, Gerardo; López-García, Marisa

    This study was carried out to develop an explicit health priority setting methodology to support decision-making regarding the technologies to be assessed for inclusion in the National Health Service service portfolio. The primary objective is to identify and analyse the criteria, approaches and conceptual frameworks used for national/international priority setting. An exhaustive review of the literature was carried out. For this purpose, a search of the main biomedical databases was performed and assessment agency websites were reviewed, among other sources. In general terms, it was found that there are no standardised criteria for priority setting, although some consensus and common trends have been identified regarding key elements (criteria, models and strategies, key actors, etc.). Globally, 8 key domains were identified: 1) need for intervention; 2) health outcomes; 3) type of benefit of the intervention; 4) economic consequences; 5) existing knowledge on the intervention/quality of and uncertainties regarding the evidence; 6) implementation and complexity of the intervention/feasibility; 7) priority, justice and ethics; and 8) overall context. The review provides a thorough analysis of the relevant issues and offers key recommendations regarding considerations for developing a national prioritisation framework. Findings are envisioned to be useful for different public organisations that are aiming to establish healthcare priorities. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. Managing across levels of government: evaluation of federal-state roles and responsibilities involving nonfederal forests in the United States

    Science.gov (United States)

    Paul V. Ellefson; Calder M. Hibbard; Michael A. Kilgore

    2006-01-01

    With the assistance of state foresters and federal agency executives, an evaluation was made of federal and state government roles and responsibilities focused nonfederal forests in the United States. The evaluation involved an inventory of legally (and administratively) defined federal roles, identification bf federal programs supporting accomplishment of such roles,...

  13. Role of the pediatric nurse practitioner in promoting breastfeeding for late preterm infants in primary care settings.

    Science.gov (United States)

    Ahmed, Azza H

    2010-01-01

    The preterm birth rate has been increasing steadily during the past two decades. Up to two thirds of this increase has been attributed to the increasing rate of late preterm births (34 to stamina; difficulty with latch, suck, and swallow; temperature instability; increased vulnerability to infection; hyperbilirubinemia, and more respiratory problems than the full-term infant. Late preterm infants usually are treated as full term and discharged within 48 hours of birth, so pediatric nurse practitioners in primary care settings play a critical role in promoting breastfeeding through early assessment and detection of breastfeeding difficulties and by providing anticipatory guidance related to breastfeeding and follow-up. The purpose of this article is to describe the developmental and physiologic immaturity of late preterm infants and to highlight the role of pediatric nurse practitioners in primary care settings in supporting and promoting breastfeeding for late preterm infants.

  14. The role of the hospice social worker in the nursing home setting.

    Science.gov (United States)

    Amar, D F

    1994-01-01

    Data and case examples from two major metropolitan hospice programs are examined in order to arrive at a definition of the hospice social worker's role in the nursing home, and how it differs from that of the hospice social worker in home care. The nursing home population tends to be older, frailer, and with poorer mental status, making them less available to "talk therapies". The nursing home environment itself needs to be assessed as a significant part of the patient/family system. Social work interventions may focus on the patient, the family, the nursing home staff, or any combination of these elements. The hospice social worker on a nursing home team may do less counseling with patients, but the role draws on diverse other skills such as groupwork, negotiation, education, and advocacy.

  15. The Role of Feedback in the Bologna Process, According to Goal Setting Theory: An Exploratory Study of Students' Perceptions

    OpenAIRE

    Puig Terrón, Miriam; Balagué i Canadell, Jordi; Solé Pla, Joan

    2016-01-01

    This study has been carried out while The Bologna Process was implemented in the European Higher Education Area (EHEA). One of the main features of TBP is Lifelong Learning (LLL), introduced to improve student learning, by emphasizing the role of feedback. The Goal Setting Theory of Motivation (GST) considers feedback as a mechanism to enhance performance. Starting from this theoretical framework, our objective is to analyse whether, for those students with specific and challenging goals, fee...

  16. Setting a good example: Regenerative energies play an important role in Schleswig-Holstein

    International Nuclear Information System (INIS)

    Rave, K.

    1995-01-01

    In Schleswig-Holstein the use of regenerative energies is supported more than in any other Land of Germany. Due to the fact that large regions of the Land are situated in strong breeze zones, wind power plays the most important role. Almost 50% of the overall German wind current is gained in Schleswig-Holstein. Furthermore solar energy and water power are also used directly. (orig.) [de

  17. The differential role of pain, work characteristics and pain and sick leave in occupational settings

    OpenAIRE

    GHELDOF, Els; VINCK, Jan; Vlaeyen, J.; Hidding, A.; Crombez, G.

    2005-01-01

    This cross-sectional questionnaire study investigated the role of pain (pain severity, radiating pain), work characteristics (physical workload, job stressors, job satisfaction), negative affect and pain-related fear in accounting for low back pain (LBP) and sick leave (SL) in 1294 employees from 10 companies in Belgium and the Netherlands. An increased risk for short-term LBP (1–30 days during the last year) was observed for workers reporting high physical workload (OR=2.39), high task exert...

  18. Sex trafficking of adolescents and young adults in the United States: healthcare provider's role.

    Science.gov (United States)

    Chaffee, Tonya; English, Abigail

    2015-10-01

    Sex trafficking of adolescents and young adults is both a human rights violation and a public health problem, globally and in the United States. Healthcare providers, including obstetricians and gynecologists, interact with victims, often while they remain under their traffickers' control, but because of providers' lack of training in identification and response many victims go unrecognized and unaided. This review provides an overview of the definitions of sex trafficking and commercial sexual exploitation, contributing factors, health consequences, recruitment of victims, and identification and response by healthcare providers. The literature on definitions and risk factors associated with sex trafficking is growing; however, literature on healthcare providers' role in addressing sex trafficking remains more limited. It is increasingly recognized that healthcare providers have an important role in victim identification and response and as advocates, collaborating with national, regional, and local agencies to increase awareness of sex trafficking as a public health problem and to address the needs of adolescent and young adult victims and survivors globally and in the United States. As professionals who interact with adolescent and young adult victims of sex trafficking, healthcare providers have an important role: in collaboration with other professionals and agencies they can help to identify, respond to, extricate, protect, and advocate for victims and survivors.

  19. Role of pharmacists in optimizing the use of anticancer drugs in the clinical setting

    Directory of Open Access Journals (Sweden)

    Ma CSJ

    2014-02-01

    Full Text Available Carolyn SJ Ma Department of Pharmacy Practice, Daniel K. Inouye College of Pharmacy, University of Hawaii at Hilo, Honolulu, HI, USA Abstract: Oncology pharmacists, also known as oncology pharmacy specialists (OPSs have specialized knowledge of anticancer medications and their role in cancer. As essential member of the interdisciplinary team, OPSs optimize the benefits of drug therapy, help to minimize toxicities and work with patients on supportive care issues. The OPSs expanded role as experts in drug therapy extends to seven major key elements of medication management that include: selection, procurement, storage, preparation/dispensing, prescribing/dosing/transcribing, administration and monitoring/evaluation/education. As front line caregivers in hospital, ambulatory care, long-term care facilities, and community specialty pharmacies, the OPS also helps patients in areas of supportive care including nausea and vomiting, hematologic support, nutrition and infection control. This role helps the patient in the recovery phase between treatment cycles and adherence to chemotherapy treatment schedules essential for optimal treatment and outcome. Keywords: oncology pharmacist, oncology pharmacy specialist, medication management, chemotherapy

  20. The role of transnational companies as oil suppliers to the United States

    International Nuclear Information System (INIS)

    Palazuelos, Enrique

    2010-01-01

    This paper analyzes the extent to which the international oil production of transnational companies meets the oil requirements of the United States. Disaggregated data from each company have been used to determine which companies (refineries) are importing crude oil, how much oil each transnational company is produced abroad, and where this production goes to. The analysis show that American international oil production represents a small part of U.S. oil imports. Two conclusions are reached. The first is that U.S. refineries buy the majority of the crude oil they process on the international market and, as a result, are dependent on the unstable conditions of this market. The second is that the economic interests the large American oil companies have abroad are far greater than those they have within the United States and, as a result, these companies do not play a decisive role in a national strategy to guarantee foreign supply.

  1. The Role in the Virtual Astronomical Observatory in the Era of Massive Data Sets

    Science.gov (United States)

    Berriman, G. Bruce; Hanisch, Robert J.; Lazio, T. Joseph W.

    2012-01-01

    The Virtual Observatory (VO) is realizing global electronic integration of astronomy data. One of the long-term goals of the U.S. VO project, the Virtual Astronomical Observatory (VAO), is development of services and protocols that respond to the growing size and complexity of astronomy data sets. This paper describes how VAO staff are active in such development efforts, especially in innovative strategies and techniques that recognize the limited operating budgets likely available to astronomers even as demand increases. The project has a program of professional outreach whereby new services and protocols are evaluated.

  2. Rationale set of indicators and prioritize relevant to assess competitive activity of hockey players of high qualification of different roles

    Directory of Open Access Journals (Sweden)

    A.P. Mikhnov

    2015-02-01

    Full Text Available Purpose: organize technical and tactical actions and determine their priority importance for high-end players of different roles. Establish their priority importance for the success of competitive activity hockey with the game roles. Material : the study involved 54 experts on hockey coaches and players of high class. The significance of technical and tactical actions evaluated for players of different roles. Results : systematic account of technical and tactical actions of athletes and prioritize them to assess the significance of competitive activity. Three groups of technical and tactical actions: 1 active attacks; 2 - active safety; 3 - organizational and maneuvering. Set priorities for technical and tactical actions for players of different roles. Conclusions : the proposed technical and tactical actions can be recommended for the evaluation of the effectiveness of competitive activity players. In the process of estimating the action game players need to consider their role playing. Identification of priority in the implementation of technical and tactical actions in the game can be used in integrated assessment of actions players different roles.

  3. Conceptual Foundations of Quantum Mechanics:. the Role of Evidence Theory, Quantum Sets, and Modal Logic

    Science.gov (United States)

    Resconi, Germano; Klir, George J.; Pessa, Eliano

    Recognizing that syntactic and semantic structures of classical logic are not sufficient to understand the meaning of quantum phenomena, we propose in this paper a new interpretation of quantum mechanics based on evidence theory. The connection between these two theories is obtained through a new language, quantum set theory, built on a suggestion by J. Bell. Further, we give a modal logic interpretation of quantum mechanics and quantum set theory by using Kripke's semantics of modal logic based on the concept of possible worlds. This is grounded on previous work of a number of researchers (Resconi, Klir, Harmanec) who showed how to represent evidence theory and other uncertainty theories in terms of modal logic. Moreover, we also propose a reformulation of the many-worlds interpretation of quantum mechanics in terms of Kripke's semantics. We thus show how three different theories — quantum mechanics, evidence theory, and modal logic — are interrelated. This opens, on one hand, the way to new applications of quantum mechanics within domains different from the traditional ones, and, on the other hand, the possibility of building new generalizations of quantum mechanics itself.

  4. Proceduralism and its role in economic evaluation and priority setting in health.

    Science.gov (United States)

    Jan, Stephen

    2014-05-01

    This paper provides a critical overview of Gavin Mooney's proceduralist approach to economic evaluation and priority setting in health. Proceduralism is the notion that the social value attached to alternative courses of action should be determined not only by outcomes, but also processes. Mooney's brand of proceduralism was unique and couched within a broader critique of 'neo-liberal' economics. It operated on a number of levels. At the micro level of the individual program, he pioneered the notion that 'process utility' could be valued and measured within economic evaluation. At a macro level, he developed a framework in which the social objective of equity was defined by procedural justice in which communitarian values were used as the basis for judging how resources should be allocated across the health system. Finally, he applied the notion of procedural justice to further our understanding of the political economy of resource allocation; highlighting how fairness in decision making processes can overcome the sometimes intractable zero-sum resource allocation problem. In summary, his contributions to this field have set the stage for innovative programs of research to help in developing health policies and programs that are both in alignment with community values and implementable. Copyright © 2014 Elsevier Ltd. All rights reserved.

  5. The role of the media in agenda setting: the case of long-term care rebalancing.

    Science.gov (United States)

    Miller, Edward Alan; Nadash, Pamela; Goldstein, Rachel

    2015-01-01

    This study investigates the role of print media in state policy agendas in four states-Connecticut, Minnesota, Oregon, and Utah-in rebalancing long-term care away from institutions toward home- and community-based (HCBS) services. Ordinary least squares regression is used to model states' policy agendas, as measured by the proportion of Medicaid long-term care spending on HCBS expenditures and number of rebalancing bills proposed, from 1999 to 2008. Results reveal a relationship between states' rebalancing agendas and the extent of media coverage, and state economic, political, and programmatic characteristics. Findings suggest that media coverage reflects broader shifts in state-level attitudes toward rebalancing.

  6. Environmental setting and factors that affect water quality in the Georgia-Florida Coastal Plain study unit

    Science.gov (United States)

    Berndt, M.P.; Oaksford, E.T.; Darst, M.R.; Marella, R.L.

    1996-01-01

    The Georgia-Florida Coastal Plain study unit covers an area of nearly 62,000 square miles in the southeastern United States, mostly in the Coastal Plain physiographic province. Land resource provinces have been designated based on generalized soil classifications. Land resource provinces in the study area include: the Coastal Flatwoods, the Southern Coastal Plain, the Central Florida Ridge, the Sand Hills, and the Southern Piedmont. The study area includes all or parts of seven hydrologic subregions: the Ogeechee-Savannah, the Altamaha- St.Marys, the Suwannee, the Ochlockonee, the St. Johns, the Peace-Tampa Bay, and the Southern Florida. The primary source of water for public supply in the study area is ground water from the Upper Floridan aquifer. In 1990, more than 90 percent of the 2,888 million gallons per day of ground water used came from this aquifer. The population of the study area was 9.3 million in 1990. The cities of Jacksonville, Orlando, St. Petersburg, Tallahassee, and Tampa, Florida, and parts of Atlanta and Savannah, Georgia, are located in the study area. Forest and agricultural areas are the most common land uses in the study area, accounting for 48 percent and 25 percent of the study area, respectively. Climatic conditions range from temperate in Atlanta, Georgia, where mean annual temperature is about 61.3 degrees Fahrenheit, to subtropical in Tampa, Florida, where mean annual temperature is about 72.4 degrees Fahrenheit. Long-term average precipitation (1961-90) ranges from 43.9 inches per year in Tampa, Florida, and 44.6 in Macon, Georgia, to 65.7 inches per year in Tallahassee, Florida. Floods in the study area result from frontal systems, hurricanes, tropical storms, or severe thunderstorms. Droughts are not common in the study area,especially in the Florida part of the study area due to extensive maritime exposure. The primary physical and cultural characteristics in the study area include physiography, soils and land resource provinces

  7. Assessment of Diagnostic and Prognostic Role of Copeptin in the Clinical Setting of Sepsis

    Directory of Open Access Journals (Sweden)

    Stefania Battista

    2016-01-01

    Full Text Available The diagnostic and prognostic usefulness of copeptin were evaluated in septic patients, as compared to procalcitonin assessment. In this single centre and observational study 105 patients were enrolled: 24 with sepsis, 25 with severe sepsis, 15 with septic shock, and 41 controls, divided in two subgroups (15 patients with gastrointestinal bleeding and 26 with suspected SIRS secondary to trauma, acute coronary syndrome, and pulmonary embolism. Biomarkers were determined at the first medical evaluation and thereafter 24, 48, and 72 hours after admission. Definitive diagnosis and in-hospital survival rates at 30 days were obtained through analysis of medical records. At entry, copeptin proved to be able to distinguish cases from controls and also sepsis group from septic shock group, while procalcitonin could distinguish also severe sepsis from septic shock group. Areas under the ROC curve for copeptin and procalcitonin were 0.845 and 0.861, respectively. Noteworthy, patients with copeptin concentrations higher than the threshold value (23.2 pmol/L, calculated from the ROC curve, at admission presented higher 30-day mortality. No significant differences were found in copeptin temporal profile among different subgroups. Copeptin showed promising diagnostic and prognostic role in the management of sepsis, together with its possible role in monitoring the response to treatment.

  8. Assessment of Diagnostic and Prognostic Role of Copeptin in the Clinical Setting of Sepsis.

    Science.gov (United States)

    Battista, Stefania; Audisio, Umberto; Galluzzo, Claudia; Maggiorotto, Matteo; Masoero, Monica; Forno, Daniela; Pizzolato, Elisa; Ulla, Marco; Lucchiari, Manuela; Vitale, Annarita; Moiraghi, Corrado; Lupia, Enrico; Settanni, Fabio; Mengozzi, Giulio

    2016-01-01

    The diagnostic and prognostic usefulness of copeptin were evaluated in septic patients, as compared to procalcitonin assessment. In this single centre and observational study 105 patients were enrolled: 24 with sepsis, 25 with severe sepsis, 15 with septic shock, and 41 controls, divided in two subgroups (15 patients with gastrointestinal bleeding and 26 with suspected SIRS secondary to trauma, acute coronary syndrome, and pulmonary embolism). Biomarkers were determined at the first medical evaluation and thereafter 24, 48, and 72 hours after admission. Definitive diagnosis and in-hospital survival rates at 30 days were obtained through analysis of medical records. At entry, copeptin proved to be able to distinguish cases from controls and also sepsis group from septic shock group, while procalcitonin could distinguish also severe sepsis from septic shock group. Areas under the ROC curve for copeptin and procalcitonin were 0.845 and 0.861, respectively. Noteworthy, patients with copeptin concentrations higher than the threshold value (23.2 pmol/L), calculated from the ROC curve, at admission presented higher 30-day mortality. No significant differences were found in copeptin temporal profile among different subgroups. Copeptin showed promising diagnostic and prognostic role in the management of sepsis, together with its possible role in monitoring the response to treatment.

  9. Loss of parental role as a cause of stress in the neonatal intensive care unit.

    Science.gov (United States)

    Bouet, Kary M; Claudio, Norma; Ramirez, Verónica; García-Fragoso, Lourdes

    2012-01-01

    Having a baby in the Neonatal Intensive Care Unit (NICU) is a major source of stress for parents. The barriers to parenting and reactions to the environment may negatively influence the parent-infant relationship. To identify NICU-related parental stress and associated factors. Parents (N = 156) of newborns admitted to NICU completed the Parental Stressor Scale. Most of the parents (46%) rated the experience to be extremely stressful. The principal cause of stress was the alteration in parental role and being separated from their baby. Stress was not associated to education, marital status, infants' birth weight, gestational age, congenital anomalies or if the parents expected the baby to be in the NICU. Identification of areas associated to higher levels of stress in parents may help the NICU staff to establish strategies to help parents cope with the stress caused by being unable to start their parenting role immediately after their babies' birth.

  10. Progressing recovery-oriented care in psychiatric inpatient units: Occupational therapy’s role in supporting a stronger peer workforce

    Directory of Open Access Journals (Sweden)

    Chris Lloyd

    2017-10-01

    Full Text Available Purpose - Initiated by the service user movement, recovery-oriented practices are one of the keystones of modern mental health care. Over the past two decades, substantial gains have been made with introducing recovery-oriented practice in many areas of mental health practice, but there remain areas where progress is delayed, notably, the psychiatric inpatient environment. The peer support workforce can play a pivotal role in progressing recovery-oriented practices. The purpose of this paper is to provide a pragmatic consideration of how occupational therapists can influence mental health systems to work proactively with a peer workforce. Design/methodology/approach - The authors reviewed current literature and considered practical approaches to building a peer workforce in collaboration with occupational therapists. Findings - It is suggested that the peer support workforce should be consciously enhanced in the inpatient setting to support culture change as a matter of priority. Occupational therapists working on inpatient units should play a key role in promoting and supporting the growth in the peer support workforce. Doing so will enrich the Occupational Therapy profession as well as improving service user outcomes. Originality/value - This paper seeks to provide a pragmatic consideration of how occupational therapists can influence mental health systems to work proactively with a peer workforce.

  11. A Systematic Review of the Liaison Nurse Role on Patient's Outcomes after Intensive Care Unit Discharge.

    Science.gov (United States)

    Tabanejad, Zeinab; Pazokian, Marzieh; Ebadi, Abbas

    2014-10-01

    This review focuses on the impact of liaison nurse in nursing care of patient after ICU discharge on patient's outcomes, compared with patients that are not taken care of by liaison nurses. The role of the ICU liaison nurse has transpired to solve the gap between intensive care unit and wards. Therefore, we aimed to review the outcomes of all studies in this field. A systematic review of intervention studies between 2004 and 2013 was undertaken using standard and sensitive keywords such as liaison nurse, intensive care unit, and patient outcomes in the following databases: Science direct, PubMed, Scopus, Ovid, Oxford, Wiley, Scholar, and Mosby. Then, the articles which had the inclusion criteria after quality control were selected for a systematic review. From 662 retrieved articles, six articles were analyzed in a case study and four articles showed a statistically significant effect of the liaison nurse on the patient's outcomes such as reducing delays in patient discharge, effective discharge planning, improvement in survival for patients at the risk for readmission. Liaison nurses have a positive role on the outcomes of patients who are discharged from the ICU and more research should be done to examine the exact function of liaison nurses and other factors that influence outcomes in patients discharged from ICU.

  12. Ingroup/Outgroup Attitudes and Group Evaluations: The Role of Competition in British Classroom Settings

    Directory of Open Access Journals (Sweden)

    Virginia L. Lam

    2016-01-01

    Full Text Available Children’s intergroup bias is one of the consequences of their readiness to categorise people into ingroups and outgroups, even when groups are assigned arbitrarily. The present study examined the influence of intergroup competition on children’s ingroup and outgroup attitudes developed within the minimal-group setting in British classrooms. One hundred and twelve children in two age groups (6-7- and 9-10-year-olds were assessed on classification skills and self-esteem before being allocated to one of two colour “teams.” In the experimental condition, children were told that the teams would have a competition after two weeks and teachers made regular use of these teams to organise activities. In the control condition, where no competition ensued, teachers did not refer to “teams.” Then children completed trait attributions to their own-team (ingroup and other-team (outgroup members and group evaluations. It was found that children developed positive ingroup bias across conditions, but outgroup negative bias was shown only by 6-7-year-olds in the experimental condition, particularly if they lost the competition, where they evaluated their team more critically. Better classification skills were associated with less negativity towards the outgroup in the experimental condition. Findings are discussed in relation to relevant theoretical premises and particulars of the intergroup context.

  13. Evaluating psychiatric nursing competencies applied to emergency settings: A pilot role delineation study.

    Science.gov (United States)

    Mello, Joanna J; Bell, Janice F; Siegel, Elena O; Ward, Deborah H

    2016-03-01

    Despite increasing emergency department (ED) use for psychiatric emergencies, limited evidence exists to clearly identify the competencies necessary of emergency nurses to care for this population. 1. To define the specialized skill and knowledge of emergency nurses by examining the frequency with which recommended psychiatric nursing competencies are performed in the ED setting. 2. To assess emergency nurses' rankings of importance and self-efficacy related to recommended psychiatric nursing competencies in order to explore their relevance to emergency nursing. Emergency nurses (n = 75) completed a survey ranking the frequency, importance and self-efficacy of 15 psychiatric nursing competencies. Data analysis revealed competency relevance and regression analysis demonstrated factors that may contribute to self-efficacy. Nurses reported performing psychiatric competencies frequently (mean scores of 0.64 to 3.04). Importance rankings were highest (mean scores of 1.81 to 3.67). Self-efficacy mean scores ranged from 0.89 to 3.47. Frequency and importance of activities predicted higher self-efficacy scores. Younger age and competencies often, and existing competencies appear applicable. As frequency and importance of competencies influence self-efficacy, practice and interventions to underscore the importance of competencies may improve self-efficacy. Younger and less experienced nurses might require more support. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. The role of the United Nations in the field of verification

    International Nuclear Information System (INIS)

    1991-01-01

    By resolution 43/81 B of 7 December 1988, the General Assembly requested the Secretary General to undertake, with the assistance of a group of qualified governmental experts, an in-depth study of the role of the United Nations in the field of verification. In August 1990, the Secretary-General transmitted to the General Assembly the unanimously approved report of the experts. The report is structured in six chapters and contains a bibliographic appendix on technical aspects of verification. The Introduction provides a brief historical background on the development of the question of verification in the United Nations context, culminating with the adoption by the General Assembly of resolution 43/81 B, which requested the study. Chapters II and III address the definition and functions of verification and the various approaches, methods, procedures and techniques used in the process of verification. Chapters IV and V examine the existing activities of the United Nations in the field of verification, possibilities for improvements in those activities as well as possible additional activities, while addressing the organizational, technical, legal, operational and financial implications of each of the possibilities discussed. Chapter VI presents the conclusions and recommendations of the Group

  15. Reduction of standby energy use in set-top boxes in the United States and the European Union

    Energy Technology Data Exchange (ETDEWEB)

    Zandelin, S.

    2000-06-01

    In the US, there were over 110 million set-top boxes in 1999. About half of these boxes were game consoles. In the EU, the number of set-top boxes was estimated to be about 71 millions in 1999. The most common set-top boxes in the EU were analog satellite receivers. That is quite a difference from the US, where almost no analog satellite receivers exist. It is expected that the amount of set-top boxes will increase rapidly when the broadcasts switch to digital. Set-top boxes in the US consume 7.9 TWh of electricity every year. Of this 5.5 TWh, or 70 %, are consumed while in standby mode. The amount of energy used in standby in the US would be enough to heat about 220,000 Swedish houses. Even though almost half of the set-top boxes in the US are game consoles, they only use 30 % of the set-top energy. This is because they have low standby power. Since most analog cable boxes have a very high standby power, 46 % of the set-top energy come from analog cable boxes. Analog cable boxes use 76 % of the energy in standby mode. The set-top electricity consumption in the US is 0.70 % of the residential electricity use. In the EU the total amount of energy used by set-top boxes is 5.1 TWh every year. The fraction used in standby mode in the EU, 60 %, is smaller than in the US. In the EU, the most common boxes are the analog satellite receivers. They use 59 % of the total set-top energy, or 3.0 TWh. The set-top energy share of the residential electricity use in the EU is about 0.85 %. Sweden has a share that is less than half of the EU share. One reason for that could be that a lot of electricity is used for heating in Sweden. In most set-top boxes, high standby power is because most circuitry and components are still powered when they are not in use. By making modest redesigns and changes of communications protocols between the service provider and the user, the energy efficiency could be increased and the standby power consumption reduced significantly. If nothing is done to

  16. Decisional Procrastination in Academic Settings: The Role of Metacognitions and Learning Strategies

    Directory of Open Access Journals (Sweden)

    Valeria de Palo

    2017-06-01

    Full Text Available Nowadays, university students suffer from a broad range of problems, such as educational underachievement or the inability to control themselves, that lead to procrastination as a consequence. The present research aimed at analyzing the determinants of decisional procrastination among undergraduate students and at assessing a path model in which self regulated learning strategies mediated the relationship between metacognitive beliefs about procrastination and decisional procrastination. 273 students from Southern Italy filled out a questionnaire composed by: the socio-demographic section, the Metacognitive Beliefs About Procrastination Questionnaire, the procrastination subscale of the Melbourne Decision Making Questionnaire, and the Anxiety, the Time Management, and the Information Processing subscales of the Learning and Study Strategies Inventory. Results showed that the relationship between negative and positive metacognitive beliefs about procrastination and decisional procrastination was mediated only by time management and anxiety. Such findings underlined the crucial role played by learning strategies in predicting the tendency to delay decisional situations and in mediating the relationship between metacognitive beliefs about procrastination and decisional procrastination.

  17. Decisional Procrastination in Academic Settings: The Role of Metacognitions and Learning Strategies.

    Science.gov (United States)

    de Palo, Valeria; Monacis, Lucia; Miceli, Silvana; Sinatra, Maria; Di Nuovo, Santo

    2017-01-01

    Nowadays, university students suffer from a broad range of problems, such as educational underachievement or the inability to control themselves, that lead to procrastination as a consequence. The present research aimed at analyzing the determinants of decisional procrastination among undergraduate students and at assessing a path model in which self regulated learning strategies mediated the relationship between metacognitive beliefs about procrastination and decisional procrastination. 273 students from Southern Italy filled out a questionnaire composed by: the socio-demographic section, the Metacognitive Beliefs About Procrastination Questionnaire, the procrastination subscale of the Melbourne Decision Making Questionnaire, and the Anxiety, the Time Management, and the Information Processing subscales of the Learning and Study Strategies Inventory. Results showed that the relationship between negative and positive metacognitive beliefs about procrastination and decisional procrastination was mediated only by time management and anxiety. Such findings underlined the crucial role played by learning strategies in predicting the tendency to delay decisional situations and in mediating the relationship between metacognitive beliefs about procrastination and decisional procrastination.

  18. The role of crystal structure and fabrics in early diagenesis: examples from continental and marine settings

    Science.gov (United States)

    Frisia, Silvia; Borsato, Andrea; Bajo, Petra; Hellstrom, John

    2015-04-01

    previously documented in marine facies. In speleothems, the process comes to a halt if the flow of the diagenetic fluid stops, which commonly happens when a new "impermeable" layer is formed atop the partially replaced aragonite. Yet, if dripwaters are allowed to percolate through crystal boundaries, the aragonite below can be completely replaced by a mosaic of calcite and geochemical properties re-set. Preservation of the original fabric, or part of it, is then influenced by both the "exhaustion" of the diagenetic fluid and the presence of organic carbon surfaces. Speleothem diagenetic pathways are not dissimilar to what occurs in the marine environment. Primary and early diagenetic dolomites seem to be preserved in some Triassic sabkha facies, being "protected" by clay or organic layers. In other "early diagenetic dolomites", such as the case of the Early Pliocene makatea reef terraces (Cook Islands, South Pacific), original, highly porous facies were replaced by a mosaic of fabric-destructive dolomite with a few relicts of organic-rich micrite. Thus, original fabric and porosity, crystal defects, crystal boundaries and presence of organic matter in carbonates dictate the diagenetic pathways, while the composition of the diagenetic fluids and the duration of the diagenetic process control the extent of geochemical re-setting of the system.

  19. SOCIAL MARKETING IN PROMOTING HEALTH BEHAVIOR: A ROLE OF PSYCHOLOGICAL SET

    Directory of Open Access Journals (Sweden)

    Conny Tjandra R

    2014-07-01

    Full Text Available AbstractIncreasingly incidences of nutrition related diseases such as cardiovascular diseases, obesity and cancers are becoming significant health burdens not only in western countries but it is also newly coming health problem in Asia, including Indonesia. To encounter this development in the future it is important to continually promote the diseases prevention actions through appropriate social marketing programs. For that purpose, understanding psychological set such as knowledge, belief, attitude and motivation to perform diseases prevention actions and their causal relationship is becoming more and more important. The most challenging issue is to perform social marketing programs that can successfully influence people future health behavior. Our study has aim to understand the relationship of some psychological factors in influencing behavior. The result of this study showed that in spite of controversial issues published in current studies, we found that inherent knowledge level influences motivation through a modulation of attitude variable.Keywords: eating behavior, knowledge, attitude, motivation, behavioral action, prevention, healthy eating habit.AbstrakMeningkatnya jumlah penyakit kronik yang berhubungan dengan gizi pangan seperti penyakit jantung koroner, kegemukan dan kanker merupakan masalah kesehatan yang utama bukan hanya di Negara barat saja melainkan juga terjadi di negara berkembang seperti Asia. Untuk mengatasi masalah ini, perlu dikembangkan sistem pencegahan yang dapat dilakukan oleh setiap individu didalam masyarakat. Pendidikan dan penyuluhan kepada masyarakat terhadap pentingnya tindakan preventif seperti melalui “social marketing programs” yang digalakkan baik oleh pemerintah atau institusi kesehatan lainnya, sangatlah penting. Didalam social marketing, promosi tentang pencegahan semestinya dilakukan dengan terlebih dahulu mengetahui dan mengenal segala macam bentuk kebutuhan dasar, pengetahuan, sikap, kepercayaan

  20. THE ROLE OF PRAGMATICS IN UNDERSTANDING HUMAN COMMUNICATION IN AN INSTITUTIONAL SETTING

    Directory of Open Access Journals (Sweden)

    Hussain AL SHAROUFI

    2013-10-01

    Full Text Available This study tries to show the importance of pragmatics in understanding human communication in an institutional setting. Speakers and listeners are actively involved in a negotiating process that leads to creating a cycle of actively changing contexts in which speech acts win their legitimacy of being real doers of action in real-time situations. Particular cultural repertoires in human societies facilitate language with a wealth of contextual resources that can help anchor meaning by favouring particular speech acts to other ones. In investigating some dialogical tactics practiced by some Kuwaiti customer service employees in Kuwait, I found that Mey’s pragmeme is the ideal outcome of these dialogic encounters. In Mey’s viewpoint, no speech act means anything without the cultural context in which it originates, a stance which casts a serious doubt on the semantico-syntactic analysis of speech acts in a Searlean sense. The communicative value of ethos in institutional encounters relies primarily on looking at meaning from a pragmatic perspective, to be more precise here from a pragmemic perspective. In order to assess the level of their socio-pragmatic awareness and their ability to depend on their socio-pragmatic resources to persuade their customers, I interviewed a group of customer service employees at some Kuwaiti banks. The results of the study showed cogently that bank employees in Kuwait have high socio-pragmatic awareness, which helped them significantly in attracting more customers to their banks. Those employees showed clear awareness of strategic positive politeness and effective usage of appropriate pragmemes, contextualized speech acts (Mey 2001, Capone 2005. Making promises, guaranteeing exceptional services, and pampering clients with versatile banking products are some of the socio-pragmatic strategies used by the aforementioned employees.

  1. UNDERSTANDING THE ROLE OF BEHAVIOR AND COGNITIONS IN A GROUP EXERCISE SETTING

    Directory of Open Access Journals (Sweden)

    Kimberley A. Dawson

    2004-11-01

    Full Text Available The first purpose of the present study examined whether individuals with different exercise behaviors (classified by attendance experienced different or similar cognitive patterns. It was hypothesized that different behavior would lead to different cognitive appraisals. It was predicted that there would be a difference between the three behavioral frequency groups with regard to self-efficacy measures and goal measures. The second purpose of the study was to describe, evaluate and observe whether social factors were associated with participating in exercise in groups. It was hypothesized that those who engage in exercise classes would elicit a social focus. Participants for the study included 39 females who registered in-group fitness classes at a mid-sized university. Attendance over the 10-week course was assessed and participants completed a self-report questionnaire during week seven. The attendance data were used to create 3 exercise frequency groups (regular attenders, sporadic attenders, and dropouts based on ACSM's exercise guidelines. Analysis of Variance (ANOVA, means and frequencies were used to describe the data. There were no significant differences on measures of self-efficacy, goal measures, enjoyment, and external motivation among the three groups (all p's > 0.05. An analysis of the whole group (N=39 discovered a low social focus and high ratings of self-efficacy. Continued research is necessary to investigate the benefit of social support in a group exercise setting, as well as to better understand how self-regulation through self-efficacy and goal factors influences and is influenced by actual behavior.

  2. Copernicus stratospheric ozone service, 2009–2012: validation, system intercomparison and roles of input data sets

    Directory of Open Access Journals (Sweden)

    K. Lefever

    2015-03-01

    Full Text Available This paper evaluates and discusses the quality of the stratospheric ozone analyses delivered in near real time by the MACC (Monitoring Atmospheric Composition and Climate project during the 3-year period between September 2009 and September 2012. Ozone analyses produced by four different chemical data assimilation (CDA systems are examined and compared: the Integrated Forecast System coupled to the Model for OZone And Related chemical Tracers (IFS-MOZART; the Belgian Assimilation System for Chemical ObsErvations (BASCOE; the Synoptic Analysis of Chemical Constituents by Advanced Data Assimilation (SACADA; and the Data Assimilation Model based on Transport Model version 3 (TM3DAM. The assimilated satellite ozone retrievals differed for each system; SACADA and TM3DAM assimilated only total ozone observations, BASCOE assimilated profiles for ozone and some related species, while IFS-MOZART assimilated both types of ozone observations. All analyses deliver total column values that agree well with ground-based observations (biases The northern spring 2011 period is studied in more detail to evaluate the ability of the analyses to represent the exceptional ozone depletion event, which happened above the Arctic in March 2011. Offline sensitivity tests are performed during this month and indicate that the differences between the forward models or the assimilation algorithms are much less important than the characteristics of the assimilated data sets. They also show that IFS-MOZART is able to deliver realistic analyses of ozone both in the troposphere and in the stratosphere, but this requires the assimilation of observations from nadir-looking instruments as well as the assimilation of profiles, which are well resolved vertically and extend into the lowermost stratosphere.

  3. Identification of unmeasured variables in the set of model constraints of the data reconciliation in a power unit

    Science.gov (United States)

    Szega, Marcin; Nowak, Grzegorz Tadeusz

    2013-12-01

    In generalized method of data reconciliation as equations of conditions beside substance and energy balances can be used equations which don't have precisely the status of conservation lows. Empirical coefficients in these equations are traded as unknowns' values. To this kind of equations, in application of the generalized method of data reconciliation in supercritical power unit, can be classified: steam flow capacity of a turbine for a group of stages, adiabatic internal efficiency of group of stages, equations for pressure drop in pipelines and equations for heat transfer in regeneration heat exchangers. Mathematical model of a power unit was developed in the code Thermoflex. Using this model the off-design calculation has been made in several points of loads for the power unit. Using these calculations identification of unknown values and empirical coefficients for generalized method of data reconciliation used in power unit has been made. Additional equations of conditions will be used in the generalized method of data reconciliation which will be used in optimization of measurement placement in redundant measurement system in power unit for new control systems

  4. Goal setting practice in services delivering community-based stroke rehabilitation: a United Kingdom (UK) wide survey.

    Science.gov (United States)

    Scobbie, Lesley; Duncan, Edward A; Brady, Marian C; Wyke, Sally

    2015-01-01

    We investigated the nature of services providing community-based stroke rehabilitation across the UK, and goal setting practice used within them, to inform evaluation of a goal setting and action planning (G-AP) framework. We designed, piloted and electronically distributed a survey to health professionals working in community-based stroke rehabilitation settings across the UK. We optimised recruitment using a multi-faceted strategy. Responses were analysed from 437 services. Services size, composition and input was highly variable; however, most were multi-disciplinary (82%; n = 335/407) and provided input to a mixed diagnostic group of patients (71%; n = 312/437). Ninety one percent of services (n = 358/395) reported setting goals with "all" or "most" stroke survivors. Seventeen percent (n = 65/380) reported that no methods were used to guide goal setting practice; 47% (n = 148/315) reported use of informal methods only. Goal setting practice varied, e.g. 98% of services (n = 362/369) reported routinely asking patients about goal priorities; 39% (n = 141/360) reported routinely providing patients with a copy of their goals. Goal setting is embedded within community-based stroke rehabilitation; however, practice varies and is potentially sub-optimal. Further evaluation of the G-AP framework is warranted to inform optimal practice. Evaluation design will take account of the diverse service models that exist. Implications for Rehabilitation Community-based stroke rehabilitation services across the UK are diverse and tend to see a mixed diagnostic group of patients. Goal setting is implemented routinely within community-based stroke rehabilitation services; however, practice is variable and potentially sub-optimal. Further evaluation of the G-AP framework is warranted to assess its effectiveness in practice.

  5. Community Intellectual Disability Nurses' Public Health Roles in the United Kingdom: An Exploratory Documentary Analysis

    Science.gov (United States)

    Mafuba, Kay; Gates, Bob; Cozens, Maria

    2018-01-01

    The aim of this study was to explore how public health policy in the United Kingdom was reflected in community intellectual disability nurses' (CIDNs)' job descriptions and person's specifications. The role of CIDNs has evolved due to policy changes. As these roles evolve, job descriptions and person specifications are important in highlighting…

  6. The role of Nuclear Energy Unit in gathering, organizing and disseminating of nuclear information

    International Nuclear Information System (INIS)

    Samsurdin Ahamad

    1986-01-01

    The Nuclear Energy Unit (UTN) was established with an aim to promote the application of Nuclear Science and Technology in industries, agriculture and medicine in Malaysia. Therefore UTN represents Malaysia in INIS so as to share the available information for collection, merging and dissemination of information. In UTN a variety of activities are being carried out, especially by the Information Science Department whereby a library, equipped with reading materials and a computerized information system (SMBK) is set up as the information centre. A number of publications have also been made so as to keep the technical officers and other staff aware of the developments in Nuclear Science and Technology. To provide a better understanding of the latest techniques and nuclear technological procedures, courses, seminars and workshops for officers involved are carried out. Talks and exhibitions are also organized in order to promote Nuclear Science and Technology amongst the layman. (author)

  7. Increased mechanical cost of walking in children with diplegia: the role of the passenger unit cannot be neglected.

    Science.gov (United States)

    Van de Walle, P; Hallemans, A; Truijen, S; Gosselink, R; Heyrman, L; Molenaers, G; Desloovere, K

    2012-01-01

    Gait efficiency in children with cerebral palsy is decreased. To date, most research did not include the upper body as a separate functional unit when exploring these changes in gait efficiency. Since children with spastic diplegia often experience problems with trunk control, they could benefit from separate evaluation of the so-called 'passenger unit'. Therefore, the aim of the current study was to improve insights in the role of the passenger unit in decreased gait efficiency in children with diplegia. Mechanical cost of walking was investigated by calculating work by the integrated joint power approach in 18 children with diplegia and 25 age-related typical developing controls. The total mechanical work in children with diplegia was 1.5 times higher than in typical children. In children with diplegia work at the lower limbs was increased by 37% compared to typical children. Substantially higher increases, up to 222%, were noted at the passenger unit. Trunk and head were the main contributors to the increased work of the passenger unit, but the role of the arms cannot be neglected. Due to these disproportional increases in locomotor and passenger unit, the demands of the passenger unit in pathological gait can no longer be considered minor, as in typical gait. Therefore, the role of the passenger unit must be recognized in the decrease of gait efficiency in children with spastic diplegia and should be part of the evaluation of gait efficiency in clinical practice. Copyright © 2012 Elsevier Ltd. All rights reserved.

  8. Structure, diversity and environmental role of foraminiferal assemblages from reefal settings of Moorea (Society Islands, French Polynesia)

    Science.gov (United States)

    Fajemila, Olugbenga; Langer, Martin R.

    2015-04-01

    Reefal and shallow lagoonal environments around the island Moorea (Society Islands, French Polynesia) offer a spectacular variety of microhabitats providing a multitude niches and ideal settings for rich assemblages of tropical benthic foraminifera. The Society Islands are located near the hotspot of tropical marine diversity and represent a transitional location between the high diversity assemblages of the coral triangle and the low diversity biotas of the eastern Pacific. This area constitutes an important biogeographic link and stepping stone between the eastern and western biotas of the tropical Pacific Ocean. We have analyzed the structure, diversity and composition of benthic foraminiferal assemblages from around Moorea to document the composition, species richness and environmental role of larger and smaller benthic foraminifera from within the lagoonal system, the mangrove habitats and fore-reef sites. Foraminifera are prominent producers of calcium carbonate and contribute significantly to structures in reefal settings of the tropical Pacific. We evaluate the potential of larger symbiont-bearing foraminifera as environmental engineers and apply the FORAM-Index as proxy to assess the conditions around Moorea Island. We also evaluate the role of the Society Islands as stepping stone between biogeographic regions of the Pacific Ocean.

  9. Study on the role of the United Nations in the field of verification

    International Nuclear Information System (INIS)

    1991-01-01

    The present report has been prepared pursuant to General Assembly resolution 43/81 B. The Group of Governmental Experts, while taking fully into account the mandate of the resolution, that is, to prepare a study that addresses the role of the United Nations in the field of verification of arms limitation and disarmament, has also taken into consideration approaches, methods, procedures and techniques relating to other arrangements in the area of international peace and security which might otherwise be useful to the process of verification of arms limitation and disarmament agreements. A selected bibliography on technical aspects of verification is given. However, materials published in languages other than English are not adequately reflected. Refs

  10. Does Competency-Based Education Have a Role in Academic Pharmacy in the United States?

    Science.gov (United States)

    Medina, Melissa S.

    2017-01-01

    Competency-based Education (CBE) is an educational model that allows students to learn and demonstrate their abilities at their own pace. CBE is growing in popularity in undergraduate educational programs and its role in pharmacy education in the United States (US) is under review. In comparison, medical education is utilizing competency-based approaches (such as competencies and Entrustable Professional Activities) to ensure that students possess the required knowledge, skills, and attitudes prior to graduation or program completion. The concept of competency-based approaches is growing in use in pharmacy education in the US, but the future related to aspects of this concept (e.g., mandatory Entrustable Professional Activities) is not certain. A review of pharmacy education’s evolution in the US and a comparison of competency-related terms offers insight into the future use of competency-based approaches and CBE in pharmacy education in the US through the lens of benefits and challenges. PMID:28970425

  11. Does Competency-Based Education Have a Role in Academic Pharmacy in the United States?

    Directory of Open Access Journals (Sweden)

    Melissa S. Medina

    2017-02-01

    Full Text Available Competency-based Education (CBE is an educational model that allows students to learn and demonstrate their abilities at their own pace. CBE is growing in popularity in undergraduate educational programs and its role in pharmacy education in the United States (US is under review. In comparison, medical education is utilizing competency-based approaches (such as competencies and Entrustable Professional Activities to ensure that students possess the required knowledge, skills, and attitudes prior to graduation or program completion. The concept of competency-based approaches is growing in use in pharmacy education in the US, but the future related to aspects of this concept (e.g., mandatory Entrustable Professional Activities is not certain. A review of pharmacy education’s evolution in the US and a comparison of competency-related terms offers insight into the future use of competency-based approaches and CBE in pharmacy education in the US through the lens of benefits and challenges.

  12. [Fear of child/family in pediatric intensive care units: what is the nurse's role?].

    Science.gov (United States)

    Machado, Cidália; Sousa, Pedro Jácome

    2007-01-01

    The fear is considered a negative emotion, lived with apprehension, uncertainty and a sense of threat or danger to the personal integrity (Torres & Guerra, 2003). It is often associated with hospitalization of the chid/family, and may be the cause to start an emotional crisis due to the separation from environment and the usual routines, the loss of independence and autonomy, and also due to be with strange people (Bicho, 2006; Festas 1994; Freitas &Freitas, 2005; Hockenberry, 2006). Hospitalization in a Pediatric Intensive Care Unit (PICU) may worsen an already existing crisis not only for the given reasons but also because the child may be in life danger. The environment "aggressive"and stressant characteristic of these units also contributes to this situation. To minimize the fear and his negative effects, the nurse has an important role to play. Because of his/her activities and function he/she is the closest health care professional to the child/family, and therefore in a better position to establish a relationship of trust and empathy that will minimize such effects, as well as to the interventions best suited to achieve this objective.

  13. The critical role of extreme heat for maize production in the United States

    Science.gov (United States)

    Lobell, David B.; Hammer, Graeme L.; McLean, Greg; Messina, Carlos; Roberts, Michael J.; Schlenker, Wolfram

    2013-05-01

    Statistical studies of rainfed maize yields in the United States and elsewhere have indicated two clear features: a strong negative yield response to accumulation of temperatures above 30°C (or extreme degree days (EDD)), and a relatively weak response to seasonal rainfall. Here we show that the process-based Agricultural Production Systems Simulator (APSIM) is able to reproduce both of these relationships in the Midwestern United States and provide insight into underlying mechanisms. The predominant effects of EDD in APSIM are associated with increased vapour pressure deficit, which contributes to water stress in two ways: by increasing demand for soil water to sustain a given rate of carbon assimilation, and by reducing future supply of soil water by raising transpiration rates. APSIM computes daily water stress as the ratio of water supply to demand, and during the critical month of July this ratio is three times more responsive to 2°C warming than to a 20% precipitation reduction. The results suggest a relatively minor role for direct heat stress on reproductive organs at present temperatures in this region. Effects of elevated CO2 on transpiration efficiency should reduce yield sensitivity to EDD in the coming decades, but at most by 25%.

  14. Fostering New Roles for Librarians: Skills Set for Repository Managers — Results of a Survey in Italy

    Directory of Open Access Journals (Sweden)

    Maria Cassella

    2012-04-01

    Full Text Available The open access movement in scholarly communication has grown considerably over the last ten years and it has driven an increase in the number of institutional repositories (IRs. New professional roles and skills had to be developed to secure effective IR management. Collection developmente expertise and metadata curation are regarded as strategic roles for repositories and therefore it is only logical for the library and information community to take on the responsibility for managing these digital archives. However, it has become clear that traditional librarian skills do not suffice anymore to run successful repositories. A richer set of skills is needed, including management and communication skills, technical skills, and expertise with regard to access rights and preservation of digital content. Referring to the work carried out by the SHERPA Project in the UK with regard to the skills set for repository staff, the authors performed a survey among repository managers in Italy to assess the educational and professional background of the repository managers and the skills set required to implement successful institutional repositories. The survey findings show that the professional profile of the repository manager is a multiform and complex one. It requires cross-functional and highly specialised competencies. Italian repository managers are of the opinion that the skills required to promote the repository within the institution and those required to deal with copyright issues as the most essential skills repository managers should acquire and be trained for. Collection development and metadata expertise, familiarity with project management and expertise in repository workflow design are also highly rated. Technical skills are needed to deal with interoperability standards and protocols. In Italy academic curricula do not meet the repository managers’ educational needs. Academic programmes should be developed to include communication

  15. The role of perfectionism, dichotomous thinking, shape and weight overvaluation, and conditional goal setting in eating disorders.

    Science.gov (United States)

    Lethbridge, Jessica; Watson, Hunna J; Egan, Sarah J; Street, Helen; Nathan, Paula R

    2011-08-01

    This study examined the role of perfectionism (self-oriented and socially prescribed), shape and weight overvaluation, dichotomous thinking, and conditional goal setting in eating disorder psychopathology. Perfectionism and shape and weight overvaluation have had longstanding implication in the development and maintenance of eating disorders. A leading evidence-based theory of eating disorders (Fairburn, Cooper & Shafran, 2003) outlines perfectionism as a maintaining mechanism of eating disorder psychopathology and as a proximal risk factor for the development of shape and weight overvaluation. These constructs have been linked to other cognitive processes relevant to eating disorders, specifically, dichotomous thinking and conditional goal setting. Women with DSM-IV eating disorders (N=238) were compared to women in the general community (N=248) and, as hypothesised, scores on measures of these constructs were pronounced in the clinical sample. Hierarchical regression analyses predicting eating disorder psychopathology showed that for both groups, dichotomous thinking and conditional goal setting significantly improved model fit beyond perfectionism and shape and weight overvaluation alone. Self-oriented perfectionism, but not socially prescribed perfectionism, was relevant to eating disorder psychopathology. We discuss the implications for current treatment protocols and early intervention. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.

  16. Spin, Unit Climate, and Aggression: Near Term, Long Term, and Reciprocal Predictors of Violence Among Workers in Military Settings

    Science.gov (United States)

    2017-08-01

    bullying, harassment, intimate partner violence) as well as physical health and mental health outcomes often associated with exposure to aggression (e.g... physical aggression, witnessing aggression in the workplace can have negative consequences for unit performance, physical health , and mental health . An...constructs (e.g., physical assault, verbal aggression, anger / rage, bullying, harassment, intimate partner violence) as well as physical health and

  17. Structure, emplacement, and tectonic setting of Late Devonian granitoid plutons in the Teplá–Barrandian unit, Bohemian Massif

    Czech Academy of Sciences Publication Activity Database

    Žák, J.; Kratinová, Zuzana; Trubač, J.; Janoušek, V.; Sláma, Jiří; Mrlina, Jan

    2011-01-01

    Roč. 100, č. 7 (2011), s. 1477-1495 ISSN 1437-3254 R&D Projects: GA AV ČR KJB300120702 Institutional research plan: CEZ:AV0Z30120515; CEZ:AV0Z30130516 Keywords : Bohemian Massif * Teplá-Barrandian unit * Variscan orogeny * granite * pluton * subduction Subject RIV: DB - Geology ; Mineralogy Impact factor: 2.342, year: 2011

  18. Entry into Nursing: An Ethnographic Study of Newly Qualified Nurses Taking on the Nursing Role in a Hospital Setting

    Directory of Open Access Journals (Sweden)

    Mari Skancke Bjerknes

    2012-01-01

    Full Text Available The transition from student to working nurse has long been recognized as challenging. This paper presents the findings of research into the opportunities and limitations encountered by newly qualified nurses when taking on the nursing role. The study had an ethnographic design. Observation, interviews, and document analysis were used to gain insight into nurses' daily work from the perspective of recently graduated nurses. Thirteen nurses were monitored closely during their first year in a hospital setting in Norway. These new nurses generally entered the field with empathy for their patients, enthusiasm for the profession, and readiness to learn more about being a good nurse. However, their more experienced colleagues seemed to neither respect nor nurture this attitude. The new nurses experienced heavier responsibilities than expected, fragmentation of patient care, and stressful interactions with colleagues. The lack of a supportive work environment and role models increased the new nurses' experience of overwhelming responsibility in their daily work situations. The nurses learned to cope the hard way, despite the organizational culture, not because of it. Adjusting the profession's expectations of new nurses, and offering good role models and more comprehensive support programmes, would markedly ease the transition for new nurses.

  19. Measuring Men's Gender Norms and Gender Role Conflict/Stress in a High HIV-Prevalence South African Setting.

    Science.gov (United States)

    Gottert, Ann; Barrington, Clare; Pettifor, Audrey; McNaughton-Reyes, Heath Luz; Maman, Suzanne; MacPhail, Catherine; Kahn, Kathleen; Selin, Amanda; Twine, Rhian; Lippman, Sheri A

    2016-08-01

    Gender norms and gender role conflict/stress may influence HIV risk behaviors among men; however scales measuring these constructs need further development and evaluation in African settings. We conducted exploratory and confirmatory factor analyses to evaluate the Gender Equitable Men's Scale (GEMS) and the Gender Role Conflict/Stress (GRC/S) scale among 581 men in rural northeast South Africa. The final 17-item GEMS was unidimensional, with adequate model fit and reliability (alpha = 0.79). Factor loadings were low (0.2-0.3) for items related to violence and sexual relationships. The final 24-item GRC/S scale was multidimensional with four factors: Success, power, competition; Subordination to women; Restrictive emotionality; and Sexual prowess. The scale had adequate model fit and good reliability (alpha = 0.83). While GEMS is a good measure of inequitable gender norms, new or revised scale items may need to be explored in the South African context. Adding the GRC/S scale to capture men's strain related to gender roles could provide important insights into men's risk behaviors.

  20. Visitor preferences for visual changes in bark beetle-impacted forest recreation settings in the United States and Germany

    Science.gov (United States)

    Arne Arnberger; Martin Ebenberger; Ingrid E. Schneider; Stuart Cottrell; Alexander C. Schlueter; Eick von Ruschkowski; Robert C. Venette; Stephanie A. Snyder; Paul H. Gobster

    2018-01-01

    Extensive outbreaks of tree-killing insects are increasing across forests in Europe and North America due to climate change and other factors. Yet, little recent research examines visitor response to visual changes in conifer forest recreation settings resulting from forest insect infestations, how visitors weigh trade-offs between physical and social forest...

  1. The role of procalcitonin in neonatal intensive care unit patients with candidemia.

    Science.gov (United States)

    Montagna, Maria Teresa; Coretti, Caterina; Rella, Antonella; Barbuti, Giovanna; Manca, Fabio; Montagna, Osvaldo; Laforgia, Nicola; Caggiano, Giuseppina

    2013-01-01

    Candidemia is a major infectious complication in neonatal patients. The isolation of yeasts from blood is still the "gold standard" for its diagnosis, but other laboratory markers (i.e., circulating antigens) have been studied with varying specificities and sensitivities. The aim of this study was to evaluate the role of procalcitonin for the diagnosis of candidemia in neonatal patients at high risk. To verify if the use of different commercial methods can highlight dissimilar results of sensitivity and/or specificity, the determination of procalcitonin serum levels was estimated by two systems. Overall, 90 patients from a Neonatal Intensive Care Units were enrolled, of whom six developed Candida bloodstream infection. Four of six infants with candidemia had slight increase of procalcitonin values (0.5-1 ng/mL). Only one baby showed very high levels but he had fungal and bacterial sepsis at the same time, while no elevation was observed in the sixth patient. No statistically significant difference was observed between two different methods at the time of monitoring (p>0.643). Both methods showed a sensitivity of 83.3 % at diagnosis, while the specificity was 73.8 and 63.1 % by methods A and B, respectively. In the light of the low sensibility and specificity of this assay, we can assume that the determination of procalcitonin would not seem to play a significant role in the diagnosis of fungal infection in neonatal patients.

  2. The role of the neuro-astro-vascular unit in the etiology of Ataxia Telangiectasia

    Directory of Open Access Journals (Sweden)

    Leenoy eMeshulam

    2012-09-01

    Full Text Available The growing recognition that brain pathologies do not affect neurons only but rather are, to a large extent, pathologies of glial cells as well as of the vasculature opens to new perspectives in our understanding of genetic disorders of the CNS. To validate the role of the neuron-glial-vascular unit in the etiology of genome instability disorders, we report about cell death and morphological aspects of neuro-glia networks and the associated vasculature in a mouse model of Ataxia Telangiectasia (A-T, a human genetic disorder that induces severe motor impairment. We found that AT-mutated protein deficiency was consistent with aberrant astrocytic morphology and alterations of the vasculature, often accompanied by reactive gliosis. Interestingly similar findings could also be reported in the case of other genetic disorders. These observations bolster the notion that astrocyte-specific pathologies, hampered vascularization and astrocyte-endothelium interactions in the CNS could play a crucial role in the etiology of genome instability brain disorders and could underlie neurodegeneration.

  3. The strategy role of transitional care units to support Integrated Care and Personalised pathways for frail persons

    OpenAIRE

    Morando, Verdiana; Tozzi, Valeria D.

    2017-01-01

    The paper presents a comparative analysis of three models of transitional care units that have been set up in Italy in the last three years within the processes of Regional Healthcare Services and healthcare organisations’ reforms. The comparative analysis is worth of providing interesting insights and generalizable lessons learnt from integrated care in practice. The three cases of transitional care units belong to a similar background wherein greater needs for care coordination across the s...

  4. Setting Up an ePathology Service at Cleveland Clinic Abu Dhabi: Joint Collaboration With Cleveland Clinic, United States.

    Science.gov (United States)

    Nahal, Ayoub; Batac, Crystal Mildred O; Slaw, Renee J; Bauer, Thomas W

    2018-04-24

    - The production of whole slide images is the most advanced form of digital pathology, in which a high-resolution digital scanner is used to rapidly scan glass microscope slides and produce a computer-generated whole slide image that can be saved, stored in a network-attached storage device, and accessed through slide management software within the hospital domain and remotely by authorized users. Digital transformation of glass slides has revolutionized the practice of anatomic pathology by facilitating and expediting consultative services, improving clinical workflow, and becoming an indispensable tool in education and research. - To highlight the institutional need of Cleveland Clinic Abu Dhabi (Abu Dhabi, United Arab Emirates) and the cultural background for obtaining the United Arab Emirates' first comprehensive digital pathology program; to describe a multiphase road map for achieving full implementation of this platform; and to describe the system's clinical applications and its future potential growth. - At Cleveland Clinic Abu Dhabi, we prioritized our efforts to initiate digital consultations (eConsultations) and digital immunohistochemistry services (eIHC) with Cleveland Clinic Laboratories (Cleveland, Ohio). After this, we established an internal archiving system together with a subspecialty-based, organ-specific digital library of pathologic diseases. - We describe the strategic adoption and implementation of digital pathology into the clinical workflow of the pathology and laboratory medicine institute of Cleveland Clinic Abu Dhabi, and we highlight its impact on clinical operations, educational activities, and patient care.

  5. Assisting role redesign: a qualitative evaluation of the implementation of a podiatry assistant role to a community health setting utilising a traineeship approach

    Directory of Open Access Journals (Sweden)

    Moran Anna M

    2012-11-01

    Full Text Available Abstract Background Increasing demands for podiatry combined with workforce shortages due to attrition, part-time working practices and rural healthcare shortages means that in some geographic areas in Australia there are insufficient professionals to meet service demand. Although podiatry assistants have been introduced to help relieve workforce shortages there has been little evaluation of their impact on patient, staff and/or service outcomes. This research explores the processes and outcomes of a ‘trainee’ approach to introducing a podiatry assistant (PA role to a community setting in the Australian Capital Territory (ACT Government Health Service Directorate. Method A qualitative methodology was employed involving interviews and focus groups with service managers, qualified practitioners, the assistant, service users and consumer representatives. Perspectives of the implementation process; the traineeship approach; the underlying mechanisms that help or hinder the implementation process; and the perceived impact of the role were explored. Data were analysed using the Richie and Spencer Framework approach. Results Although the impact of the PA role had not been measured at the time of the evaluation, the implementation of the PA traineeship was considered a success in terms of enabling the transfer of a basic foot-care service from nursing back to podiatry; releasing Enrolled Nurses (ENs from foot-care duties; an increase in the number of treatments delivered by the podiatry service; and high levels of stakeholder satisfaction with the role. It was perceived that the transfer of the basic foot-care role from nursing to podiatry through the use of a PA impacted on communication and feedback loops between the PA and the podiatry service; the nursing-podiatry relationship; clinical governance around the foot-care service; and continuity of care for clients through the podiatry service. The traineeship was considered successful in terms of

  6. Assisting role redesign: a qualitative evaluation of the implementation of a podiatry assistant role to a community health setting utilising a traineeship approach.

    Science.gov (United States)

    Moran, Anna M; Nancarrow, Susan A; Wiseman, Leah; Maher, Kerryn; Boyce, Rosalie A; Borthwick, Alan M; Murphy, Karen

    2012-11-27

    Increasing demands for podiatry combined with workforce shortages due to attrition, part-time working practices and rural healthcare shortages means that in some geographic areas in Australia there are insufficient professionals to meet service demand. Although podiatry assistants have been introduced to help relieve workforce shortages there has been little evaluation of their impact on patient, staff and/or service outcomes. This research explores the processes and outcomes of a 'trainee' approach to introducing a podiatry assistant (PA) role to a community setting in the Australian Capital Territory (ACT) Government Health Service Directorate. A qualitative methodology was employed involving interviews and focus groups with service managers, qualified practitioners, the assistant, service users and consumer representatives. Perspectives of the implementation process; the traineeship approach; the underlying mechanisms that help or hinder the implementation process; and the perceived impact of the role were explored. Data were analysed using the Richie and Spencer Framework approach. Although the impact of the PA role had not been measured at the time of the evaluation, the implementation of the PA traineeship was considered a success in terms of enabling the transfer of a basic foot-care service from nursing back to podiatry; releasing Enrolled Nurses (ENs) from foot-care duties; an increase in the number of treatments delivered by the podiatry service; and high levels of stakeholder satisfaction with the role. It was perceived that the transfer of the basic foot-care role from nursing to podiatry through the use of a PA impacted on communication and feedback loops between the PA and the podiatry service; the nursing-podiatry relationship; clinical governance around the foot-care service; and continuity of care for clients through the podiatry service. The traineeship was considered successful in terms of producing a PA whose skills were shaped by and directly

  7. Testing a "content meets process" model of depression vulnerability and rumination: Exploring the moderating role of set-shifting deficits.

    Science.gov (United States)

    Vergara-Lopez, Chrystal; Lopez-Vergara, Hector I; Roberts, John E

    2016-03-01

    MacCoon and Newman's (2006) "content meets process" model posits that deficits in cognitive control make it difficult to disengage from negative cognitions caused by a negative cognitive style (NCS). The present study examined if the interactive effect of cognitive set-shifting abilities and NCS predicts rumination and past history of depression. Participants were 90 previously depressed individuals and 95 never depressed individuals. We administered three laboratory tasks that assess set-shifting: the Wisconsin Card-Sorting Task, the Emotional Card-Sorting Task, and the Internal Switch Task, and self-report measures of NCS and rumination. Shifting ability in the context of emotional distractors moderated the association between NCS and depressive rumination. Although previously depressed individuals had more NCS and higher trait rumination relative to never depressed individuals, shifting ability did not moderate the association between NCS and depression history. The cross-sectional correlational design cannot address the causal direction of effects. It is also not clear whether findings will generalize beyond college students. NCS was elevated in previously depressed individuals consistent with its theoretical role as trait vulnerability to the disorder. Furthermore, NCS may be particularly likely to trigger rumination among individuals with poor capacity for cognitive control in the context of emotional distraction. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Collaborative Memory and Part-Set Cuing Impairments: The Role of Executive Depletion in Modulating Retrieval Disruption

    Science.gov (United States)

    Barber, Sarah J.; Rajaram, Suparna

    2011-01-01

    When people are exposed to a subset of previously studied list items they recall fewer of the remaining items compared to a condition where none of the studied items are provided during recall. This occurs both when the subset of items is provided by the experimenter (i.e., the part-set cuing deficit in individual recall) and when they are provided during the course of a collaborative discussion (i.e., the collaborative inhibition effect in group recall). Previous research has identified retrieval disruption as a common mechanism underlying both effects; however, less is known about the factors that may make individuals susceptible to such retrieval disruption. In the current studies we tested one candidate factor, namely, executive control. Using an executive depletion paradigm we directly manipulated an individual’s level of executive control during retrieval. Results revealed no direct role of executive depletion in modulating retrieval disruption. In contrast, executive control abilities were indirectly related to retrieval disruption through their influence at encoding. Together, these results suggest that executive control does not directly affect retrieval disruption at the retrieval stage, and that the role of this putative mechanism may be limited to the encoding stage. PMID:21678155

  9. Physical health monitoring in mental health settings: a study exploring mental health nurses' views of their role.

    Science.gov (United States)

    Mwebe, Herbert

    2017-10-01

    To explore nurses' views of their role in the screening and monitoring of the physical care needs of people with serious mental illness in a mental health service provider. There is increasing awareness through research that people with serious mental illness disproportionately experience and die early from physical health conditions. Mental health nurses are best placed as front-line workers to offer screening, monitoring and interventions; however, their views on physical care interventions are not studied often. Qualitative exploratory study. The study was carried out in a mental health inpatient centre in England. Volunteer sampling was adopted for the study with a total target sample of (n = 20) nurses from three inpatient wards. Semistructured interviews were conducted with (n = 10) registered mental health nurses who had consented to take part in the study. Inductive data analysis and theme development were guided by a thematic analytic framework. Participants shared a clear commitment regarding their role regarding physical health screening and monitoring in mental health settings. Four themes emerged as follows: features of current practice and physical health monitoring; perceived barriers to physical health monitoring; education and training needs; and strategies to improve physical health monitoring. Nurses were unequivocal in their resolve to ensure good standard physical health monitoring and screening interventions in practice. However, identified obstacles have to be addressed to ensure that physical health screening and monitoring is integrated adequately in everyday clinical activities. Achieving this would require improvements in nurses' training, and an integrated multiservice and team-working approach. Attending to the physical health needs of people with serious mental illness has been associated with multiple improvements in both mental and physical health; nurses have a vital role to play in identifying and addressing causes of poor

  10. Observations of the role of science in the United States medical cannabis state policies: Lessons learnt.

    Science.gov (United States)

    Grbic, Jelica; Goddard, Perilou; Ryder, David

    2017-04-01

    Clinical trials have shown cannabis to be effective in the treatment of some medical conditions and there is mounting public and political pressure to enact laws enabling the use of cannabis for medicinal purposes. To date, 28 United States (U.S.) states and the District of Columbia have enacted medical cannabis laws. This study sought to identify the main issues pertaining to the development of medical cannabis laws in the U.S, including the role of scientific evidence. Data were collected from three groups of participants: government officials, lobbyists and medical professionals involved in the medical cannabis debate in five selected states in the U.S.; researchers from the same five states conducting funded research in the alcohol and other drugs field; and members of the International Society for the Study of Drug Policy. The data were analysed using thematic analysis. Six major themes emerged in relation to the factors influencing policy: scientific evidence plays a limited role in the development of policy; the available research is limited and mixed; there is a need for clearer communication and active dissemination of evidence to policy makers; researchers need to consider what research is likely to impact on policy; scientific evidence is not a major factor in policy development; and there is a need to consider evidence within a political context. Researchers need to be aware of the political context in which medical cannabis laws are or are not enacted and consider ways in which research findings can achieve a higher profile within this context. Copyright © 2016. Published by Elsevier B.V.

  11. Alleviating gender role strain in adult men with traumatic brain injury: an evaluation of a set of guidelines for occupational therapy.

    Science.gov (United States)

    Gutman, S A

    1999-01-01

    A set of guidelines to assist men with traumatic brain injury (TBI) to alleviate gender role strain was assessed to determine its effectiveness and acceptability to participants. Four adult male participants with TBI received the intervention (the set of guidelines) for 4 months. The intervention consisted of rebuilding self-identified gendered social roles and activities. Focused interviews and participant observation were used to determine whether gender role strain changed after intervention. The participants reported that the intervention enabled them to (a) enhance their gender role satisfaction through newly rebuilt roles and activities, (b) attain certain long-held personal goals, (c) feel more like members of society, (d) perceive a greater congruency between their internal self-images and external postinjury roles, (e) learn more about personal skills and values as men, (f) feel more comfortable using help-seeking behaviors, (g) feel a sense of shared experience and affinity, (h) feel more understood and accepted, and (i) contribute to others through community member roles. The set of guidelines for alleviating gender role strain was effective in assisting these participants to enhance their gender role satisfaction through rebuilding desired male-gendered social roles and activities. Dating, courtship, extended family member, community member, friend, and mentor-protege roles, lost as a result of TBI, were rebuilt through gender-neutral activities that facilitated a sense of volitional control, competency, and normalcy. Nonetheless, the men continued to lack desired rites of passage leading from male adolescence to adulthood.

  12. Changes in Default Alarm Settings and Standard In-Service are Insufficient to Improve Alarm Fatigue in an Intensive Care Unit: A Pilot Project.

    Science.gov (United States)

    Sowan, Azizeh Khaled; Gomez, Tiffany Michelle; Tarriela, Albert Fajardo; Reed, Charles Calhoun; Paper, Bruce Michael

    2016-01-11

    Clinical alarm systems safety is a national concern, specifically in intensive care units (ICUs) where alarm rates are known to be the highest. Interventional projects that examined the effect of changing default alarm settings on overall alarm rate and on clinicians' attitudes and practices toward clinical alarms and alarm fatigue are scarce. To examine if (1) a change in default alarm settings of the cardiac monitors and (2) in-service nursing education on cardiac monitor use in an ICU would result in reducing alarm rate and in improving nurses' attitudes and practices toward clinical alarms. This quality improvement project took place in a 20-bed transplant/cardiac ICU with a total of 39 nurses. We implemented a unit-wide change of default alarm settings involving 17 parameters of the cardiac monitors. All nurses received an in-service education on monitor use. Alarm data were collected from the audit log of the cardiac monitors 10 weeks before and 10 weeks after the change in monitors' parameters. Nurses' attitudes and practices toward clinical alarms were measured using the Healthcare Technology Foundation National Clinical Alarms Survey, pre- and postintervention. Alarm rate was 87.86 alarms/patient day (a total of 64,500 alarms) at the preintervention period compared to 59.18 alarms/patient day (49,319 alarms) postintervention (P=.01). At baseline, Arterial Blood Pressure (ABP), Pair Premature Ventricular Contractions (PVCs), and Peripheral Capillary Oxygen Saturation (SpO2) alarms were the highest. ABP and SpO2 alarms remained among the top three at the postproject period. Out of the 39 ICU nurses, 24 (62%) provided complete pre- and postproject survey questionnaires. Compared to the preintervention survey, no remarkable changes in the postproject period were reported in nurses' attitudes. Themes in the narrative data were related to poor usability of cardiac monitors and the frequent alarms. The data showed great variation among nurses in terms of changing

  13. The perceptual trap: Experimental and modelling examples of soil moisture, hydraulic conductivity and response units in complex subsurface settings.

    Science.gov (United States)

    Jackisch, Conrad; Demand, Dominic; Allroggen, Niklas; Loritz, Ralf; Zehe, Erwin

    2017-04-01

    analyse the apparent vertical soil water velocity for different soils and different measurement techniques. The results give rise to questions about the universality of the Darcy-scale assumptions and a scale-invariant assessment of hydraulic conductivity. Example surface characteristics and subsurface processes: Hydrological models require the identification of some sort of response units based on available data. For this purpose many approaches relating surface properties to hydrological function have been developed. To test the coherence of surface characteristics and subsurface processes we contrasted in situ measurements, pedo-physical analyses of soil samples, an examination of the flow regimes and an investigation of GIS and remote sensing data. Our results show that landscape features and process characteristics do not necessarily align. Landscape classes and pedo-physical property means are not sufficient to define hydrologically functional units.

  14. Effect of Intrafix® SafeSet infusion apparatus on phlebitis in a neurological intensive care unit: a case-control study.

    Science.gov (United States)

    Liu, F; Chen, D; Liao, Y; Diao, L; Liu, Y; Wu, M; Xue, X; You, C; Kang, Y

    2012-01-01

    To investigate the effect of the Intrafix(®) SafeSet infusion apparatus on the incidence of phlebitis in patients being intravenously infused in a neurological intensive care unit (ICU). Patients aged > 12 years, with no history of diabetes mellitus and no existing phlebitis, requiring a daily peripheral intravenous infusion of ≥ 8 h with the total period lasting ≥ 3 days, were enrolled. Infusions were performed using the Intrafix(®) SafeSet or normal infusion apparatus. Incidence of phlebitis (scored according to the Infusion Nursing Standards of Practice of the American Infusion Nurses Society) was analysed. Patients (n = 1545) were allocated to Intrafix(®) SafeSet (n = 709) or normal infusion (n = 836) groups, matched for age, gender and preliminary diagnosis. Incidence of phlebitis was significantly higher using normal infusion apparatus compared with the Intrafix(®) SafeSet (23.4% versus 17.9%, respectively). Intrafix(®) SafeSet infusion apparatus significantly reduced the incidence of phlebitis in patients in the neurological ICU, compared with normal infusion apparatus, and may be suitable for use in routine clinical practice.

  15. Spiritual and religious components of patient care in the neonatal intensive care unit: sacred themes in a secular setting.

    Science.gov (United States)

    Catlin, E A; Guillemin, J H; Thiel, M M; Hammond, S; Wang, M L; O'Donnell, J

    2001-01-01

    We hypothesized that spiritual distress was a common, unrecognized theme for neonatal intensive care unit (NICU) care providers. An anonymous questionnaire form assigned to a data table in a relational database was designed. Surveys were completed by 66% of NICU staff. All respondents viewed a family's spiritual and religious concerns as having a place in patient care. Eighty-three percent reported praying for babies privately. Asked what theological sense they made of suffering of NICU babies, 2% replied that children do not suffer in the NICU. Regarding psychological suffering of families, the majority felt God could prevent this, with parents differing (p = 0.039) from nonparents. There exists a strong undercurrent of spirituality and religiosity in the study NICU. These data document actual religious and spiritual attitudes and practices and support a need for pastoral resources for both families and care providers. NICU care providers approach difficulties of their work potentially within a religious and spiritual rather than a uniquely secular framework.

  16. Management of persistent occiput posterior position: a substantial role of instrumental rotation in the setting of failed manual rotation.

    Science.gov (United States)

    Guerby, Paul; Allouche, Mickael; Simon-Toulza, Caroline; Vayssiere, Christophe; Parant, Olivier; Vidal, Fabien

    2018-01-01

    To compare the maternal and neonatal outcomes associated with Instrumental Rotation (IR) to operative vaginal delivery in occiput posterior (OP) position with Thierry's spatulas (TS), in the setting of failed manual rotation (MR). We led a prospective observational cohort study in a tertiary referral hospital in Toulouse, France. All women presenting in labor with persistent OP position at full cervical dilatation and who delivered vaginally after failed MR and with IR or OP assisted delivery were included from January 2014 to December 2015. The main outcomes measured were maternal morbidity parameters including episiotomy rate, incidence and severity of perineal lacerations, perineal hematomas and postpartum hemorrhage. Severe perineal tears corresponded to third and fourth degree lacerations. Fetal morbidity outcomes comprised neonatal Apgar scores, acidemia, fetal injuries, birth trauma and neonatal intensive care unit admissions. Among 9762 women, 910 (9.3%) presented with persistent OP position at full cervical dilatation and 222 deliveries were enrolled. Of 111 attempted IR, 97 were successful (87.4%). The incidence of anal sphincter injuries was significantly reduced after IR attempt (1.8% vs. 12.6%; p manual rotation.

  17. The role of therapeutic optimism in recruitment to a clinical trial in a peripartum setting: balancing hope and uncertainty.

    Science.gov (United States)

    Hallowell, Nina; Snowdon, Claire; Morrow, Susan; Norman, Jane E; Denison, Fiona C; Lawton, Julia

    2016-06-01

    Hope has therapeutic value because it enables people to cope with uncertainty about their future health. Indeed, hope, or therapeutic optimism (TO), is seen as an essential aspect of the provision and experience of medical care. The role of TO in clinical research has been briefly discussed, but the concept, and whether it can be transferred from care to research and from patients to clinicians, has not been fully investigated. The role played by TO in research emerged during interviews with staff involved in a peripartum trial. This paper unpacks the concept of TO in this setting and considers the role it may play in the wider delivery of clinical trials. The Got-it trial is a UK-based, randomised placebo-controlled trial that investigates the use of sublingual glyceryl trinitrate (GTN) spray to treat retained placenta. Qualitative data were collected in open-ended interviews with obstetricians, research and clinical midwives (n =27) involved in trial recruitment. Data were analysed using the method of constant comparison. TO influenced staff engagement with Got-it at different points in the trial and in different ways. Prior knowledge of, and familiarity with, GTN meant that from the outset staff perceived the trial as low risk. TO facilitated staff involvement in the trial; staff who already understood GTN's effects were optimistic that it would work, and staff collaborated because they hoped that the trial would address what they identified as an important clinical need. TO could fluctuate over the course of the trial, and was sustained or undermined by unofficial observation of clinical outcomes and speculations about treatment allocation. Thus, TO appeared to be influenced by key situational factors: prior knowledge and experience, clinical need and observed participant outcomes. Situational TO plays a role in facilitating staff engagement with clinical research. TO may affect trial recruitment by enabling staff to sustain the levels of uncertainty, or

  18. Intervention Techniques Used With Autism Spectrum Disorder by Speech-Language Pathologists in the United States and Taiwan: A Descriptive Analysis of Practice in Clinical Settings.

    Science.gov (United States)

    Hsieh, Ming-Yeh; Lynch, Georgina; Madison, Charles

    2018-04-27

    This study examined intervention techniques used with children with autism spectrum disorder (ASD) by speech-language pathologists (SLPs) in the United States and Taiwan working in clinic/hospital settings. The research questions addressed intervention techniques used with children with ASD, intervention techniques used with different age groups (under and above 8 years old), and training received before using the intervention techniques. The survey was distributed through the American Speech-Language-Hearing Association to selected SLPs across the United States. In Taiwan, the survey (Chinese version) was distributed through the Taiwan Speech-Language Pathologist Union, 2018, to certified SLPs. Results revealed that SLPs in the United States and Taiwan used 4 common intervention techniques: Social Skill Training, Augmentative and Alternative Communication, Picture Exchange Communication System, and Social Stories. Taiwanese SLPs reported SLP preparation program training across these common intervention strategies. In the United States, SLPs reported training via SLP preparation programs, peer therapists, and self-taught. Most SLPs reported using established or emerging evidence-based practices as defined by the National Professional Development Center (2014) and the National Standards Report (2015). Future research should address comparison of SLP preparation programs to examine the impact of preprofessional training on use of evidence-based practices to treat ASD.

  19. An Investigation of the Role of Grapheme Units in Word Recognition

    Science.gov (United States)

    Lupker, Stephen J.; Acha, Joana; Davis, Colin J.; Perea, Manuel

    2012-01-01

    In most current models of word recognition, the word recognition process is assumed to be driven by the activation of letter units (i.e., that letters are the perceptual units in reading). An alternative possibility is that the word recognition process is driven by the activation of grapheme units, that is, that graphemes, rather than letters, are…

  20. Blood Pressure Guideline Adherence in Patients with Ischemic and Hemorrhagic Stroke in the Neurointensive Care Unit Setting.

    Science.gov (United States)

    Porto, Guilherme B F; Spiotta, Alejandro M; Chalela, Julio A; Kellogg, Ryan T; Jauch, Edward C

    2015-12-01

    Patients with acute brain injuries require strict physiologic control to minimize morbidity and mortality. This study aimed to assess in-hospital compliance to strict physiologic parameters (BP, HR, ICP, SpO2) in these populations. Patients with severe cerebrovascular events were admitted to the neurointensive care unit (NSICU) and were continuously monitored using the BedMasterEX (Excel Medical Electronics Inc, FL) system, which recorded hemodynamic data via an arterial catheter continuously in 5-s intervals. Furthermore, we investigated the impact of healthcare provider shift changes (6-8 a.m./p.m) and of day (6 a.m.-6 p.m.) versus night (6 p.m-6 a.m) shifts in hemodynamic control. Fifty patients admitted to the NSICU, 50 % male, mean age 59.7 ± 13.9 years with subarachnoid hemorrhage (23), ischemic stroke (8), subdural hematoma (4), intracerebral hemorrhage (3), intraventricular hemorrhage (2), and miscellaneous injuries (10) were enrolled. Data represented 2,337 total hours of continuous monitoring. Systolic BPs (SBP) were on average outside of recommended ranges 32.26 ± 30.46 % of the monitoring period. We subdivided adherence to ideal SBP range: optimal (≥99 % of time spent in NSICU within range) was achieved in 12 %, adequate (90 %) in 16 %, suboptimal (80 %) in 20 %, inadequate I (70 %) in 12 %, and inadequate II (<70 %) in 40 % of patients. Comparison of shift change %time and day versus night %time out of parameter yielded no statistically significant differences across SAH patients. Hemodynamic management of patients with cerebrovascular injuries, based on targeted thresholds in the NSICU, yielded optimal control of SBP in only 28 % of our patients (within parameters ≥90 % of time).

  1. Challenges in setting up a potable water supply system in a United Nations peacekeeping mission: the South Sudan experience.

    Science.gov (United States)

    Hazra, Aniruddha

    2013-01-01

    A United Nations peacekeeping contingent was deployed in the conflict affected areas of South Sudan with inadequate environmental sanitation, lack of clean drinking water and a heightened risk of water-borne diseases. In the immediate post-deployment phase, the contingent-owned water purification system was pressed into service. However, laboratory analyses of processed water revealed its unsuitability for human consumption. A systematic, sanitary survey was conducted to identify the shortcomings in the water supply system's ability to provide potable water. Under field conditions, the 'H2S method' was used to detect faecal contamination of drinking water. The raw water from the only available source, the White Nile River, was highly turbid and contaminated by intestinal and other pathogens due to an unprotected watershed. Water sterilizing powder was not readily available in the local area to replenish the existing stocks that had deteriorated during the long transit period from the troop contributing country. The water pipelines that had been laid along the ground, under water-logged conditions, were prone to microbial recontamination due to leakages in the network. The critical evaluation of the water supply system and necessary modifications in the purification process, based upon locally available options, yielded safe drinking water. Provision of safe drinking water in the mission area requires an in-depth analysis of prevailing conditions and appropriate planning in the pre-deployment phase. The chemicals for water purification should be procured through UN sources via a 'letter of assist' request from the troop contributor. Copyright © 2012 Elsevier GmbH. All rights reserved.

  2. Visitor Preferences for Visual Changes in Bark Beetle-Impacted Forest Recreation Settings in the United States and Germany

    Science.gov (United States)

    Arnberger, Arne; Ebenberger, Martin; Schneider, Ingrid E.; Cottrell, Stuart; Schlueter, Alexander C.; von Ruschkowski, Eick; Venette, Robert C.; Snyder, Stephanie A.; Gobster, Paul H.

    2018-02-01

    Extensive outbreaks of tree-killing insects are increasing across forests in Europe and North America due to climate change and other factors. Yet, little recent research examines visitor response to visual changes in conifer forest recreation settings resulting from forest insect infestations, how visitors weigh trade-offs between physical and social forest environment factors, or how visitor preferences might differ by nationality. This study explored forest visitor preferences with a discrete choice experiment that photographically simulated conifer forest stands with varying levels of bark beetle outbreaks, forest and visitor management practices, and visitor use levels and compositions. On-site surveys were conducted with visitors to State Forest State Park in Colorado ( n = 200), Lake Bemidji State Park in Minnesota ( n = 228), and Harz National Park in Germany ( n = 208). Results revealed that the condition of the immediate forest surrounding was the most important variable influencing visitors' landscape preferences. Visitors preferred healthy mature forest stands and disliked forests with substantial dead wood. The number of visitors was the most important social factor influencing visitor landscape preferences. Differences in the influence of physical and social factors on visual preferences existed between study sites. Findings suggest that both visual forest conditions and visitor use management are important concerns in addressing landscape preferences for beetle-impacted forest recreation areas.

  3. Role of parents in the promotion of hand hygiene in the paediatric setting: a systematic literature review.

    Science.gov (United States)

    Bellissimo-Rodrigues, F; Pires, D; Zingg, W; Pittet, D

    2016-06-01

    When a child is hospitalized, parents have to share their role to protect the child with the hospital, and establish a partnership with healthcare workers to deliver safe care to the child, including undertaking good hand hygiene practices. To review the scientific evidence about the participation of parents in the promotion of hand hygiene in paediatric settings. A systematic search of MEDLINE, EMBASE and SciELO databases was undertaken using the following terms: ('hand hygiene'[MeSH] OR 'hand hygiene' OR 'hand disinfection'[MeSH] OR hand disinf* OR hand wash* OR handwash* OR hand antisep*) AND (parent OR caregiver OR mother OR father OR family OR families OR relatives). The Integrated Quality Criteria for Review of Multiple Study Designs tool was used for quality assessment. The literature search yielded 1645 articles, and 11 studies met the inclusion criteria for the final analysis. Most studies were observational, and were based on questionnaires or interviews. Most parents had little knowledge about the indications to perform hand hygiene, but recognized hand hygiene as a relevant tool for the prevention of healthcare-associated infections. Their willingness to remind healthcare workers about a failed opportunity to perform hand hygiene was variable and, overall, rather low. Parents felt more comfortable about reminding healthcare workers about hand hygiene if they had previously been invited to do so. Literature on the subject is scarce. The promotion of hand hygiene by parents should be further explored by research as a potential intervention for enhancing patient safety in paediatric settings. Copyright © 2016. Published by Elsevier Ltd.

  4. Role of intraocular Leptospira infections in the pathogenesis of Equine Recurrent Uveitis in the Southern United States

    Science.gov (United States)

    To investigate the role of intraocular leptospiral infections in horses with Equine Recurrent Uveitis (ERU) in the southern United States, blood and ocular fluid samples were collected from horses with a history and ocular findings consistent with ERU. Samples were also obtained from control horses ...

  5. The Role of Music in Speech Intelligibility of Learners with Post Lingual Hearing Impairment in Selected Units in Lusaka District

    Science.gov (United States)

    Katongo, Emily Mwamba; Ndhlovu, Daniel

    2015-01-01

    This study sought to establish the role of music in speech intelligibility of learners with Post Lingual Hearing Impairment (PLHI) and strategies teachers used to enhance speech intelligibility in learners with PLHI in selected special units for the deaf in Lusaka district. The study used a descriptive research design. Qualitative and quantitative…

  6. Future shift of the relative roles of precipitation and temperature in controlling annual runoff in the conterminous United States

    Science.gov (United States)

    Kai Duan; Ge Sun; Steven G. McNulty; Peter V. Caldwell; Erika C. Cohen; Shanlei Sun; Heather D. Aldridge; Decheng Zhou; Liangxia Zhang; Yang Zhang

    2017-01-01

    This study examines the relative roles of cli- matic variables in altering annual runoff in the contermi- nous United States (CONUS) in the 21st century, using a monthly ecohydrological model (the Water Supply Stress In- dex model, WaSSI) driven with historical records and future scenarios constructed from 20 Coupled Model Intercompar- ison Project Phase 5 (CMIP5)...

  7. University research reactors in the United States: Their role and value

    International Nuclear Information System (INIS)

    1988-01-01

    This report is primarily addressed to the people who make decisions affecting the levels of future university reactor programs URR: university administrators, department heads, federal policy makers, state and local policy makers, those in industry and government who depend upon a supply of nuclear-trained personnel, and those who are concerned with the future of the many sciences that benefit from the unique capabilities of nuclear-based techniques as well as from the nuclear sciences themselves. The major thrust of this report is to illustrate the scientific and social benefits and contributions associated with well-managed and well-funded university reactor programs. The intent is to help a decision maker gain a perspective and appreciation of the scientific, academic, social, and technical values of URR programs. The report also examines the role of university-like reactors in Europe, where a productive community of researchers is apparently served in an exemplary manner. The committee, assesses the security and safeguard needs at small reactors in a university setting in order to help gain a perspective on the potential hazards and relative risks involved. The last chapter discusses the kind of commitment and support needed if a significant population of URRs is to remain productive. 83 refs., 11 figs., 2 tabs

  8. The role of health information technology in care coordination in the United States.

    Science.gov (United States)

    Hsiao, Chun-Ju; King, Jennifer; Hing, Esther; Simon, Alan E

    2015-02-01

    Examine the extent to which office-based physicians in the United States receive patient health information necessary to coordinate care across settings and determine whether receipt of information needed to coordinate care is associated with use of health information technology (HIT) (defined by presence or absence of electronic health record system and electronic sharing of information). Cross-sectional study using the 2012 National Electronic Health Records Survey (65% weighted response rate). Office-based physicians. Use of HIT and 3 types of patient health information needed to coordinate care. In 2012, 64% of physicians routinely received the results of a patient's consultation with a provider outside of their practice, whereas 46% routinely received a patient's history and reason for a referred consultation from a provider outside of their practice. About 54% of physicians reported routinely receiving a patient's hospital discharge information. In adjusted analysis, significant differences in receiving necessary information were observed by use of HIT. Compared with those not using HIT, a lower percentage of physicians who used an electronic health record system and shared patient health information electronically failed to receive the results of outside consultations or patient's history and reason for a referred consultation. No significant differences were observed for the receipt of hospital discharge information by use of HIT. Among physicians routinely receiving information needed for care coordination, at least 54% of them did not receive the information electronically. Although a higher percentage of physicians using HIT received patient information necessary for care coordination than those who did not use HIT, more than one third did not routinely receive the needed patient information at all.

  9. Unit cost of healthcare services at 200-bed public hospitals in Myanmar: what plays an important role of hospital budgeting?

    Science.gov (United States)

    Than, Thet Mon; Saw, Yu Mon; Khaing, Moe; Win, Ei Mon; Cho, Su Myat; Kariya, Tetsuyoshi; Yamamoto, Eiko; Hamajima, Nobuyuki

    2017-09-19

    Cost information is important for efficient allocation of healthcare expenditure, estimating future budget allocation, and setting user fees to start new financing systems. Myanmar is in political transition, and trying to achieve universal health coverage by 2030. This study assessed the unit cost of healthcare services at two public hospitals in the country from the provider perspective. The study also analyzed the cost structure of the hospitals to allocate and manage the budgets appropriately. A hospital-based cross-sectional study was conducted at 200-bed Magway Teaching Hospital (MTH) and Pyinmanar General Hospital (PMN GH), in Myanmar, for the financial year 2015-2016. The step-down costing method was applied to calculate unit cost per inpatient day and per outpatient visit. The costs were calculated by using Microsoft Excel 2010. The unit costs per inpatient day varied largely from unit to unit in both hospitals. At PMN GH, unit cost per inpatient day was 28,374 Kyats (27.60 USD) for pediatric unit and 1,961,806 Kyats (1908.37 USD) for ear, nose, and throat unit. At MTH, the unit costs per inpatient day were 19,704 Kyats (19.17 USD) for medicine unit and 168,835 Kyats (164.24 USD) for eye unit. The unit cost of outpatient visit was 14,882 Kyats (14.48 USD) at PMN GH, while 23,059 Kyats (22.43 USD) at MTH. Regarding cost structure, medicines and medical supplies was the largest component at MTH, and the equipment was the largest component at PMN GH. The surgery unit of MTH and the eye unit of PMN GH consumed most of the total cost of the hospitals. The unit costs were influenced by the utilization of hospital services by the patients, the efficiency of available resources, type of medical services provided, and medical practice of the physicians. The cost structures variation was also found between MTH and PMN GH. The findings provided the basic information regarding the healthcare cost of public hospitals which can apply the efficient utilization of the

  10. Do critical care units play a role in the management of gynaecological oncology patients? The contribution of gynaecologic oncologist in running critical care units.

    Science.gov (United States)

    Davidovic-Grigoraki, Miona; Thomakos, Nikolaos; Haidopoulos, Dimitrios; Vlahos, Giorgos; Rodolakis, Alexandros

    2017-03-01

    Routine post-operative care in high dependency unit (HDU), surgical intensive care unit (SICU) and intensive care unit (ICU) after high-risk gynaecological oncology surgical procedures may allow for greater recognition and correct management of post-operative complications, thereby reducing long-term morbidity and mortality. On the other hand, unnecessary admissions to these units lead to increased morbidity - nosocomial infections, increased length of hospital stay and higher hospital costs. Gynaecological oncology surgeons continue to look after their patient in the HDU/SICU and have the final role in decision-making on day-to-day basis, making it important to be well versed in critical care management and ensure the best care for their patients. Post-operative monitoring and the presence of comorbid illnesses are the most common reasons for admission to the HDU/SICU. Elderly and malnutritioned patients, as well as, bowel resection, blood loss or greater fluid resuscitation during the surgery have prolonged HDU/SICU stay. Patients with ovarian cancer have a worse survival outcome than the patients with other types of gynaecological cancer. Dependency care is a part of surgical management and it should be incorporated formally into gynaecologic oncology training programme. © 2016 John Wiley & Sons Ltd.

  11. Leveling the field: The role of training, safety programs, and knowledge management systems in fostering inclusive field settings

    Science.gov (United States)

    Starkweather, S.; Crain, R.; Derry, K. R.

    2017-12-01

    Knowledge is empowering in all settings, but plays an elevated role in empowering under-represented groups in field research. Field research, particularly polar field research, has deep roots in masculinized and colonial traditions, which can lead to high barriers for women and minorities (e.g. Carey et al., 2016). While recruitment of underrepresented groups into polar field research has improved through the efforts of organizations like the Association of Polar Early Career Scientists (APECS), the experiences and successes of these participants is often contingent on the availability of specialized training opportunities or the quality of explicitly documented information about how to survive Arctic conditions or how to establish successful measurement protocols in harsh environments. In Arctic field research, knowledge is often not explicitly documented or conveyed, but learned through "experience" or informally through ad hoc advice. The advancement of field training programs and knowledge management systems suggest two means for unleashing more explicit forms of knowledge about field work. Examples will be presented along with a case for how they level the playing field and improve the experience of field work for all participants.

  12. Progress towards modeling tokamak boundary plasma turbulence and understanding its role in setting divertor heat flux widths

    Science.gov (United States)

    Chen, B.; Xu, X. Q.; Xia, T. Y.; Li, N. M.; Porkolab, M.; Edlund, E.; LaBombard, B.; Terry, J.; Hughes, J. W.; Ye, M. Y.; Wan, Y. X.

    2018-05-01

    The heat flux distributions on divertor targets in H-mode plasmas are serious concerns for future devices. We seek to simulate the tokamak boundary plasma turbulence and heat transport in the edge localized mode-suppressed regimes. The improved BOUT++ model shows that not only Ip but also the radial electric field Er plays an important role on the turbulence behavior and sets the heat flux width. Instead of calculating Er from the pressure gradient term (diamagnetic Er), it is calculated from the plasma transport equations with the sheath potential in the scrape-off layer and the plasma density and temperature profiles inside the separatrix from the experiment. The simulation results with the new Er model have better agreement with the experiment than using the diamagnetic Er model: (1) The electromagnetic turbulence in enhanced Dα H-mode shows the characteristics of quasi-coherent modes (QCMs) and broadband turbulence. The mode spectra are in agreement with the phase contrast imaging data and almost has no change in comparison to the cases which use the diamagnetic Er model; (2) the self-consistent boundary Er is needed for the turbulence simulations to get the consistent heat flux width with the experiment; (3) the frequencies of the QCMs are proportional to Er, while the divertor heat flux widths are inversely proportional to Er; and (4) the BOUT++ turbulence simulations yield a similar heat flux width to the experimental Eich scaling law and the prediction from the Goldston heuristic drift model.

  13. Role of Papanicolaou Smear in the Diagnosis of Pathologic Flora in Asymptomatic Patients in Rural Health Care Set-Up

    Directory of Open Access Journals (Sweden)

    Siona Sabu

    2017-10-01

    Full Text Available Introduction: The infections of female genital tract, especially the cervix are asymptomatic in presentation and pose a diagnostic challenge. Vaginal infections can lead to cytoplasmic and nuclear abnormalities in the epithelial cells. Additionally, these infections could augur an inflammatory response of varying nature. The most common flora include Candida albicans, Gardnerella vaginalis, Trichomonas vaginalis, Human Papilloma Virus (HPV, Human Herpes Virus (HHV and Actinomyces sp. Aim: This study seeks to measure the role of Papanicolaou smear in detection of pathologic flora: Candida albicans, Gardnerella vaginalis, Trichomonas vaginalis, HPV, HHV and Actinomyces; in a rural health care set up amongst women in the reproductive and menopausal age group. Materials and Methods: A retrospective study of cervical smears by Papanicolaou method, over a 14 month period was carried out in a tertiary care centre including a total number of 150 patients. Results: Of the total of 150 samples examined, Candida species was the most frequently detected (8.7% followed by Trichomonas vaginalis (5.3% and Gardnerella vaginalis species (4.7%. HPV-induced changes were noted in a mere 2% of cases. Actinomyces species was noted in less than 1% of cases. Conclusion: The Papanicolaou test for examining cervical smear has definite uses in detecting vaginal microorganisms. Apart from detection of the usual pathogenic flora, the test has utility in defining the degree of inflammation and additional reparative changes.

  14. The role of a palliative care inpatient unit in disease management of ...

    African Journals Online (AJOL)

    Objectives. To monitor the success of an inpatient palliative care unit combining private and state patients, and accessible to patients with cancer and AIDS. Design. An observational study was conducted of patients admitted to the unit in the first 3 months following opening of the ward (1 March - 31 May 2006). Methods.

  15. Report on the International Workshop on Drug Prevention and Treatment in Rural Settings Organized by United Nation Office on Drugs and Crime (UNODC) and World Health Organization (WHO).

    Science.gov (United States)

    Milano, Giulia; Saenz, Elizabeth; Clark, Nicolas; Busse, Anja; Gale, John; Campello, Giovanna; Mattfeld, Elizabeth; Maalouf, Wadih; Heikkila, Hanna; Martelli, Antonietta; Morales, Brian; Gerra, Gilberto

    2017-11-10

    Very little evidence has been reported in literature regarding the misuse of substances in rural areas. Despite the common perception of rural communities as a protective and risk-mitigating environment, the scientific literature demonstrated the existence of many risk factors in rural communities. The Drug Prevention and Health Branch (DHB) of the United Nations Office on Drugs and Crime (UNODC), and the World Health Organization (WHO), in June 2016, organized a meeting of experts in treatment and prevention of SUDs in rural settings. The content presented during the meeting and the related discussion have provided materials for the preparation of an outline document, which is the basis to create a technical tool on SUDs prevention and treatment in rural settings. The UNODC framework for interventions in rural settings is a technical tool aimed to assist policy makers and managers at the national level. This paper is a report on UNODC/WHO efforts to improve the clinical conditions of people affected by SUDs and living in rural areas. The purpose of this article is to draw attention on a severe clinical and social problem in a reality forgotten by everyone.

  16. Effect of study design and setting on tuberculosis clustering estimates using Mycobacterial Interspersed Repetitive Units-Variable Number Tandem Repeats (MIRU-VNTR): a systematic review.

    Science.gov (United States)

    Mears, Jessica; Abubakar, Ibrahim; Cohen, Theodore; McHugh, Timothy D; Sonnenberg, Pam

    2015-01-21

    To systematically review the evidence for the impact of study design and setting on the interpretation of tuberculosis (TB) transmission using clustering derived from Mycobacterial Interspersed Repetitive Units-Variable Number Tandem Repeats (MIRU-VNTR) strain typing. MEDLINE, EMBASE, CINHAL, Web of Science and Scopus were searched for articles published before 21st October 2014. Studies in humans that reported the proportion of clustering of TB isolates by MIRU-VNTR were included in the analysis. Univariable meta-regression analyses were conducted to assess the influence of study design and setting on the proportion of clustering. The search identified 27 eligible articles reporting clustering between 0% and 63%. The number of MIRU-VNTR loci typed, requiring consent to type patient isolates (as a proxy for sampling fraction), the TB incidence and the maximum cluster size explained 14%, 14%, 27% and 48% of between-study variation, respectively, and had a significant association with the proportion of clustering. Although MIRU-VNTR typing is being adopted worldwide there is a paucity of data on how study design and setting may influence estimates of clustering. We have highlighted study design variables for consideration in the design and interpretation of future studies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  17. Assessment of physiological performance and perception of pushing different wheelchairs on indoor modular units simulating a surface roughness often encountered in under-resourced settings.

    Science.gov (United States)

    Sasaki, Kotaro; Rispin, Karen

    2017-01-01

    In under-resourced settings where motorized wheelchairs are rarely available, manual wheelchair users with limited upper-body strength and functionalities need to rely on assisting pushers for their mobility. Because traveling surfaces in under-resourced settings are often unpaved and rough, wheelchair pushers could experience high physiological loading. In order to evaluate pushers' physiological loading and to improve wheelchair designs, we built indoor modular units that simulate rough surface conditions, and tested a hypothesis that pushing different wheelchairs would result in different physiological performances and pushers' perception of difficulty on the simulated rough surface. Eighteen healthy subjects pushed two different types of pediatric wheelchairs (Moti-Go manufactured by Motivation, and KidChair by Hope Haven) fitted with a 50-kg dummy on the rough and smooth surfaces at self-selected speeds. Oxygen uptake, traveling distance for 6 minutes, and the rating of difficulty were obtained. The results supported our hypothesis, showing that pushing Moti-Go on the rough surface was physiologically less loading than KidChair, but on the smooth surface, the two wheelchairs did not differ significantly. These results indicate wheelchair designs to improve pushers' performance in under-resourced settings should be evaluated on rough surfaces.

  18. Inpatient Peripherally Inserted Central Venous Catheter Complications: Should Peripherally Inserted Central Catheter Lines Be Placed in the Intensive Care Unit Setting?

    Science.gov (United States)

    Martyak, Michael; Kabir, Ishraq; Britt, Rebecca

    2017-08-01

    Peripherally inserted central venous catheters (PICCs) are now commonly used for central access in the intensive care unit (ICU) setting; however, there is a paucity of data evaluating the complication rates associated with these lines. We performed a retrospective review of all PICCs placed in the inpatient setting at our institution during a 1-year period from January 2013 to December 2013. These were divided into two groups: those placed at the bedside in the ICU and those placed by interventional radiology in non-ICU patients. Data regarding infectious and thrombotic complications were collected and evaluated. During the study period, 1209 PICC line placements met inclusion criteria and were evaluated; 1038 were placed by interventional radiology in non-ICU patients, and 171 were placed at the bedside in ICU patients. The combined thrombotic and central line associated blood stream infection rate was 6.17 per cent in the non-ICU group and 10.53 per cent in the ICU group (P = 0.035). The thrombotic complication rate was 5.88 per cent in the non-ICU group and 7.60 per cent in the ICU group (P = 0.38), whereas the central line associated blood stream infection rate was 0.29 per cent in the non-ICU group and 2.92 per cent in the ICU group (P = 0.002). This study seems to suggest that PICC lines placed at the bedside in the ICU setting are associated with higher complication rates, in particular infectious complications, than those placed by interventional radiology in non-ICU patients. The routine placement of PICC lines in the ICU settings needs to be reevaluated given these findings.

  19. Relevance of Army National Guard Infantry Units in the Force Structure and Their Role in Combat

    National Research Council Canada - National Science Library

    Harris, Brian

    2004-01-01

    ...% of a total force of 346,848 assigned. Such large numbers are staggering considering that National Guard infantry units are not being utilized according to their organization training and equipment...

  20. The Role of the Company Officer at the United States Naval Academy

    National Research Council Canada - National Science Library

    Moxey, Tyrel

    2001-01-01

    ... contributing or not contributing to the mission of the United States Naval Academy. The author conducted 30 questionnaires on the 30 Company Officers stationed at the Naval Academy during this period...

  1. Reconsidering information management roles and capabilities in disaster response decision-making units

    NARCIS (Netherlands)

    Bharosa, N.; Janssen, M.F.W.H.A.

    2009-01-01

    When disaster strikes, the emerging task environment requires relief agencies to transform from autonomous mono-disciplinary organizations into interdependent multidisciplinary decision-making units. Evaluation studies reveal that adaptation of information management to the changing task environment

  2. Accounting for medical communication: Parents’ perceptions of communicative roles and responsibilities in the pediatric intensive care unit

    OpenAIRE

    GORDON, CYNTHIA; BARTON, ELLEN; MEERT, KATHLEEN L.; EGGLY, SUSAN; POLLACK, MURRAY; ZIMMERMAN, JERRY; ANAND, K. J. S.; CARCILLO, JOSEPH; NEWTH, CHRISTOPHER J. L.; DEAN, J. MICHAEL; WILLSON, DOUGLAS F.; NICHOLSON, CAROL

    2009-01-01

    Through discourse analysis of transcribed interviews conducted over the phone with parents whose child died in the Pediatric Intensive Care Unit (PICU) (n = 51), this study uncovers parents’ perceptions of clinicians’ and their own communicative roles and responsibilities in the context of team-based care. We examine parents’ descriptions and narratives of communicative experiences they had with PICU clinicians, focusing on how parents use accounts to evaluate the communicative behaviors they...

  3. Impact of role-, job- and organizational characteristics on Nursing Unit Managers' work related stress and well-being.

    Science.gov (United States)

    Van Bogaert, Peter; Adriaenssens, Jef; Dilles, Tinne; Martens, Daisy; Van Rompaey, Bart; Timmermans, Olaf

    2014-11-01

    To study the impact of role, job- and organizational characteristics on nurse managers' work related stress and well-being such as feelings of emotional exhaustion, work engagement, job satisfaction and turnover intention. Various studies investigated role-, job- and organizational characteristics influencing nurse-related work environments. Research on nurse managers' related work environments define influencing factors, but, a clear understanding of the impact of nurse-managers' work-environment characteristics on their work related stress and well-being is limited. A cross-sectional design with a survey. A cross-sectional survey (N = 365) was carried out between December 2011-March 2012. The questionnaire was based on various validated measurement instruments identified by expert meetings (e.g. staff nurses, nurse managers and executives and physicians). Hierarchical regression analyses were performed using emotional exhaustion, work engagement, job satisfaction and turnover intentions as outcome variables. Study results showed one out of six nursing unit managers have high to very high feelings of emotional exhaustion and two out of three respondents have high to very high work engagement. Hierarchical regression models showed that role conflict and role meaningfulness were strong predictors of nursing unit managers' work related stress and well-being, alongside with job- and organizational characteristics. Several risk factors and stimulating factors influencing nurse unit managers' work related stress and well-being were identified. Further challenges will be to develop proper interventions and strategies to support nursing unit managers and their team in daily practice to deliver the best and safest patient care. © 2014 John Wiley & Sons Ltd.

  4. The role of leader behaviors in hospital-based emergency departments' unit performance and employee work satisfaction.

    Science.gov (United States)

    Lin, Blossom Yen-Ju; Hsu, Chung-Ping C; Juan, Chi-Wen; Lin, Cheng-Chieh; Lin, Hung-Jung; Chen, Jih-Chang

    2011-01-01

    The role of the leader of a medical unit has evolved over time to expand from simply a medical role to a more managerial one. This study aimed to explore how the behavior of a hospital-based emergency department's (ED's) leader might be related to ED unit performance and ED employees' work satisfaction. One hundred and twelve hospital-based EDs in Taiwan were studied: 10 in medical centers, 32 in regional hospitals, and 70 in district hospitals. Three instruments were designed to assess leader behaviors, unit performance and employee satisfaction in these hospital-based EDs. A mail survey revealed that task-oriented leader behavior was positively related to ED unit performance. Both task- and employee-oriented leader behaviors were found to be positively related to ED nurses' work satisfaction. However, leader behaviors were not shown to be related to ED physicians' work satisfaction at a statistically significant level. Some ED organizational characteristics, however, namely departmentalization and hospital accreditation level, were found to be related to ED physicians' work satisfaction. Copyright © 2010 Elsevier Ltd. All rights reserved.

  5. A systematic review evaluating the role of nurses and processes for delivering early mobility interventions in the intensive care unit.

    Science.gov (United States)

    Krupp, Anna; Steege, Linsey; King, Barbara

    2018-04-19

    To investigate processes for delivering early mobility interventions in adult intensive care unit patients used in research and quality improvement studies and the role of nurses in early mobility interventions. A systematic review was conducted. Electronic databases PubMED, CINAHL, PEDro, and Cochrane were searched for studies published from 2000 to June 2017 that implemented an early mobility intervention in adult intensive care units. Included studies involved progression to ambulation as a component of the intervention, included the role of the nurse in preparing for or delivering the intervention, and reported at least one patient or organisational outcome measure. The System Engineering Initiative for Patient Safety (SEIPS) model, a framework for understanding structure, processes, and healthcare outcomes, was used to evaluate studies. 25 studies were included in the final review. Studies consisted of randomised control trials, prospective, retrospective, or mixed designs. A range of processes to support the delivery of early mobility were found. These processes include forming interdisciplinary teams, increasing mobility staff, mobility protocols, interdisciplinary education, champions, communication, and feedback. Variation exists in the process of delivering early mobility in the intensive care unit. In particular, further rigorous studies are needed to better understand the role of nurses in implementing early mobility to maintain a patient's functional status. Copyright © 2018 Elsevier Ltd. All rights reserved.

  6. The role of routine post-natal abdominal ultrasound for newborns in a resource-poor setting: a longitudinal study

    Directory of Open Access Journals (Sweden)

    Omokhodion Samuel I

    2011-07-01

    Full Text Available Abstract Background- Neonatal abdominal ultrasound is usually performed in Nigeria to investigate neonatal symptoms rather than as a follow up to evaluate fetal abnormalities which were detected on prenatal ultrasound. The role of routine obstetric ultrasonography in the monitoring of pregnancy and identification of fetal malformations has partly contributed to lowering of fetal mortality rates. In Nigeria which has a high maternal and fetal mortality rate, many pregnant women do not have ante-natal care and not infrequently, women also deliver their babies at home and only bring the newborns to the clinics for immunization. Even when performed, most routine obstetric scans are not targeted towards the detection of fetal abnormalities. The aim of the present study is to evaluate the benefit of routinely performing abdominal scans on newborns with a view to detecting possible abnormalities which may have been missed ante-natally. Methods- This was a longitudinal study of 202 consecutive, apparently normal newborns. Routine clinical examination and abdominal ultrasound scans were performed on the babies by their mother's bedside, before discharge. Neonates with abnormal initial scans had follow-up scans. Results- There were 108 males and 94 females. There were 12 (5.9% abnormal scans seen in five male and seven female neonates. Eleven of the twelve abnormalities were in the kidneys, six on the left and five on the right. Three of the four major renal anomalies- absent kidney, ectopic/pelvic kidney and two cases of severe hydronephrosis were however on the left side. There was one suprarenal abnormality on the right suspected to be a possible infected adrenal haemorrage. Nine of the abnormal cases reported for follow- up and of these, two cases had persistent severe abnormalities. Conclusions- This study demonstrated a 5.9% incidence of genito urinary anomalies on routine neonatal abdominal ultrasound in this small population. Routine obstetric USS

  7. Leadership style and culturally competent care: Nurse leaders' views of their practice in the multicultural care settings of the United Arab Emirates.

    Science.gov (United States)

    El Amouri, Souher; O'Neill, Shirley

    2014-01-01

    Abstract It is well recognized that nurse-leader-managers play an important role in facilitating the quality and nature of hospital care, the improvement of work performance and work satisfaction. In the United Arab Emirates they face the additional challenge of working within a context of significant linguistic and cultural diversity where leadership in the provision of culturally competent care is a major requirement. With this goal at the fore, a sample of 153 nurse-leader-managers, including matrons, nursing directors, supervisors, nurses-in-charge and in-service education staff from 4 private and 6 government hospitals completed the multifactor leadership questionnaire (Bass & Avolio, 2004). The survey also explored participants' perceptions of the characteristics of good leaders and what they needed to do in their particular work place to enhance culturally competent care. The results showed nurse-leader-managers used both transformational and transactional leadership attributes but in different combinations across the two hospital types.

  8. Assistance at mealtimes in hospital settings and rehabilitation units for older adults from the perspective of patients, families and healthcare professionals: a mixed methods systematic review protocol.

    Science.gov (United States)

    Edwards, Deborah; Carrier, Judith; Hopkinson, Jane

    2015-11-01

    The review question is: assistance at mealtimes for older adults in hospital settings and rehabilitation units: what goes on, what works and what do patients, families and healthcare professionals think about it?The specific objectives are:This mixed methods review seeks to develop an aggregated synthesis of quantitative and qualitative data on assistance at mealtimes for older adults in hospital settings and rehabilitation units in order to derive conclusions and recommendations useful for clinical practice and policy decision making. Worldwide, it is estimated that between 20% and 50% of all adult patients admitted to hospital wards are malnourished. Reported prevalence occurs, depending on the specific patient group of interest, type of healthcare setting, disease state and criteria used to assess malnutrition. For older adults in hospital (over 65 years) the prevalence of malnutrition has been reported as being as high as 60% and can continue to deteriorate during the hospital stay. This is an area of concern as it is associated with prolonged hospital stays and increased morbidity (pressure ulcers, infections and falls) and mortality, especially for those with chronic conditions.Malnutrition in adults in developed countries is frequently associated with disease and may occur because of reduced dietary intake, malabsorption, increased nutrient losses or altered metabolic demands, with reduced dietary intake being considered the single most important aetiological factor. For the hospitalized older adult patient with pre-existing malnutrition, further nutritional problems are often encountered due to a reduced dietary intake. Poor food intake for older patients in hospital may be due to the effects of acute illness, poor appetite, nausea or vomiting, "nil by mouth" orders, medication side effects, catering limitations, swallowing and/or oral problems, difficulty with vision and opening containers, the placement of food out of the patients' reach, limited access

  9. Deciphering the Role of Sulfonated Unit in Heparin-Mimicking Polymer to Promote Neural Differentiation of Embryonic Stem Cells.

    Science.gov (United States)

    Lei, Jiehua; Yuan, Yuqi; Lyu, Zhonglin; Wang, Mengmeng; Liu, Qi; Wang, Hongwei; Yuan, Lin; Chen, Hong

    2017-08-30

    Glycosaminoglycans (GAGs), especially heparin and heparan sulfate (HS), hold great potential for inducing the neural differentiation of embryonic stem cells (ESCs) and have brought new hope for the treatment of neurological diseases. However, the disadvantages of natural heparin/HS, such as difficulty in isolating them with a sufficient amount, highly heterogeneous structure, and the risk of immune responses, have limited their further therapeutic applications. Thus, there is a great demand for stable, controllable, and well-defined synthetic alternatives of heparin/HS with more effective biological functions. In this study, based upon a previously proposed unit-recombination strategy, several heparin-mimicking polymers were synthesized by integrating glucosamine-like 2-methacrylamido glucopyranose monomers (MAG) with three sulfonated units in different structural forms, and their effects on cell proliferation, the pluripotency, and the differentiation of ESCs were carefully studied. The results showed that all the copolymers had good cytocompatibility and displayed much better bioactivity in promoting the neural differentiation of ESCs as compared to natural heparin; copolymers with different sulfonated units exhibited different levels of promoting ability; among them, copolymer with 3-sulfopropyl acrylate (SPA) as a sulfonated unit was the most potent in promoting the neural differentiation of ESCs; the promoting effect is dependent on the molecular weight and concentration of P(MAG-co-SPA), with the highest levels occurring at the intermediate molecular weight and concentration. These results clearly demonstrated that the sulfonated unit in the copolymers played an important role in determining the promoting effect on ESCs' neural differentiation; SPA was identified as the most potent sulfonated unit for copolymer with the strongest promoting ability. The possible reason for sulfonated unit structure as a vital factor influencing the ability of the copolymers

  10. Set-up of a pre-test mock-up experiment in preparation for the HCPB Breeder Unit mock-up experimental campaign

    Energy Technology Data Exchange (ETDEWEB)

    Hernández, F., E-mail: francisco.hernandez@kit.edu [Karlsruhe Institute of Technology (KIT), Institute for Neutron Physics and Reactor Technology (INR) (Germany); Kolb, M. [Karlsruhe Institute of Technology (KIT), Institute for Applied Materials (IAM-WPT) (Germany); Ilić, M.; Kunze, A. [Karlsruhe Institute of Technology (KIT), Institute for Neutron Physics and Reactor Technology (INR) (Germany); Németh, J. [KFKI Research Institute for Particle and Nuclear Physics (Hungary); Weth, A. von der [Karlsruhe Institute of Technology (KIT), Institute for Neutron Physics and Reactor Technology (INR) (Germany)

    2013-10-15

    Highlights: ► As preparation for the HCPB-TBM Breeder Unit out-of-pile testing campaign, a pre-test experiment (PREMUX) has been prepared and described. ► A new heater system based on a wire heater matrix has been developed for imitating the neutronic volumetric heating and it is compared with the conventional plate heaters. ► The test section is described and preliminary thermal results with the available models are presented and are to be benchmarked with PREMUX. ► The PREMUX integration in the air cooling loop L-STAR/LL in the Karlsruhe Institute for Technology is shown and future steps are discussed. -- Abstract: The complexity of the experimental set-up for testing a full-scaled Breeder Unit (BU) mock-up for the European Helium Cooled Pebble Bed Test Blanket Module (HCPB-TBM) has motivated to build a pre-test mock-up experiment (PREMUX) consisting of a slice of the BU in the Li{sub 4}SiO{sub 4} region. This pre-test aims at verifying the feasibility of the methods to be used for the subsequent testing of the full-scaled BU mock-up. Key parameters needed for the modeling of the breeder material is also to be determined by the Hot Wire Method (HWM). The modeling tools for the thermo-mechanics of the pebble beds and for the mock-up structure are to be calibrated and validated as well. This paper presents the setting-up of PREMUX in the L-STAR/LL facility at the Karlsruhe Institute of Technology. A key requirement of the experiments is to mimic the neutronic volumetric heating. A new heater concept is discussed and compared to several conventional heater configurations with respect to the estimated temperature distribution in the pebble beds. The design and integration of the thermocouple system in the heater matrix and pebble beds is also described, as well as other key aspects of the mock-up (dimensions, layout, cooling system, purge gas line, boundary conditions and integration in the test facility). The adequacy of these methods for the full-scaled BU

  11. Eleanor Roosevelt, the United Nations and the Role of Radio Communications

    NARCIS (Netherlands)

    Luscombe, Anya

    Eleanor Roosevelt communicated with the public through a variety of media, both before, during and following her time in the White House. In 1946 she became part of the US delegation to the newly formed United Nations and she used newspaper columns, speeches and radio broadcasts to converse with

  12. The Role of Emotional Intelligence in the Academic Success of United Arab Emirates University Students

    Science.gov (United States)

    Ahammed, Shaima; Abdullah, Abdullah S.; Hassane, Sofoh H.

    2011-01-01

    Psycho-educational researchers have often suggested that Emotional Intelligence (EI) is critical to academic success (Drago, 2004; La Civita, 2003), yet there is hardly any research that has ever addressed the question in the United Arab Emirates (UAE). The purpose of this study was to examine the relationship between EI as conceptualized by Mayer…

  13. The Role of Gender in Management Behaviors on Family Forest Lands in the United States

    Science.gov (United States)

    Sarah M. Butler; Emily S. Huff; Stephanie A. Snyder; Brett J. Butler; Mary Tyrrell

    2017-01-01

    In the United States, 58% of the 11 million family forest ownerships with at least 10 acres of forestland have at least one female owner. Within the single-owner population of landowners, women are the sole owners of and primary decisionmakers for 31% of ownerships. Despite the number of female family forest owners (FFOs), little research has focused on whether land-...

  14. The role of familiarity in associative recognition of unitized compound word pairs.

    Science.gov (United States)

    Ahmad, Fahad N; Hockley, William E

    2014-01-01

    This study examined the effect of unitization and contribution of familiarity in the recognition of word pairs. Compound words were presented as word pairs and were contrasted with noncompound word pairs in an associative recognition task. In Experiments 1 and 2, yes-no recognition hit and false-alarm rates were significantly higher for compound than for noncompound word pairs, with no difference in discrimination in both within- and between-subject comparisons. Experiment 2 also showed that item recognition was reduced for words from compound compared to noncompound word pairs, providing evidence of the unitization of the compound pairs. A two-alternative forced-choice test used in Experiments 3A and 3B provided evidence that the concordant effect for compound word pairs was largely due to familiarity. A discrimination advantage for compound word pairs was also seen in these experiments. Experiment 4A showed that a different pattern of results is seen when repeated noncompound word pairs are compared to compound word pairs. Experiment 4B showed that memory for the individual items of compound word pairs was impaired relative to items in repeated and nonrepeated noncompound word pairs, and Experiment 5 demonstrated that this effect is eliminated when the elements of compound word pairs are not unitized. The concordant pattern seen in yes-no recognition and the discrimination advantage in forced-choice recognition for compound relative to noncompound word pairs is due to greater reliance on familiarity at test when pairs are unitized.

  15. The Role of Ethiopia's Public Universities in Achieving the United Nations Sustainable Development Goals

    Science.gov (United States)

    O'Keeffe, Paul

    2016-01-01

    In recent years, the Ethiopian government has embarked on an ambitious agriculture development strategy aimed at raising Ethiopia to the status of a middle-income-level country by 2025. Encouraged by the international development push behind the United Nations Sustainable Development Goals (SDGs), the rapid expansion of public universities has…

  16. Unauthorized Immigrant Students in the United States: Educational Policies, Practices, and the Role of School Psychology

    Science.gov (United States)

    Sulkowski, Michael L.

    2017-01-01

    Overlooking Ellis Island, the famous port of entry for millions of U.S. immigrants, is the Statue of Liberty. Miss Liberty's lamp has welcomed millions of immigrants to the United States. However, in light of recent executive orders against immigration as well as efforts to detain and deport millions of unauthorized immigrants, one might wonder…

  17. Brucellosis in the United States: Role and Significance of Wildlife Reservoirs

    Science.gov (United States)

    Regulatory programs for brucellosis in domestic livestock have been active in the United States for almost 80 years. Wildlife reservoirs of brucellosis include bison (Bison bison) and elk (Cervus elaphus nelsonii) for B. abortus whereas B. suis is the predominant species infecting feral swine. The...

  18. Setting a good example: supervisors as work-life-friendly role models within the context of boundary management.

    Science.gov (United States)

    Koch, Anna R; Binnewies, Carmen

    2015-01-01

    This multisource, multilevel study examined the importance of supervisors as work-life-friendly role models for employees' boundary management. Particularly, we tested whether supervisors' work-home segmentation behavior represents work-life-friendly role modeling for their employees. Furthermore, we tested whether work-life-friendly role modeling is positively related to employees' work-home segmentation behavior. Also, we examined whether work-life-friendly role modeling is positively related to employees' well-being in terms of feeling less exhausted and disengaged. In total, 237 employees and their 75 supervisors participated in our study. Results from hierarchical linear models revealed that supervisors who showed more segmentation behavior to separate work and home were more likely perceived as work-life-friendly role models. Employees with work-life-friendly role models were more likely to segment between work and home, and they felt less exhausted and disengaged. One may conclude that supervisors as work-life-friendly role models are highly important for employees' work-home segmentation behavior and gatekeepers to implement a work-life-friendly organizational culture. PsycINFO Database Record (c) 2014 APA, all rights reserved.

  19. The use of supplements and performance and image enhancing drugs in fitness settings: A exploratory cross-sectional investigation in the United Kingdom.

    Science.gov (United States)

    Mooney, Roisin; Simonato, Pierluigi; Ruparelia, Risha; Roman-Urrestarazu, Andres; Martinotti, Giovanni; Corazza, Ornella

    2017-05-01

    The strive for perfection is prevalent in the fitness industry. This study aimed to explore the use of products to enhance performance alongside exposure to exercise addiction, appearance anxiety and self-esteem in fitness settings. An online survey was prepared and piloted before wider dissemination in fitness clubs via snowballing and selected mailing lists. A list of commonly used products, including Performance and Image Enhancing Drugs (PIEDs) was provided. Exercise addiction (Exercise Addiction Inventory; EAI), anxiety levels (Appearance Anxiety Inventory; AAI) and their self-esteem (Rosenberg's Self-Esteem Scale; RSE) were also measured. 377 questionnaires were completed. A significant number of participants declared the use products either to lose weight (16%) or to reach their fitness goals (41%). The Internet played a major role in both the supply of information and the provision of the enhancement products (33.7%) and side effects were reported (10.5%). Only a limited number of participants sought a medical opinion about taking products (5.1%). EAI scores were high (m=20.02 ± 4.1), AAI (m=15.98 ± 4.8) showed an intermediate level of anxiety, while self-esteem was low (RSE m=12.59 ± 2.2). This pilot study identified the emergence of a new drug trend in fitness settings and showed a potential relationship to exercise addiction, anxiety disorders and low self-esteem. The Internet played a crucial role in disseminating often untested products, including PIEDs without medical supervision and unwanted side-effects were reported. More studies in the field are required in order to safeguard public health and inform policy making. Copyright © 2017 John Wiley & Sons, Ltd.

  20. An ethnographic study exploring the role of ward-based Advanced Nurse Practitioners in an acute medical setting.

    Science.gov (United States)

    Williamson, Susan; Twelvetree, Timothy; Thompson, Jacqueline; Beaver, Kinta

    2012-07-01

    This article is a report of a study that aimed to examine the role of ward-based Advanced Nurse Practitioners and their impact on patient care and nursing practice. Revised doctor/nurse skill mix combined with a focus on improving quality of care while reducing costs has had an impact on healthcare delivery in the western world. Diverse advanced nursing practice roles have developed and their function has varied globally over the last decade. However, roles and expectations for ward-based Advanced Nurse Practitioners lack clarity, which may hinder effective contribution to practice. An ethnographic approach was used to explore the advanced nurse practitioner role. Participant observation and interviews of five ward-based Advanced Nurse Practitioners working in a large teaching hospital in the North West of England during 2009 were complemented by formal and informal interviews with staff and patients. Data were descriptive and broken down into themes, patterns and processes to enable interpretation and explanation. The overarching concept that ran through data analysis was that of Advanced Nurse Practitioners as a lynchpin, using their considerable expertise, networks and insider knowledge of health care not only to facilitate patient care but to develop a pivotal role facilitating nursing and medical practice. Sub-themes included enhancing communication and practice, acting as a role model, facilitating the patients' journey and pioneering the role. Ward-based Advanced Nurse Practitioners are pivotal and necessary for providing quality holistic patient care and their role can be defined as more than junior doctor substitutes. © 2012 Blackwell Publishing Ltd.

  1. Parent Expectancies and Preferences for Mental Health Treatment: The Roles of Emotion Mind-Sets and Views of Failure.

    Science.gov (United States)

    Schleider, Jessica L; Weisz, John R

    2018-01-24

    Because parents are primary gatekeepers to mental health care for their children, parental expectations that mental health treatment is ineffective may undermine treatment seeking, retention, and response. Thus, a need exists to understand parents' expectations about treatment and to develop scalable interventions that can instill more favorable views. We examined parents' treatment expectancies and preferences for their offspring and themselves in relation to two global beliefs: mind-sets (malleability beliefs) of emotions and anxiety, and views of failure as enhancing versus debilitating. Study 1 (N = 200; 49.5% fathers; 70.4% Caucasian) examined associations among parents' emotion mind-sets, anxiety mind-sets, failure beliefs, and treatment expectancies and preferences. Study 2 (N = 430; 44.70% fathers; 75.80% Caucasian) tested whether online inductions teaching "growth emotion mind-sets" (viewing emotions as malleable), adaptive failure beliefs, or both improved parents' treatment expectancies and hypothetical preferences for treatment (vs. no-treatment). Participants received one of three 8- to 15-min inductions or a psychoeducation control, rating treatment expectancies. and preferences pre- and postinduction. In Study 1, fixed emotion mind-sets and failure-is-debilitating beliefs were associated with lower parent psychotherapy expectancies for offspring and themselves and stronger "no-treatment" preferences for offspring. In Study 2, inductions teaching (a) growth emotion mind-sets only and (b) growth emotion mind-sets and failure-is-enhancing beliefs improved parents' psychotherapy expectancies for themselves (ds = .38, .51) and offspring (ds = .30, .43). No induction increased parents' hypothetical preferences for treatment (vs. no-treatment). Findings suggest scalable strategies for strengthening parents' psychotherapy effectiveness beliefs for themselves and their children.

  2. Interface unit

    NARCIS (Netherlands)

    Keyson, D.V.; Freudenthal, A.; De Hoogh, M.P.A.; Dekoven, E.A.M.

    2001-01-01

    The invention relates to an interface unit comprising at least a display unit for communication with a user, which is designed for being coupled with a control unit for at least one or more parameters in a living or working environment, such as the temperature setting in a house, which control unit

  3. THE CLEAN ENERGY MANUFACTURING JOB MARKET AND ITS ROLE IN THE UNITED STATES ECONOMY

    OpenAIRE

    Plaskacz, Audrey

    2009-01-01

    This paper provides an overview of green jobs in the United States, with a focus on synthesizing various estimates of the current and future number of green jobs, and relating these to estimates of the future number of clean energy manufacturing jobs. In doing so, it answers the following two research questions: ?can lost manufacturing jobs become clean energy jobs?? and ?can existing manufacturing jobs be saved from disappearing by transforming into clean energy jobs?? By combining current f...

  4. Is there a Role of Palliative Care in the Neonatal Intensive Care Unit in India?

    OpenAIRE

    Dighe, Manjiri P; Muckaden, Maryann A; Manerkar, Swati A; Duraisamy, Balaji P

    2011-01-01

    Recent advances in medical care have improved the survival of newborn babies born with various problems. Despite this death in the neonatal intensive care unit (NICU) is an inevitable reality. For babies who are not going to "get better," the health care team still has a duty to alleviate the physical suffering of the baby and to support the family. Palliative care is a multidisciplinary approach to relieve the physical, psycho social, and spiritual suffering of patients and their families. P...

  5. The Role of the Family in Immigrants' Labor-Market Activity: Evidence from the United States

    OpenAIRE

    Francine D. Blau; Lawrence M. Kahn; Joan Y. Moriarty; Andre Portela Souza

    2002-01-01

    We use Census of Population microdata for 1980 and 1990 to examine the labor supply and wages of immigrant husbands and wives in the United States in a family context. Earlier research by Baker and Benjamin (1997) posits a family investment model in which, upon arrival, immigrant husbands invest in their human capital while immigrant wives work to provide the family with liquidity during this period. Consistent with this model, they find for Canada that immigrant wives work longer hours upon ...

  6. The Role of the Unit of Analysis in Tax Policy Reform Evaluations

    OpenAIRE

    John Creedy; Rosanna Scutella

    2003-01-01

    This paper examines the implications, for overall social welfare and inequality comparisons, of using different definitions of the unit of analysis - the income recipient - in computing summary measures. Comparisons are made using the Melbourne Institute Tax and Transfer Simulator (MITTS), a simulation model of the Australian direct tax and benefit system, of the effects of flattening the marginal tax rate structure. The reform was found to reduce inequality in all cases. However, it was not ...

  7. "Seeing the Life": Redefining self-worth and family roles among Iraqi refugee families resettled in the United States.

    Science.gov (United States)

    Nelson, Matthew; Hess, Julia Meredith; Isakson, Brian; Goodkind, Jessica

    2016-08-01

    Social and geographic displacement is a global phenomenon that precipitates novel stressors and disruptions that intersect with longstanding familial and social roles. Among the displaced are war-torn Iraqi refugee families, who must address these new obstacles in unconventional ways. This study explores how such disruptions have influenced associations between gender and apparent self-worth experienced by Iraqi refugee families upon relocation to the United States. Further, the psychosocial mechanisms requisite of any novel approach to a new social construct are explored and reveal that production in the family is at the core of instability and shifting power dynamics during resettlement, preventing family members from "seeing the life" in the United States that they had envisioned prior to immigration. Over 200 semi-structured qualitative interviews with Iraqi participants and mental health providers were conducted over the course of the study, and demonstrate a plasticity among social roles in the family and community that transcends the notion of a simple role reversal, and illustrate the complex positionalities that families under stress must approximate during such physical and social displacement.

  8. Building visual identity of scientific and research units and the role of visualization in cooperation with business

    Directory of Open Access Journals (Sweden)

    Alfreda Kamińska

    2014-12-01

    Full Text Available The need for commercialization of scientific research leads to the necessity of changing the orientation of scientific-research units to marketing orientation, which is characterized by, among others, conducting research aimed at learning the clients’ needs and building better communication with the recipients. What is an important element of a unit’s marketing communication is its visual identity system, which the recipients use to build their opinion and their picture of the unit. The goal of this article is an attempt to define the key rules of designing visual identity of scientific and research institutions, as well as presenting the role of visualization in their cooperation with business. In the article the notions of image, identity, corporate identity and visual identity are subject to analysis. The article also presents the significance of visualization in the functioning of research and scientific units, elements of visual identity system and the rules of designing visual identity of scientific and research institutions. An analysis of chosen research-scientific units was carried out with regard to visualization.

  9. The role of the lacrimal functional unit in the pathophysiology of dry eye.

    Science.gov (United States)

    Stern, Michael E; Gao, Jianping; Siemasko, Karyn F; Beuerman, Roger W; Pflugfelder, Stephen C

    2004-03-01

    The majority of dry eye symptoms are due to a chronic inflammation of the lacrimal functional unit resulting in a loss of tear film integrity and normal function. This leads to a reduction in the ability of the ocular surface to respond to environmental challenges. The underlying cause of tear film dysfunction is the alteration of tear aqueous, mucin, and lipid components. This may result from a systemic autoimmune disease or a local autoimmune event. A lack of systemic androgen support to the lacrimal gland has been shown to be a facilitative factor in the initiation of this type of pathophysiology. Tear secretion is controlled by the lacrimal functional unit consisting of the ocular surface (cornea, conjunctiva, accessory lacrimal glands, and meibomian glands), the main lacrimal gland and the interconnecting innervation. If any portion of this functional unit is compromised, lacrimal gland support to the ocular surface is impeded. Factors such as neurogenic inflammation and T cell involvement in the disease pathogenesis as well as newly developed animal models of ocular surface inflammation are discussed.

  10. Culture and Healthy Eating: The Role of Independence and Interdependence in the United States and Japan.

    Science.gov (United States)

    Levine, Cynthia S; Miyamoto, Yuri; Markus, Hazel Rose; Rigotti, Attilio; Boylan, Jennifer Morozink; Park, Jiyoung; Kitayama, Shinobu; Karasawa, Mayumi; Kawakami, Norito; Coe, Christopher L; Love, Gayle D; Ryff, Carol D

    2016-10-01

    Healthy eating is important for physical health. Using large probability samples of middle-aged adults in the United States and Japan, we show that fitting with the culturally normative way of being predicts healthy eating. In the United States, a culture that prioritizes and emphasizes independence, being independent predicts eating a healthy diet (an index of fish, protein, fruit, vegetables, reverse-coded sugared beverages, and reverse-coded high fat meat consumption; Study 1) and not using nonmeat food as a way to cope with stress (Study 2a). In Japan, a culture that prioritizes and emphasizes interdependence, being interdependent predicts eating a healthy diet (Studies 1 and 2b). Furthermore, reflecting the types of agency that are prevalent in each context, these relationships are mediated by autonomy in the United States and positive relations with others in Japan. These findings highlight the importance of understanding cultural differences in shaping healthy behavior and have implications for designing health-promoting interventions. © 2016 by the Society for Personality and Social Psychology, Inc.

  11. The prospective United Kingdom nuclear energy programme up to 2000 AD and the UKAEA's role and manpower requirements

    International Nuclear Information System (INIS)

    Simeone, R.N.; Hodgkinson, I.A.

    1980-01-01

    This paper begins by surveying the development of the United Kingdom nuclear industry, its organization in both the public and private sectors of the economy, and changes in the numbers employed up to the present day. The possible future nuclear programme and overall manpower needs, and the UKAEA's role and manpower requirements within this programme, are outlined. Manpower problems arising from national shortages of engineers and technicians and reviews of arrangements for their education and training, and also from the pattern of historical development of the UKAEA, are described. UKAEA arrangements for formulating and implementing personnel policies, current policies for recruitment, carrier management and in-service training and their relationship to present and future needs are then discussed. The final section draws attention to UKAEA facilities for the training of staff from other organizations in the United Kingdom and from overseas. (author)

  12. THE ROLE OF THE UNITED STATES OF AMERICA IN THE POST-COLD WAR WORLD: A GLOBAL LEADER OR HEGEMON?

    Directory of Open Access Journals (Sweden)

    Katarina Jonev

    2016-09-01

    Full Text Available The authors of this paper deal with the role of the USA in the post-Cold War world and their position from the standpoint of relevant indicators and theoretical considerations. This work also refers to path that the United States took from isolationism to the world domination and considers justification of the position of the USA in the period after the Cold War from the point of hegemonic stability theories, while at the end indicates the diversity of understanding of contemporary thinkers regarding the position of the United States as the hegemon or rather “just” a global leader. This paper does not prejudge the final definition of the position of the USA in international relations, but aims to launch discussions on the necessity and justification of the existence of such vision on a global scale.

  13. Pollination biology of fruit-bearing hedgerow plants and the role of flower-visiting insects in fruit-set.

    Science.gov (United States)

    Jacobs, Jennifer H; Clark, Suzanne J; Denholm, Ian; Goulson, Dave; Stoate, Chris; Osborne, Juliet L

    2009-12-01

    In the UK, the flowers of fruit-bearing hedgerow plants provide a succession of pollen and nectar for flower-visiting insects for much of the year. The fruits of hedgerow plants are a source of winter food for frugivorous birds on farmland. It is unclear whether recent declines in pollinator populations are likely to threaten fruit-set and hence food supply for birds. The present study investigates the pollination biology of five common hedgerow plants: blackthorn (Prunus spinosa), hawthorn (Crataegus monogyna), dog rose (Rosa canina), bramble (Rubus fruticosus) and ivy (Hedera helix). The requirement for insect pollination was investigated initially by excluding insects from flowers by using mesh bags and comparing immature and mature fruit-set with those of open-pollinated flowers. Those plants that showed a requirement for insect pollination were then tested to compare fruit-set under two additional pollination service scenarios: (1) reduced pollination, with insects excluded from flowers bagged for part of the flowering period, and (2) supplemental pollination, with flowers hand cross-pollinated to test for pollen limitation. The proportions of flowers setting fruit in blackthorn, hawthorn and ivy were significantly reduced when insects were excluded from flowers by using mesh bags, whereas fruit-set in bramble and dog rose were unaffected. Restricting the exposure of flowers to pollinators had no significant effect on fruit-set. However, blackthorn and hawthorn were found to be pollen-limited, suggesting that the pollination service was inadequate in the study area. Ensuring strong populations of insect pollinators may be essential to guarantee a winter fruit supply for birds in UK hedgerows.

  14. Monetary policy and the transaction role of money in the United States

    NARCIS (Netherlands)

    Kriwoluzky, A.; Stoltenberg, C.A.

    2012-01-01

    We argue that the declining importance of money in saving transaction costs can explain the well-known fact that U.S. interest rate policy was passive in the pre-Volcker period and active after 1982. To identify the declining role of money in transactions as the driving force for the change in

  15. Role Expectations for United States Air Force Psychiatric Clinical Nurse Specialists.

    Science.gov (United States)

    1986-01-01

    perspective of symbolic interactionism . Symbolic interactionism provides a matrix within which to understand how humans perceive and interact with the...theoretical framework for understanding role theory in this study is that tradition in social psychology derived from symbolic interactionism (Clayton...influence of the clinical nurse specialist. Nursing Administration Quarterly, 6(l), 53-63. Blumer, H. (1969). Symbolic interactionism : Perspective and

  16. Role of the Property Engineering in the units' construction of the Cernavoda nuclear power plant

    International Nuclear Information System (INIS)

    Esteban-Zazo Gomez, J. A.; Varas Suarez, M. I.; Dehalu, J. M.; Giura, A.

    2010-01-01

    The engineering of the property acts as owner's representative to ensure that the technical execution of the work is done according to the specifications. Normally, his paper complements the role of project management often tends to be more focused on the monitoring and supervision of commercial and financial aspects of it.

  17. Foreign-Born Women Faculty Work Roles and Productivity at Research Universities in the United States

    Science.gov (United States)

    Mamiseishvili, Ketevan

    2010-01-01

    Using the data from the 2004 National Study of Postsecondary Faculty (NSOPF:04) survey, the study examined foreign-born women faculty members' work roles and productivity in the areas of teaching, research, and service in comparison with their US-born counterparts at research universities in the US. The findings provided some evidence to suggest…

  18. A Systematic Review of the Liaison Nurse Role on Patient’s Outcomes after Intensive Care Unit Discharge

    OpenAIRE

    Tabanejad, Zeinab; Pazokian, Marzieh; Ebadi, Abbas

    2014-01-01

    Background: This review focuses on the impact of liaison nurse in nursing care of patient after ICU discharge on patient’s outcomes, compared with patients that are not taken care of by liaison nurses. The role of the ICU liaison nurse has transpired to solve the gap between intensive care unit and wards. Therefore, we aimed to review the outcomes of all studies in this field. Methods: A systematic review of intervention studies between 2004 and 2013 was undertaken using standard and sensitiv...

  19. Intensive-care unit lung infections: The role of imaging with special emphasis on multi-detector row computed tomography

    International Nuclear Information System (INIS)

    Romano, Luigia; Pinto, Antonio; Merola, Stefanella; Gagliardi, Nicola; Tortora, Giovanni; Scaglione, Mariano

    2008-01-01

    Nosocomial pneumonia is the most frequent hospital-acquired infection. In mechanically ventilated patients admitted to an intensive-care unit as many as 7-41% may develop pneumonia. The role of imaging is to identify the presence, location and extent of pulmonary infection and the presence of complications. However, the poor resolution of bedside plain film frequently limits the value of radiography as an accurate diagnostic tool. To date, multi-detector row computed tomography with its excellent contrast resolution is the most sensitive modality for evaluating lung parenchyma infections

  20. Challenges of pain control and the role of the ambulatory pain specialist in the outpatient surgery setting.

    Science.gov (United States)

    Vadivelu, Nalini; Kai, Alice M; Kodumudi, Vijay; Berger, Jack M

    2016-01-01

    Ambulatory surgery is on the rise, with an unmet need for optimum pain control in ambulatory surgery centers worldwide. It is important that there is a proportionate increase in the availability of acute pain-management services to match the rapid rise of clinical patient load with pain issues in the ambulatory surgery setting. Focus on ambulatory pain control with its special challenges is vital to achieve optimum pain control and prevent morbidity and mortality. Management of perioperative pain in the ambulatory surgery setting is becoming increasingly complex, and requires the employment of a multimodal approach and interventions facilitated by ambulatory surgery pain specialists, which is a new concept. A focused ambulatory pain specialist on site at each ambulatory surgery center, in addition to providing safe anesthesia, could intervene early once problematic pain issues are recognized, thus preventing emergency room visits, as well as readmissions for uncontrolled pain. This paper reviews methods of acute-pain management in the ambulatory setting with risk stratification, the utilization of multimodal interventions, including pharmacological and nonpharmacological options, opioids, nonopioids, and various routes with the goal of preventing delayed discharge and unexpected hospital admissions after ambulatory surgery. Continued research and investigation in the area of pain management with outcome studies in acute surgically inflicted pain in patients with underlying chronic pain treated with opioids and the pattern and predictive factors for pain in the ambulatory surgical setting is needed.

  1. Athletic Trainers' Roles and Responsibilities Regarding Academic Adjustments as Part of the Concussion-Management Process in the Secondary School Setting.

    Science.gov (United States)

    Bacon, Cailee E Welch; Kay, Melissa C; McLeod, Tamara C Valovich

    2017-10-01

      Athletic trainers (ATs) play a vital role in managing the care of student-athletes after a sport-related concussion, yet little is known about their specific involvement in the implementation of academic adjustments as part of the concussion-management plan.   To explore ATs' perceived roles and responsibilities regarding the implementation of academic adjustments for concussed student-athletes.   Qualitative study.   Individual telephone interviews.   Sixteen ATs employed in the secondary school setting (8 women, 8 men; age = 39.6 ± 7.9 years; athletic training experience = 15.1 ± 5.6 years), representing 12 states, were interviewed.   One telephone interview was conducted with each participant. After the interviews were transcribed, the data were analyzed and coded into themes and categories, which were determined via consensus of a 4-person research team. To decrease researcher bias, triangulation occurred through participant member checking, the inclusion of multiple researchers, and an internal auditor.   Several categories related to participants' perceptions regarding their roles and responsibilities within the academic-adjustments process emerged from data analysis: (1) understanding of academic adjustments, (2) perceptions of their roles in academic adjustments, (3) initiation of academic adjustments, (4) facilitation of academic adjustments, and (5) lack of a role in the academic-adjustments process. Although most ATs perceived that they had a role in the initiation and facilitation of academic adjustments for concussed student-athletes, some reported they did not want a role in the process. Regardless, participants frequently suggested the need for further education.   These findings highlight that ATs either wanted to be involved in the implementation of academic adjustments but felt further education was needed or they did not want to be involved because they felt that it was not in their area of expertise. To create a cohesive

  2. Eleanor Roosevelt, the United Nations and the Role of Radio Communications

    OpenAIRE

    Luscombe, Anya

    2016-01-01

    Eleanor Roosevelt communicated with the public through a variety of media, both before, during and following her time in the White House. In 1946 she became part of the US delegation to the newly formed United Nations and she used newspaper columns, speeches and radio broadcasts to converse with citizens about the importance of the UN. This paper focuses on some of her radio performances of the early 1950s, both in the USA and in Europe. Despite increasing competition from television in the 1...

  3. The role of the United States Food Safety and Inspection Service after the Chernobyl accident

    International Nuclear Information System (INIS)

    Engel, Ronald E.; Randecker, Victor; Johnson, Wesley

    1989-01-01

    The Food Safety and Inspection Service (FSIS) of the United States Department of Agriculture (USDA) inspects domestic and imported meat and poultry food products to assure the public that they are safe, wholesome, not economically adulterated and properly labeled. The Service also monitors the activities of meat and poultry plants and related activities in allied industries, and establishes standards and approves labels for meat and poultry products. As part of its responsibility, shortly after the Chernobyl accident occurred, FSIS developed a plan to assess this accident's impact on domestically produced and imported meat and poultry

  4. The role of the United States Food Safety and Inspection Service after the Chernobyl accident

    Energy Technology Data Exchange (ETDEWEB)

    Engel, Ronald E; Randecker, Victor; Johnson, Wesley [Food Safety and Inspection Service, United States Department of Agriculture (United States)

    1989-09-01

    The Food Safety and Inspection Service (FSIS) of the United States Department of Agriculture (USDA) inspects domestic and imported meat and poultry food products to assure the public that they are safe, wholesome, not economically adulterated and properly labeled. The Service also monitors the activities of meat and poultry plants and related activities in allied industries, and establishes standards and approves labels for meat and poultry products. As part of its responsibility, shortly after the Chernobyl accident occurred, FSIS developed a plan to assess this accident's impact on domestically produced and imported meat and poultry.

  5. A qualitative interpretive study exploring parents' perception of the parental role in the paediatric intensive care unit.

    Science.gov (United States)

    Ames, Kaitlin E; Rennick, Janet E; Baillargeon, Sophie

    2011-06-01

    The purpose of this study was to explore parents' perception of the parental role in a tertiary care Canadian university affiliated hospital's paediatric intensive care unit (PICU). A descriptive interpretive design was used with a purposive heterogeneous sample to reflect the range of children and parents normally admitted to the PICU. Semi-structured interviews were conducted with seven parents. Interview data were collected and analysed using the constant comparative method. Three main themes emerged: (1) being present and participating in the child's care; (2) forming a partnership of trust with the PICU health care team; and (3) being informed of the child's progress and treatment plan as the person who "knows" the child best. Enhanced understanding of the parental role in the PICU from the perspective of parents can help guide the development of strategies to more effectively support parents and promote parenting during this extremely stressful time. Copyright © 2011 Elsevier Ltd. All rights reserved.

  6. Effect of the clinical support nurse role on work-related stress for nurses on an inpatient pediatric oncology unit.

    Science.gov (United States)

    Chang, Ann; Kicis, Jennifer; Sangha, Gurjit

    2007-01-01

    High patient acuity, heavy workload, and patient deaths can all contribute to work-related stress for pediatric oncology nurses. A new leadership role, the clinical support nurse (CSN), was recently initiated on the oncology unit of a large Canadian pediatric hospital to support frontline staff and reduce some of the stresses related to clinical activity. The CSN assists nurses with complex patient care procedures, provides hands-on education at the bedside, and supports staff in managing challenging family situations. This study explores the effect of the CSN role on the nurses' work-related stress using the Stressor Scale for Pediatric Oncology Nurses. A total of 58 nurses participated in this study for a response rate of 86%. The results show that the intensity of work-related stress experienced by nurses in this study is significantly less (P < .001) on shifts staffed with a CSN compared with shifts without a CSN.

  7. Transformational leadership and group potency in small military units: The mediating role of group identification and cohesion

    Directory of Open Access Journals (Sweden)

    Carlos García-Guiu

    2016-12-01

    Full Text Available In the present study, we examined an exploratory model to assess the relationship between transformational leadership and group potency and analyze the mediating role of group identification and cohesion. The research was conducted with squads of the Spanish Army. The sample was composed of 243 members of 51 squads of operational units. Our findings highlighted the importance of the transformational leadership style of command of non-commissioned officers (NCOs due to its positive relationship with the group potency of the squad. We also analyzed the indirect relationships between transformational leadership and group identification and group cohesion and found that the latter variables played a mediating role between transformational leadership and group potency. The conclusions of this study are relevant due to the growing importance of transformational leadership and actions implemented at lower levels of the command chain for the success of missions of security organizations and defense.

  8. [Communication, information, and roles of parents in the pediatric intensive care unit: A review article].

    Science.gov (United States)

    Béranger, A; Pierron, C; de Saint Blanquat, L; Jean, S; Chappuy, H

    2017-03-01

    Pediatric intensive care units (PICUs), whose accessibility to parents raises controversy, often operate under their own rules. Patients are under critical and unstable conditions, often in a life-threatening situation. In this context, the communication with the parents and their participation in the unit may be difficult. Information is a legal, deontological, and moral duty for caregivers, confirmed by the parents' needs. But the ability to enforce them is a challenge, and there is a gap between the theory and the reality. The communication between the parents and the physicians starts at the admission of the child with a family conference. According to the Société de réanimation de langue française (SRLF), the effectiveness of the communication is based on three criteria: the patients' comprehension, their satisfaction and their anxiety and depression. It has been shown that comprehension depends on multiple factors, related on the parents, the physicians, and the medical condition of the child. Regarding the parents' participation in the organization of the service, the parents' presence is becoming an important factor. In the PICU, the parents' status has evolved. They become a member of the care team, as a partner. The best interest of the child is always discussed with the parents, as the person knowing the best their child. This partnership gives them a responsibility, which is complementary to the physician's one, but does not substitute it. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  9. Modeling the Current and Future Roles of Particulate Organic Nitrates in the Southeastern United States.

    Science.gov (United States)

    Pye, Havala O T; Luecken, Deborah J; Xu, Lu; Boyd, Christopher M; Ng, Nga L; Baker, Kirk R; Ayres, Benjamin R; Bash, Jesse O; Baumann, Karsten; Carter, William P L; Edgerton, Eric; Fry, Juliane L; Hutzell, William T; Schwede, Donna B; Shepson, Paul B

    2015-12-15

    Organic nitrates are an important aerosol constituent in locations where biogenic hydrocarbon emissions mix with anthropogenic NOx sources. While regional and global chemical transport models may include a representation of organic aerosol from monoterpene reactions with nitrate radicals (the primary source of particle-phase organic nitrates in the Southeast United States), secondary organic aerosol (SOA) models can underestimate yields. Furthermore, SOA parametrizations do not explicitly take into account organic nitrate compounds produced in the gas phase. In this work, we developed a coupled gas and aerosol system to describe the formation and subsequent aerosol-phase partitioning of organic nitrates from isoprene and monoterpenes with a focus on the Southeast United States. The concentrations of organic aerosol and gas-phase organic nitrates were improved when particulate organic nitrates were assumed to undergo rapid (τ = 3 h) pseudohydrolysis resulting in nitric acid and nonvolatile secondary organic aerosol. In addition, up to 60% of less oxidized-oxygenated organic aerosol (LO-OOA) could be accounted for via organic nitrate mediated chemistry during the Southern Oxidants and Aerosol Study (SOAS). A 25% reduction in nitrogen oxide (NO + NO2) emissions was predicted to cause a 9% reduction in organic aerosol for June 2013 SOAS conditions at Centreville, Alabama.

  10. The Role of Overshooting Convection in Elevated Stratospheric Water Vapor over the Summertime Continental United States

    Science.gov (United States)

    Herman, R. L.; Ray, E. A.; Rosenlof, K. H.; Bedka, K. M.; Schwartz, M. J.; Read, W. G.; Troy, R. F.

    2016-12-01

    The NASA ER-2 aircraft sampled the UTLS region over North America during the NASA Studies of Emissions and Atmospheric Composition, Clouds and Climate Coupling by Regional Surveys (SEAC4RS) field mission. On four flights targeting convectively-influenced air parcels, in situ measurements of enhanced water vapor in the lower stratosphere over the summertime continental United States were made using the JPL Laser Hygrometer (JLH Mark2). Water vapor mixing ratios greater than 10 ppmv, twice the stratospheric background levels, were measured at pressure levels between 80 and 160 hPa. Through satellite observations and analysis, we make the connection between these in situ water measurements and overshooting cloud tops. The overshooting tops (OT) are identified from a SEAC4RS OT detection product based on satellite infrared window channel brightness temperature gradients. Back-trajectory analysis ties enhanced water to OT one to seven days prior to the intercept by the aircraft. The trajectory paths are dominated by the North American Monsoon (NAM) anticyclonic circulation. This connection suggests that ice is convectively transported to the overworld stratosphere in OT events and subsequently sublimated; such events may irreversibly enhance stratospheric water vapor in the summer over Mexico and the United States. Regional context is provided by water observations from the Aura Microwave Limb Sounder (MLS).

  11. Enhanced stratospheric water vapor over the summertime continental United States and the role of overshooting convection

    Science.gov (United States)

    Herman, Robert L.; Ray, Eric A.; Rosenlof, Karen H.; Bedka, Kristopher M.; Schwartz, Michael J.; Read, William G.; Troy, Robert F.; Chin, Keith; Christensen, Lance E.; Fu, Dejian; Stachnik, Robert A.; Bui, T. Paul; Dean-Day, Jonathan M.

    2017-05-01

    The NASA ER-2 aircraft sampled the lower stratosphere over North America during the field mission for the NASA Studies of Emissions and Atmospheric Composition, Clouds and Climate Coupling by Regional Surveys (SEAC4RS). This study reports observations of convectively influenced air parcels with enhanced water vapor in the overworld stratosphere over the summertime continental United States and investigates three case studies in detail. Water vapor mixing ratios greater than 10 ppmv, which is much higher than the background 4 to 6 ppmv of the overworld stratosphere, were measured by the JPL Laser Hygrometer (JLH Mark2) at altitudes between 16.0 and 17.5 km (potential temperatures of approximately 380 to 410 K). Overshooting cloud tops (OTs) are identified from a SEAC4RS OT detection product based on satellite infrared window channel brightness temperature gradients. Through trajectory analysis, we make the connection between these in situ water measurements and OT. Back trajectory analysis ties enhanced water to OT 1 to 7 days prior to the intercept by the aircraft. The trajectory paths are dominated by the North American monsoon (NAM) anticyclonic circulation. This connection suggests that ice is convectively transported to the overworld stratosphere in OT events and subsequently sublimated; such events may irreversibly enhance stratospheric water vapor in the summer over Mexico and the United States. A regional context is provided by water observations from the Aura Microwave Limb Sounder (MLS).

  12. The role of Clinical Trial Units in investigator- and industry-initiated research projects.

    Science.gov (United States)

    von Niederhäusern, Belinda; Fabbro, Thomas; Pauli-Magnus, Christiane

    2015-01-01

    Six multidisciplinary competence centres (Clinical Trial Units, CTUs) in Basel, Berne, Geneva, Lausanne, St. Gallen and Zurich provide professional support to clinical researchers in the planning, implementation, conduct and evaluation of clinical studies. Through their coordinated network, these units promote high-quality, nationally harmonised and internationally standardised clinical research conduct in Switzerland. We will describe why this network has been established, how it has been successful in stilling the growing need for clinical research support, which training and education opportunities it offers, and how it created national awareness for the still-existing hurdles towards clinical research excellence in Switzerland. Taking the CTU Basel as an example, we show that a considerable number (25%) of the studies submitted for regulatory approval in 2013 were supported by the CTU, decreasing the number of findings in ethics reviews by about one-third. We conclude that these achievements, together with a Swiss national funding model for clinical research, and improved national coordination, will be critical factors to successfully position Swiss clinical research at the international forefront.

  13. Manual hyperinflation and the role of physical therapy in intensive care and emergency units

    Directory of Open Access Journals (Sweden)

    Rafael Vinícius Santos Cruz

    Full Text Available Abstract Introduction: Although manual hyperinflation (MHI is a physical therapy technique commonly used in intensive care and emergency units, there is little consensus about its use. Objective: To investigate the knowledge of physical therapists working in intensive care and emergency units about manual hyperinflation. Methods: Data were collected through self-administered questionnaires on manual hyperinflation. Data collection took place between September 2014 and January 2015, in Itabuna and Ilhéus, Bahia, Brazil. Results: The study sample was composed of 32 physical therapists who had between 4 months and 10 years working experience. All respondents affirmed that they used the technique in their professional practice. However, only 34.4% reported it to be a routine practice. 90.6% stated that the most common patient position during manual hyperinflation is “supine”. Participants were almost unanimous (93.8% in citing secretion removal and cough stimulation as perceived benefits of MHI. High peak airway pressure was identified as being a precaution to treatment with MHI by 84.4% of participants, whilst 100% of the sample agreed that an undrained pneumothorax was a contraindication to MHI. Conclusion: The most common answers to the questionnaire were: supine position during MHI; secretion removal and cough stimulation as perceived benefits; high peak airway pressure as a precaution; and an undrained pneumothorax as a contraindication.

  14. Role of pattern recognition receptors of the neurovascular unit in inflamm-aging.

    Science.gov (United States)

    Wilhelm, Imola; Nyúl-Tóth, Ádám; Kozma, Mihály; Farkas, Attila E; Krizbai, István A

    2017-11-01

    Aging is associated with chronic inflammation partly mediated by increased levels of damage-associated molecular patterns, which activate pattern recognition receptors (PRRs) of the innate immune system. Furthermore, many aging-related disorders are associated with inflammation. PRRs, such as Toll-like receptors (TLRs) and nucleotide-binding oligomerization domain-like receptors (NLRs), are expressed not only in cells of the innate immune system but also in other cells, including cells of the neurovascular unit and cerebral vasculature forming the blood-brain barrier. In this review, we summarize our present knowledge about the relationship between activation of PRRs expressed by cells of the neurovascular unit-blood-brain barrier, chronic inflammation, and aging-related pathologies of the brain. The most important damage-associated molecular pattern-sensing PRRs in the brain are TLR2, TLR4, and NLR family pyrin domain-containing protein-1 and pyrin domain-containing protein-3, which are activated during physiological and pathological aging in microglia, neurons, astrocytes, and possibly endothelial cells and pericytes. Copyright © 2017 the American Physiological Society.

  15. Shelter from the Storm: Roles, responsibilities, and challenges in United States housing policy governance.

    Science.gov (United States)

    Willison, Charley

    2017-11-01

    Housing is a critical social determinant of health. Housing policy not only affects health by improving housing quality, affordability, and insecurity; housing policy affects health upstream through the politics that shape housing policy design, implementation, and management. These politics, or governance strategies, determine the successes or failures of housing policy programs. This paper is an overview of challenges in housing policy governance in the United States. I examine the important relationship between housing and health, and emphasize why studying housing policy governance matters. I then present three cases of housing governance challenges in the United States, from each pathway by which housing affects health - housing quality, affordability, and insecurity. Each case corresponds to an arm of the TAPIC framework for evaluating governance (Krieger and Higgins) [1], to assess mechanisms of housing governance in each case. While housing governance has come a long way over the past century, political decentralization and the expansion of the submerged state have increased the number of political actors and policy conflict in many areas. This creates inherent challenges for improving accountability, transparency, and policy capacity. In many instances, too, reduced government accountability and transparency increases the risk of harm to the public and lessens governmental integrity. Copyright © 2017 The Author. Published by Elsevier B.V. All rights reserved.

  16. Information contracting tools in a cancer specialist unit:the role of Healthcare Resource Groups (HRGs

    Directory of Open Access Journals (Sweden)

    Carol Marlow

    1998-01-01

    Full Text Available The need for high quality management information within the contracting process has driven many of the major developments in health service computing. These have often merged clinical and financial requirements, usually along patient-centred lines. In order to identify a common currency for a range of clinical activities that are inherently variable, price tariffs have been drawn up on the basis of 'episodes of care' within specialties. Healthcare Resource Groups (HRGs were designed to meet the need for a common information currency. However, they were designed for acute care. The study on which this paper is based aims to examine their applicability to chronic care in a cancer specialist unit. The data were drawn from the patient information system within a major cancer unit. The focus of the investigation is encapsulated in the following questions: a Do HRGs really work as a grouping and costing methodology? b How relevant are HRG classifications for long-term patient care? The investigation demonstrated that not all HRGs are iso-resource within this environment. The findings from the data analysis are echoed by the NHS Executive's own evaluation . This does not negate advantages in their use. Furthermore, the development of Health Benefit Groups as information management tools, through a focus on health conditions and interventions rather than on purely on treatments, offers potential for greater validity within a chronic care situation.

  17. A regulatory perspective of the role of construction in revitalizing the United States nuclear industry

    International Nuclear Information System (INIS)

    Stello, V. Jr.

    1983-01-01

    Technical and managerial experience in nuclear power plant construction is presented from the perspective of the United States Nuclear Regulatory Commission (NRC). In the context of actions that would contribute to revitalizing the nuclear industry in the United States of America, greater effectiveness of utility management during construction is proposed. The reasons why management effectiveness is so important are developed beginning with summaries of defects that were built into several US plants under construction. The root causes of these significant defects were management failures. In terms of benefits, effective management is important because of its effects on nuclear safety, project construction costs, and future reliability of the plant after commissioning. Actions that would enhance good management include emphasizing the inseparable nature of production and quality, that quality cannot be inspected into a plant, and that a strong construction management staff and exchanges of experience and information are essential. Techniques that have been used successfully in construction management are discussed. NRC and industry initiatives are in progress to improve management responsibility and learning from experience. Projects include Owner's Certification, assessments of licensee performance, fostering good practices across the industry, and improving the NRC inspection programme. Revitalization will not be easy, but it is achievable. (author)

  18. Role of the United States Military in Panama Beyond 2000 A.D.

    Science.gov (United States)

    1991-11-15

    national debt, deregulates the labor market, removes industrial protectionism, minimizes state interference in the market, lowers the high cost of...34Presentation to Asociacion Panamae na de Ejecutivos de Empresa ," Director J.S.A.I.D., Panama, 14 November 1990. 25 CHAPTER VII U.S. MILITARY’S ROLE IN...effort. For Panama, the continued U.S. presence at these bases would create jobs, stimulate small industry growth and enhance Panamanian

  19. The role of the negative selection activities in securing the competence of an organization belonging to SEN units

    International Nuclear Information System (INIS)

    Boruga, Carmen

    2008-01-01

    The transformation and the accommodation of National Power System (SEN) units to a new management system, own to a decentralized economy and having financial support from both native capital and foreign capital, in uncertain proportion at the moment and being in a continuous adjustment determined by the reasons and the motivations first of all political, generated conceptual changes in the so-called modern management theory. The accommodation of this theory to the concrete situation from SEN units imposed the concept of negative selection. It is a concept which represents author's desire to be created as an original contribution to the contemporary management theory. Unlike the selection at the hiring (or positive selection), the negative selection is achieved on personal already employed, in the conditions of activities of a decreased number of personnel and also of a redistribution of personnel on the other side. The negative selection, much more than the positive selection activity in this period in the SEN units (recording a drastic decrease from 90.000 employees counted by the energetic system at the end of 9th decade of the past century, to a little over 30.000 who at the moment work in the societies became independent), determines the specialist in human resources to ensure a judicious training and high competence. It concerns the knowledge of the standard systems and is also related to the method of knowledge and valuation of behavior of the organizational employees. This subject was developed on basis of the documentation and the analyses of documents but also on the basis of a set of studies and researches that were made during 1996-2006 in the SEN units. The work methods and models of negative selection used in the SEN units were analysed. This work concerns four companies which constitute currently the SEN nucleus at present at which the nuclear units with a particular status were added. One finds out that these methods and models of negative selection

  20. Multiple role occupancy and social participation among midlife wives and husbands in the United Kingdom.

    Science.gov (United States)

    Glaser, Karen; Evandrou, Maria; Tomassini, Cecilia

    2006-01-01

    We investigated the relationship between intensive multiple role occupancy and one key dimension of well-being, social participation (i.e., frequency of participation in social and leisure activities and meeting friends or relatives). Moreover, we examined gender differences in the association between individual, spousal and couple intensive multiple role commitments and individual social participation. Our research is based on a sample of mid-life wives (45-59) and their husbands from the 2000 British Household Panel Study (BHPS). Our findings show that, among wives whose husbands were providing care to a dependent for 20 or more hours a week, there was a negative association with social and leisure activity participation, whereas husbands' level of participation in social and leisure activities was higher if their wives were in full-time paid work. We also found lower odds of meeting friends or relatives among wives and husbands in full-time employment, and higher odds of meeting friends and relatives among wives providing care for 20 or more hours a week. Our results will aid policy thinking in addressing how people can be best supported to balance work and family commitments in order to optimize different dimensions of well-being in later life and help alleviate the pressures associated with multiple-role occupancy in mid-life.

  1. Challenges of pain control and the role of the ambulatory pain specialist in the outpatient surgery setting

    Directory of Open Access Journals (Sweden)

    Vadivelu N

    2016-06-01

    Full Text Available Nalini Vadivelu,1 Alice M Kai,2 Vijay Kodumudi,3 Jack M Berger4 1Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, 2Stony Brook University School of Medicine, Stony Brook, NY, 3Department of Molecular and Cell Biology, College of Liberal Arts and Sciences, University of Connecticut, Storrs, CT, 4Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA Abstract: Ambulatory surgery is on the rise, with an unmet need for optimum pain control in ambulatory surgery centers worldwide. It is important that there is a proportionate increase in the availability of acute pain-management services to match the rapid rise of clinical patient load with pain issues in the ambulatory surgery setting. Focus on ambulatory pain control with its special challenges is vital to achieve optimum pain control and prevent morbidity and mortality. Management of perioperative pain in the ambulatory surgery setting is becoming increasingly complex, and requires the employment of a multimodal approach and interventions facilitated by ambulatory surgery pain specialists, which is a new concept. A focused ambulatory pain specialist on site at each ambulatory surgery center, in addition to providing safe anesthesia, could intervene early once problematic pain issues are recognized, thus preventing emergency room visits, as well as readmissions for uncontrolled pain. This paper reviews methods of acute-pain management in the ambulatory setting with risk stratification, the utilization of multimodal interventions, including pharmacological and nonpharmacological options, opioids, nonopioids, and various routes with the goal of preventing delayed discharge and unexpected hospital admissions after ambulatory surgery. Continued research and investigation in the area of pain management with outcome studies in acute surgically inflicted pain in patients with underlying chronic pain treated with

  2. The Role of Parliaments in Times of Transition: The Impact of Participatory Politics on Social Cohesion and the Quality of Governance in Post-Authoritarian Settings

    DEFF Research Database (Denmark)

    Afsah, Ebrahim

    The Role of Parliaments in Times of Transition: The Impact of Participatory Politics on Social Cohesion and the Quality of Governance in Post-Authoritarian Settings This contribution presents the theoretical basis for the normative preference given to electoral politics and investigates the insti......The Role of Parliaments in Times of Transition: The Impact of Participatory Politics on Social Cohesion and the Quality of Governance in Post-Authoritarian Settings This contribution presents the theoretical basis for the normative preference given to electoral politics and investigates...... the institutional prerequisites if competitive electoral politics are to lead to better governance outcomes and greater social stability. Examining why these preconditions are largely lacking in the Arab world, this contribution investigates what could be done to redress these shortcomings....

  3. Surviving the Lead Reliability Engineer Role in High Unit Value Projects

    Science.gov (United States)

    Perez, Reinaldo J.

    2011-01-01

    A project with a very high unit value within a company is defined as a project where a) the project constitutes one of a kind (or two-of-a-kind) national asset type of project, b) very large cost, and c) a mission failure would be a very public event that will hurt the company's image. The Lead Reliability engineer in a high visibility project is by default involved in all phases of the project, from conceptual design to manufacture and testing. This paper explores a series of lessons learned, over a period of ten years of practical industrial experience by a Lead Reliability Engineer. We expand on the concepts outlined by these lessons learned via examples. The lessons learned are applicable to all industries.

  4. The World Health Organization Global Health Emergency Workforce: What Role Will the United States Play?

    Science.gov (United States)

    Burkle, Frederick M

    2016-08-01

    During the May 2016 World Health Assembly of 194 member states, the World Health Organization (WHO) announced the process of developing and launching emergency medical teams as a critical component of the global health workforce concept. Over 64 countries have either launched or are in the development stages of vetting accredited teams, both international and national, to provide surge support to national health systems through WHO Regional Organizations and the delivery of emergency clinical care to sudden-onset disasters and outbreak-affected populations. To date, the United States has not yet committed to adopting the emergency medical team concept in funding and registering an international field hospital level team. This article discusses future options available for health-related nongovernmental organizations and the required educational and training requirements for health care provider accreditation. (Disaster Med Public Health Preparedness. 2016;10:531-535).

  5. Successful global assessments and monitoring: The roles of the international community and the United States

    International Nuclear Information System (INIS)

    Lund, H.G.

    1991-01-01

    Successful global assessments and monitoring of natural resources requires teamwork between participating nations and the international communities charged with the responsibility for collecting and disseminating information. In an attempt to identify emerging information needs and to promote coordination, the International Union of Forestry Research Organizations (IUFRO) and other national and international groups held a major conference and workshop in Venice, Italy, on global monitoring last September. The results of the meeting and subsequent events in Montreal indicated a need for more aggressive leadership at the international level and more cooperation at the national level. This paper reports on the outcome of the Venice conference and list some things that the international community and the United States must do to make global assessments and monitoring a reality

  6. THE ROLE OF ECONOMIC EFFICIENCY OF ACCOMMODATION UNITS IN DETERMINATION OF PURCHASE INTENTIONS OF TOURIST SERVICES

    Directory of Open Access Journals (Sweden)

    Simona Cristina Martin

    2014-10-01

    Full Text Available The indicators of demand distribution for various types of accommodation provide information regarding changing tourist preferences for different ways of tourist accommodation. Appreciation of economic efficiency for hotels activity is done through quantitative results obtained in accommodation units. For this purpose it uses, currently, a partial or synthetic indicators system. Taking into account the fact that, in appreciation of hotel business, it must start from the premise that it may not be fully reflected only in terms of economic results, but also through social results, appear obvious the need to maintain costs at a level that satisfies both requirements at the same time. Achieving superior social-financial indicators, remains one of the main goals also in hotel activities, but do not be overlooked the fact that it is necessary that these indicators must be obtained by ensuring a higher level of satisfaction of consumers requirements. Only simultaneous achievement of these two objectives can provide raising efficiency in accommodation sector.

  7. Staff satisfaction and retention and the role of the nursing unit manager.

    Science.gov (United States)

    Duffield, Christine; Roche, Michael; O'Brien-Pallas, Linda; Catling-Paull, Christine; King, Madeleine

    2009-01-01

    Despite recent increases in nursing recruitment in Australia, participation in the workforce is still below the numbers predicted to meet future needs. This paper discusses factors impacting on nurses' job satisfaction, satisfaction with nursing and intention to leave in public sector hospitals in New South Wales (NSW), Australia. Staffing and patient data were collected on 80 medical and surgical units during 2004/5. This included a wide range of individual nurse data from a Nurse Survey; detailed and comprehensive staffing data including skill mix variables; patient characteristics; workload data; a profile of the ward's characteristics; and adverse event patient data. Nurses who were intending to remain in their job were more likely to be satisfied, be older, and have dependents. They were also likely to be experiencing good leadership and to have allied health support on the ward. Most nurses reported being satisfied with their profession, while a lower proportion reported satisfaction with their current position. Work environment factors such as nurses' autonomy, control over their practice and nursing leadership on the ward were statistically significant predictors of job satisfaction. This study will inform decision-making and policy for managers in both the public and private hospital sectors. This is the first large study which explored the work environment at the ward/unit level in public hospitals in NSW (Australia). It illustrates that there are no typical wards; each ward functions differently. The importance of nursing leadership at the ward level to job satisfaction, satisfaction with nursing and intention to leave, cannot be overstated.

  8. Serratia marcescens outbreak in a neonatal intensive care unit: crucial role of implementing hand hygiene among external consultants.

    Science.gov (United States)

    Montagnani, Carlotta; Cocchi, Priscilla; Lega, Laura; Campana, Silvia; Biermann, Klaus Peter; Braggion, Cesare; Pecile, Patrizia; Chiappini, Elena; de Martino, Maurizio; Galli, Luisa

    2015-01-13

    Serratia marcescens represents an important pathogen involved in hospital acquired infections. Outbreaks are frequently reported and are difficult to eradicate. The aim of this study is to describe an outbreak of Serratia marcescens occurred from May to November 2012 in a neonatal intensive care unit, to discuss the control measures adopted, addressing the role of molecular biology in routine investigations during the outbreak. After an outbreak of Serratia marcescens involving 14 neonates, all admitted patients were screened for rectal and ocular carriage every two weeks. Extensive environmental sampling procedure and hand sampling of the staff were performed. Antimicrobial susceptibility pattern and molecular analysis of isolates were carried out. Effective hand hygiene measures involving all the external consultants has been implemented. Colonized and infected babies were cohorted. Dedicated staff was established to care for the colonized or infected babies. During the surveillance, 65 newborns were sampled obtaining 297 ocular and rectal swabs in five times. Thirty-four Serratia marcescens isolates were collected: 11 out of 34 strains were isolated from eyes, being the remaining 23 isolated from rectal swabs. Two patients presented symptomatic conjunctivitis. Environmental and hand sampling resulted negative. During the fifth sampling procedure no colonized or infected patients have been identified. Two different clones have been identified. Ocular and rectal colonization played an important role in spread of infections. Implementation of infection control measures, involving also external specialists, allowed to control a serious Serratia marcescens outbreak in a neonatal intensive care unit.

  9. The role of resting duration in the kinematic pattern of two consecutive bench press sets to failure in elite sprint kayakers.

    Science.gov (United States)

    García-López, D; Herrero, J A; Abadía, O; García-Isla, F J; Ualí, I; Izquierdo, M

    2008-09-01

    This study aimed to investigate the role of rest period duration (RP) on the time course of the acceleration portion (AP) and mean velocity of the concentric phase across two bench press sets to failure with a submaximal load (60% of the 1RM) using different RP. Ten elite junior kayakers performed, on four different days, two consecutive bench press sets to failure, allowing randomly 1-, 2-, 3- and 4-min RP between sets. AP reached a maximal value of 66% of the concentric movement time. This maximal AP was observed in repetition number 2 or 3, and then AP declined during the set, with a significant decrease when the number of repetitions was over 80% of the total number of repetitions performed. AP and lifting velocity patterns of the concentric phase were not altered during a second set to failure, regardless of RP. However, when velocity was expressed in absolute terms, 1-min RP was insufficient to maintain the average lifting velocity during the second set, compared to the first one. These results may be of use in selecting number of repetitions and resting duration in order to ensure optimal maintenance of the accelerative portion of concentric movement time with different resting-period durations.

  10. Relationships between work unit climate and labour productivity in the financial sector: A longitudinal test of the mediating role of work satisfaction

    NARCIS (Netherlands)

    Voorde, F.C. van de; Veldhoven, M.J.P.M. van; Paauwe, J.

    2014-01-01

    This study is designed to test the mediating role of work satisfaction in the relationship between work unit climate and labour productivity. Two work unit climate facets are examined: goals and service orientation. Longitudinal data obtained from more than 14,000 employees in 171 branches of a

  11. Relationships between work unit climate and labour productivity in the financial sector : A longitudinal test of the mediating role of work satisfaction

    NARCIS (Netherlands)

    van de Voorde, F.C.; van Veldhoven, M.J.P.M.; Paauwe, J.

    2014-01-01

    This study is designed to test the mediating role of work satisfaction in the relationship between work unit climate and labour productivity. Two work unit climate facets are examined: goals and service orientation. Longitudinal data obtained from more than 14,000 employees in 171 branches of a

  12. Intersections between polyvictimisation and mental health among adolescents in five urban disadvantaged settings: the role of gender

    Directory of Open Access Journals (Sweden)

    Mphatso Kamndaya

    2017-07-01

    Full Text Available Abstract Background Polyvictimisation (PV – exposure to violence across multiple contexts – causes considerable morbidity and mortality among adolescents. Despite high levels of violence in urban disadvantaged settings, gender differences in associations between PV and mental health have not been well established. Methods We analysed data from a survey with 2393 adolescents aged 15-19 years, recruited using respondent-driven sampling from urban disadvantaged settings in Baltimore (USA, Delhi (India, Ibadan (Nigeria, Johannesburg (South Africa and Shanghai (China. PV was defined as exposure to two or more types of violence in the past 12 months with family, peers, in the community, or from intimate partners and non-partner sexual violence. Weighted logistic regression models are presented by gender to evaluate whether PV is associated with posttraumatic stress, depression, suicidal thoughts and perceived health status. Results PV was extremely common overall, but ranged widely, from 74.5% of boys and 82.0% of girls in Johannesburg, to 25.8 and 23.9% respectively in Shanghai. Community violence was the predominant violence type, affecting 72.8–93.7% across the sites. More than half of girls (53.7% and 45.9% of boys had at least one adverse mental health outcome. Compared to those that did not report violence, boys exposed to PV had 11.4 higher odds of having a negative perception of health (95%CI adjusted OR = 2.45-53.2, whilst this figure was 2.58 times in girls (95%CI = 1.62-4.12. Among girls, PV was associated with suicidal thoughts (adjusted OR = 4.68; 95%CI = 2.29-9.54, posttraumatic stress (aOR = 4.53; 95%CI = 2.44-8.41 and depression (aOR = 2.65; 95%CI = 1.25-5.63. Among boys, an association was only detected between PV and depression (aOR = 1.82; 95%CI = 1.00-3.33. Conclusion The findings demonstrate that PV is common among both sexes in urban disadvantaged settings across the world, and that it is associated

  13. Intersections between polyvictimisation and mental health among adolescents in five urban disadvantaged settings: the role of gender.

    Science.gov (United States)

    Kamndaya, Mphatso; Pisa, Pedro T; Chersich, Matthew F; Decker, Michele R; Olumide, Adesola; Acharya, Rajib; Cheng, Yan; Brahmbhatt, Heena; Delany-Moretlwe, Sinead

    2017-07-04

    Polyvictimisation (PV) - exposure to violence across multiple contexts - causes considerable morbidity and mortality among adolescents. Despite high levels of violence in urban disadvantaged settings, gender differences in associations between PV and mental health have not been well established. We analysed data from a survey with 2393 adolescents aged 15-19 years, recruited using respondent-driven sampling from urban disadvantaged settings in Baltimore (USA), Delhi (India), Ibadan (Nigeria), Johannesburg (South Africa) and Shanghai (China). PV was defined as exposure to two or more types of violence in the past 12 months with family, peers, in the community, or from intimate partners and non-partner sexual violence. Weighted logistic regression models are presented by gender to evaluate whether PV is associated with posttraumatic stress, depression, suicidal thoughts and perceived health status. PV was extremely common overall, but ranged widely, from 74.5% of boys and 82.0% of girls in Johannesburg, to 25.8 and 23.9% respectively in Shanghai. Community violence was the predominant violence type, affecting 72.8-93.7% across the sites. More than half of girls (53.7%) and 45.9% of boys had at least one adverse mental health outcome. Compared to those that did not report violence, boys exposed to PV had 11.4 higher odds of having a negative perception of health (95%CI adjusted OR = 2.45-53.2), whilst this figure was 2.58 times in girls (95%CI = 1.62-4.12). Among girls, PV was associated with suicidal thoughts (adjusted OR = 4.68; 95%CI = 2.29-9.54), posttraumatic stress (aOR = 4.53; 95%CI = 2.44-8.41) and depression (aOR = 2.65; 95%CI = 1.25-5.63). Among boys, an association was only detected between PV and depression (aOR = 1.82; 95%CI = 1.00-3.33). The findings demonstrate that PV is common among both sexes in urban disadvantaged settings across the world, and that it is associated with poor mental health outcomes in girls, and with poor

  14. Perception of community pharmacists toward their current professional role in the healthcare system of Dubai, United Arab Emirates.

    Science.gov (United States)

    Rayes, Ibrahim Khalid; Hassali, Mohamed Azmi; Abduelkarem, Abduelmula R

    2015-07-01

    The new paradigm to pharmacy profession has changed the focus of pharmacists from product-centered to patient-oriented. This change has brought new set of beliefs and assumptions on the way services should be delivered to pharmacy clients. The main aim of this study was to explore the perception of community pharmacists on their current professional role in Dubai. Key findings show that community pharmacists are more directed toward business than patients. They almost dispense all categories of medicines over-the-counter without the need of prescriptions. However, a new trend of pharmacists in Dubai is to provide enhanced pharmacy services such as consultation to patients upon request.

  15. Intensive symptom control of opioid-refractory dyspnea in congestive heart failure: Role of milrinone in the palliative care unit.

    Science.gov (United States)

    Silvestre, Julio; Montoya, Maria; Bruera, Eduardo; Elsayem, Ahmed

    2015-12-01

    We describe an exemplary case of congestive heart failure (CHF) symptoms controlled with milrinone. We also analyze the benefits and risks of milrinone administration in an unmonitored setting. We describe the case of a patient with refractory leukemia and end-stage CHF who developed severe dyspnea after discontinuation of milrinone. At that point, despite starting opioids, she had been severely dyspneic and anxious, requiring admission to the palliative care unit (PCU) for symptom control. After negotiation with hospital administrators, milrinone was administered in an unmonitored setting such as the PCU. A multidisciplinary team approach was also provided. Milrinone produced a dramatic improvement in the patient's symptom scores and performance status. The patient was eventually discharged to home hospice on a milrinone infusion with excellent symptom control. This case suggests that milrinone may be of benefit for short-term inpatient administration for dyspnea management, even in unmonitored settings and consequently during hospice in do-not-resuscitate (DNR) patients. This strategy may reduce costs and readmissions to the hospital related to end-stage CHF.

  16. Interprofessional Simulations Promote Knowledge Retention and Enhance Perceptions of Teamwork Skills in a Surgical-Trauma-Burn Intensive Care Unit Setting.

    Science.gov (United States)

    George, Katie L; Quatrara, Beth

    The current state of health care encompasses highly acute, complex patients, managed with ever-changing technology. The ability to function proficiently in critical care relies on knowledge, technical skills, and interprofessional teamwork. Integration of these factors can improve patient outcomes. Simulation provides "hands-on" practice and allows for the integration of teamwork into knowledge/skill training. However, simulation can require a significant investment of time, effort, and financial resources. The Institute of Medicine recommendations from 2015 include "strengthening the evidence base for interprofessional education (IPE)" and "linking IPE with changes in collaborative behavior." In one surgical-trauma-burn intensive care unit (STBICU), no IPE existed. The highly acute and diverse nature of the patients served by the unit highlights the importance of appropriate training. This is heightened during critical event situations where patients deteriorate rapidly and the team intervenes swiftly. The aims of this study were to (1) evaluate knowledge retention and analyze changes in perceptions of teamwork among nurses and resident physicians in a STBICU setting after completion of an interprofessional critical event simulation and (2) provide insight for future interprofessional simulations (IPSs), including the ideal frequency of such training, associated cost, and potential effect on nursing turnover. A comparison-cohort pilot study was developed to evaluate knowledge retention and analyze changes in perceptions of teamwork. A 1-hour critical event IPS was held for nurses and resident physicians in a STBICU setting. A traumatic brain injury patient with elevated intracranial pressure, rapid deterioration, and cardiac arrest was utilized for the simulation scenario. The simulation required the team to use interventions to reduce elevated intracranial pressure and then perform cardiac resuscitation according to Advanced Cardiac Life Support guidelines. A

  17. Comparative Simulation Study of Glucose Control Methods Designed for Use in the Intensive Care Unit Setting via a Novel Controller Scoring Metric.

    Science.gov (United States)

    DeJournett, Jeremy; DeJournett, Leon

    2017-11-01

    Effective glucose control in the intensive care unit (ICU) setting has the potential to decrease morbidity and mortality rates and thereby decrease health care expenditures. To evaluate what constitutes effective glucose control, typically several metrics are reported, including time in range, time in mild and severe hypoglycemia, coefficient of variation, and others. To date, there is no one metric that combines all of these individual metrics to give a number indicative of overall performance. We proposed a composite metric that combines 5 commonly reported metrics, and we used this composite metric to compare 6 glucose controllers. We evaluated the following controllers: Ideal Medical Technologies (IMT) artificial-intelligence-based controller, Yale protocol, Glucommander, Wintergerst et al PID controller, GRIP, and NICE-SUGAR. We evaluated each controller across 80 simulated patients, 4 clinically relevant exogenous dextrose infusions, and one nonclinical infusion as a test of the controller's ability to handle difficult situations. This gave a total of 2400 5-day simulations, and 585 604 individual glucose values for analysis. We used a random walk sensor error model that gave a 10% MARD. For each controller, we calculated severe hypoglycemia (140 mg/dL), and coefficient of variation (CV), as well as our novel controller metric. For the controllers tested, we achieved the following median values for our novel controller scoring metric: IMT: 88.1, YALE: 46.7, GLUC: 47.2, PID: 50, GRIP: 48.2, NICE: 46.4. The novel scoring metric employed in this study shows promise as a means for evaluating new and existing ICU-based glucose controllers, and it could be used in the future to compare results of glucose control studies in critical care. The IMT AI-based glucose controller demonstrated the most consistent performance results based on this new metric.

  18. Adolescents' sense-making of alcohol-related risks: The role of drinking situations and social settings.

    Science.gov (United States)

    Katainen, Anu; Lehto, Anna-Sofia; Maunu, Antti

    2015-09-01

    The article explores how young people understand the risks of alcohol use and how these understandings are associated with differing drinking situations and social settings. By taking account of situational factors, the aim is to demonstrate how young people have highly nuanced notions of drinking styles that suit different drinking situations and of associated risks. The data for the research were gathered in 18 group interviews with Finnish ninth graders aged 14-15 years. Short film clips portraying young people in different drinking situations were used as stimulus material for the interviews. Data analysis focussed on the risk factors related to the social situations illustrated in the film clips. The results show that young people's risk assessments are not based on alcohol itself, but the magnitude of risk is estimated in relation to the social setting of the drinking situation. What is relevant for young people is whether the social situation allows them to make choices with which they feel comfortable. At the opposite pole of problem drinking was social drinking for the purpose of having fun together with other people in such a way that one remains in control of the drinking situation. From a prevention point of view, a key implication is that awareness of the risks is closely associated with situational and social factors. However, the awareness of those risks does not necessarily prevent young people from drinking because they may be accepted as part of the drinking experience. © The Author(s) 2014.

  19. The Community Role of Schools in Jicamarca and Villa El Salvador (Peru: Crosscutting Behavior Settings in Personal Networks

    Directory of Open Access Journals (Sweden)

    Isidro Maya-Jariego

    2018-03-01

    Full Text Available The personal networks of 138 parents of children participating in a child labor prevention initiative in three schools in Lima (Peru are analyzed. First, relevant behavior settings in two informal population settlements in the periphery of the big city were detected. Second, the distribution of personal relationships in that small set of community contexts served to describe the everyday interaction in the neighborhood. Each interviewee provided information on the 45 persons with whom he/she interacts regularly, indicating in each case the context where that relationship preferably takes place. They also reported on the involvement of families in school and citizen participation initiatives in their community. The clustered graphs technique showed that the school is the second most relevant space for the development of interpersonal relationships in the neighborhood. Relationships among different family households were the most powerful predictor of community integration in the neighborhood of residence. The highest rates of child labor coincide with the most recently created community environments, with more fragmented personal networks, and with a less structured community as a whole. School is a community hub that facilitates interaction between the families of the neighborhood and connect to value resources outside of their usual place of residence.

  20. Emotion and Exclusion: Key Ideas from Vygotsky to Review our Role in a School with a Cultural Diversity Setting

    Directory of Open Access Journals (Sweden)

    Enrique Riquelme MELLA

    Full Text Available ABSTRACT: Research demonstrates that minorities' children diagnosed with Emotional and Behavioural Disorders is overrepresented, being the ethnic minorities the most affected. The diagnostics have resulted in racism and discrimination. This article reflects upon the necessity to develop more integrated and dynamic models of inclusion for the schools. Based on Vygotsky´s ideas, a reflexion is done regarding the emotional education in schools, specifically about the need to include -in the teacher formation- the main role of the culture emotional rules in the dynamic of exclusion/inclusion of minorities. The article concludes with proposals to be considered for a culturally sensible vision on inclusion.

  1. The rise of pathophysiologic research in the United States: the role of two Harvard hospitals.

    Science.gov (United States)

    Tishler, Peter V

    2013-01-01

    Pathophysiologic research, the major approach to understanding and treating disease, was created in the 20th century, and two Harvard-affiliated hospitals, the Peter Bent Brigham Hospital and Boston City Hospital, played a key role in its development. After the Flexner Report of 1910, medical students were assigned clinical clerkships in teaching hospitals. Rockefeller-trained Francis Weld Peabody, who was committed to investigative, pathophysiologic research, was a critical leader in these efforts. At the Brigham, Harvard medical students observed patients closely and asked provocative questions about their diseases. Additionally, physicians returned from World War I with questions concerning the pathophysiology of wartime injuries. At the Boston City Hospital's new Thorndike Memorial Laboratory, Peabody fostered investigative question-based research by physicians. These physicians expanded pathophysiologic investigation from the 1920s. Post-war, Watson and Crick's formulation of the structure of DNA led shortly to modern molecular biology and new research approaches that are being furthered at the Boston Hospitals.

  2. Cities' Role in Mitigating United States Food System Greenhouse Gas Emissions.

    Science.gov (United States)

    Mohareb, Eugene A; Heller, Martin C; Guthrie, Peter M

    2018-05-15

    Current trends of urbanization, population growth, and economic development have made cities a focal point for mitigating global greenhouse gas (GHG) emissions. The substantial contribution of food consumption to climate change necessitates urban action to reduce the carbon intensity of the food system. While food system GHG mitigation strategies often focus on production, we argue that urban influence dominates this sector's emissions and that consumers in cities must be the primary drivers of mitigation. We quantify life cycle GHG emissions of the United States food system through data collected from literature and government sources producing an estimated total of 3800 kg CO 2 e/capita in 2010, with cities directly influencing approximately two-thirds of food sector GHG emissions. We then assess the potential for cities to reduce emissions through selected measures; examples include up-scaling urban agriculture and home delivery of grocery options, which each may achieve emissions reductions on the order of 0.4 and ∼1% of this total, respectively. Meanwhile, changes in waste management practices and reduction of postdistribution food waste by 50% reduce total food sector emissions by 5 and 11%, respectively. Consideration of the scale of benefits achievable through policy goals can enable cities to formulate strategies that will assist in achieving deep long-term GHG emissions targets.

  3. Social influence and adolescent health-related physical activity in structured and unstructured settings: role of channel and type.

    Science.gov (United States)

    Spink, Kevin S; Wilson, Kathleen S; Ulvick, Jocelyn

    2012-08-01

    Social influence channels (e.g., parents) and types (e.g., compliance) have each been related to physical activity independently, but little is known about how these two categories of influence may operate in combination. This study examined the relationships between various combinations of social influence and physical activity among youth across structured and unstructured settings. Adolescents (N=304), classified as high or low active, reported the social influence combinations they received for being active. Participants identified three channels and three types of influence associated with being active. For structured activity, compliance with peers and significant others predicted membership in the high active group (values of psocial influence, when examining health-related physical activity.

  4. Spatial Distribution of Dengue in a Brazilian Urban Slum Setting: Role of Socioeconomic Gradient in Disease Risk.

    Science.gov (United States)

    Kikuti, Mariana; Cunha, Geraldo M; Paploski, Igor A D; Kasper, Amelia M; Silva, Monaise M O; Tavares, Aline S; Cruz, Jaqueline S; Queiroz, Tássia L; Rodrigues, Moreno S; Santana, Perla M; Lima, Helena C A V; Calcagno, Juan; Takahashi, Daniele; Gonçalves, André H O; Araújo, Josélio M G; Gauthier, Kristine; Diuk-Wasser, Maria A; Kitron, Uriel; Ko, Albert I; Reis, Mitermayer G; Ribeiro, Guilherme S

    2015-01-01

    Few studies of dengue have shown group-level associations between demographic, socioeconomic, or geographic characteristics and the spatial distribution of dengue within small urban areas. This study aimed to examine whether specific characteristics of an urban slum community were associated with the risk of dengue disease. From 01/2009 to 12/2010, we conducted enhanced, community-based surveillance in the only public emergency unit in a slum in Salvador, Brazil to identify acute febrile illness (AFI) patients with laboratory evidence of dengue infection. Patient households were geocoded within census tracts (CTs). Demographic, socioeconomic, and geographical data were obtained from the 2010 national census. Associations between CTs characteristics and the spatial risk of both dengue and non-dengue AFI were assessed by Poisson log-normal and conditional auto-regressive models (CAR). We identified 651 (22.0%) dengue cases among 2,962 AFI patients. Estimated risk of symptomatic dengue was 21.3 and 70.2 cases per 10,000 inhabitants in 2009 and 2010, respectively. All the four dengue serotypes were identified, but DENV2 predominated (DENV1: 8.1%; DENV2: 90.7%; DENV3: 0.4%; DENV4: 0.8%). Multivariable CAR regression analysis showed increased dengue risk in CTs with poorer inhabitants (RR: 1.02 for each percent increase in the frequency of families earning ≤1 times the minimum wage; 95% CI: 1.01-1.04), and decreased risk in CTs located farther from the health unit (RR: 0.87 for each 100 meter increase; 95% CI: 0.80-0.94). The same CTs characteristics were also associated with non-dengue AFI risk. This study highlights the large burden of symptomatic dengue on individuals living in urban slums in Brazil. Lower neighborhood socioeconomic status was independently associated with increased risk of dengue, indicating that within slum communities with high levels of absolute poverty, factors associated with the social gradient influence dengue transmission. In addition, poor

  5. Variable Linezolid Exposure in Intensive Care Unit Patients-Possible Role of Drug-Drug Interactions.

    Science.gov (United States)

    Töpper, Christoph; Steinbach, Cathérine L; Dorn, Christoph; Kratzer, Alexander; Wicha, Sebastian G; Schleibinger, Michael; Liebchen, Uwe; Kees, Frieder; Salzberger, Bernd; Kees, Martin G

    2016-10-01

    Standard doses of linezolid may not be suitable for all patient groups. Intensive care unit (ICU) patients in particular may be at risk of inadequate concentrations. This study investigated variability of drug exposure and its potential sources in this population. Plasma concentrations of linezolid were determined by high-performance liquid chromatography in a convenience sample of 20 ICU patients treated with intravenous linezolid 600 mg twice daily. Ultrafiltration applying physiological conditions (pH 7.4/37°C) was used to determine the unbound fraction. Individual pharmacokinetic (PK) parameters were estimated by population PK modeling. As measures of exposure to linezolid, area under the concentration-time curve (AUC) and trough concentrations (Cmin) were calculated and compared with published therapeutic ranges (AUC 200-400 mg*h/L, Cmin 2-10 mg/L). Coadministered inhibitors or inducers of cytochrome P450 and/or P-glycoprotein were noted. Data from 18 patients were included into the PK evaluation. Drug exposure was highly variable (median, range: AUC 185, 48-618 mg*h/L, calculated Cmin 2.92, 0.0062-18.9 mg/L), and only a minority of patients had values within the target ranges (6 and 7, respectively). AUC and Cmin were linearly correlated (R = 0.98), and classification of patients (underexposed/within therapeutic range/overexposed) according to AUC or Cmin was concordant in 15 cases. Coadministration of inhibitors was associated with a trend to higher drug exposure, whereas 3 patients treated with levothyroxine showed exceedingly low drug exposure (AUC ∼60 mg*h/L, Cmin linezolid is highly variable and difficult to predict in ICU patients, and therapeutic drug monitoring seems advisable. PK drug-drug interactions might partly be responsible and should be further investigated; protein binding appears to be stable and irrelevant.

  6. [New container of sample: role in the reduction of bacterial contamination of standard platelet units].

    Science.gov (United States)

    Fehri, S; Tazi, I; Loukhmass, L; Benchemsi, N

    2006-12-01

    Bacterial contamination of unstable blood products constitutes today the most frequent infectious risk transmitted by blood transfusion. Platelet concentrates are often incrimineted. As responsible germs are in general of cutaneous origin, a sample procedure with diversion of the first 20 ml during blood donation is studied. The aim of this study is to evaluate the results of this technique on bacterial contamination rate of standard platelet units prepared at the regional blood transfusion center in Casablanca. A comparative study of two types of sample pockets is made: 500 Standard Platelet concentrates (CPS) are prepared after collection using standard triple bags (Baxter) (group 1) and 560 pockets of CPS were prepared after collection using triple bags with Sample Diversion Pouch sampling system for elimination of the first 20 ml of donation (Macopharma and Terumo) (group 2). The skin was disinfected in two times with alcohol 70%. The bacteriological study was made in the two groups at the third day of conservation. Six CPS of group 1 were contaminated, of which five were staphylococci coagulase negative and one bacillus sp. Six CPS of group 2 were contaminated, of which five were staphylococci coagulase negative and one staphylococcus aureus. The bacteria isolated were those of cutaneous flora at 100%. Diversion of first 20 ml of blood donation results in a 16.6% reduction in bacterial contamination of CPS (P>0.05). The non-significant reduction in the prevalence of the bacterial infection of CP formulates the problem of the indication of the sampling devices with derivation of first 20 ml during blood collection.

  7. EU Research and Innovation (R and I) in renewable energies: The role of the Strategic Energy Technology Plan (SET-Plan)

    Energy Technology Data Exchange (ETDEWEB)

    Hervas Soriano, Fernando [Joint Research Centre, Institute for Prospective Technological Studies, Edificio EXPO, c/ Inca Garcilaso 3, E-41092 Seville (Spain); Mulatero, Fulvio, E-mail: fulvio.mulatero@ec.europa.eu [Joint Research Centre, Institute for Prospective Technological Studies, Edificio EXPO, c/ Inca Garcilaso 3, E-41092 Seville (Spain)

    2011-06-15

    The SET-Plan established a strategy to use Research and Innovation (R and I) to green the EU energy sector while ensuring a secure supply and increasing EU competitiveness. The strategy sets clear objectives and programming plans and takes stock of existing initiatives in the energy sector, fosters a cooperative approach to R and I, introduces a high-level steering group (the SET-Plan Steering Group) to monitor progress, creates a dedicated information system (the SETIS) to fill the void in policy information and produces estimates of financial needs over the programming period. In this respect, the SET-Plan could serve as a blueprint for R and I strategies to tackle other societal challenges. To be effective, such strategies should further clarify the hierarchy of existing objectives and instruments, introduce specific instruments to pull the demand of new technologies, strengthen links with education and training policies and formalize links with the governance structures of existing initiatives. - Highlights: > This paper assesses the impact of the SET-Plan on EU renewable energy policy. > We analyze the degree of complementarity and duplication with existing initiatives. > We discuss the role of a new system of indicators (SETIS). > The analysis of financing reveals the existence of sizeable shortfalls. > Lessons for future similar initiatives are sketched.

  8. EU Research and Innovation (R and I) in renewable energies: The role of the Strategic Energy Technology Plan (SET-Plan)

    International Nuclear Information System (INIS)

    Hervas Soriano, Fernando; Mulatero, Fulvio

    2011-01-01

    The SET-Plan established a strategy to use Research and Innovation (R and I) to green the EU energy sector while ensuring a secure supply and increasing EU competitiveness. The strategy sets clear objectives and programming plans and takes stock of existing initiatives in the energy sector, fosters a cooperative approach to R and I, introduces a high-level steering group (the SET-Plan Steering Group) to monitor progress, creates a dedicated information system (the SETIS) to fill the void in policy information and produces estimates of financial needs over the programming period. In this respect, the SET-Plan could serve as a blueprint for R and I strategies to tackle other societal challenges. To be effective, such strategies should further clarify the hierarchy of existing objectives and instruments, introduce specific instruments to pull the demand of new technologies, strengthen links with education and training policies and formalize links with the governance structures of existing initiatives. - Highlights: → This paper assesses the impact of the SET-Plan on EU renewable energy policy. → We analyze the degree of complementarity and duplication with existing initiatives. → We discuss the role of a new system of indicators (SETIS). → The analysis of financing reveals the existence of sizeable shortfalls. → Lessons for future similar initiatives are sketched.

  9. Cross-cultural adjustment to the United States: The role of contextualized extraversion change

    Directory of Open Access Journals (Sweden)

    Mengqiao eLiu

    2015-10-01

    Full Text Available Personality traits can predict how well sojourners and expatriates adjust to new cultures, but the adjustment process remains largely unexamined. Based on recent findings that reveal personality traits predict as well as respond to life events and experiences, this research focuses on within-person change in contextualized extraversion and its predictive validity for cross-cultural adjustment in international students who newly arrived in U.S. colleges. We proposed that the initial level as well as the rate of change in school extraversion (i.e., contextualized extraversion that reflects behavioral tendency in school settings will predict cross-cultural adjustment, withdrawal cognitions, and school satisfaction. Latent growth modeling of three-wave longitudinal surveys of 215 new international students (54% female, Mage = 24 years revealed that the initial level of school extraversion significantly predicted cross-cultural adjustment, (lower withdrawal cognitions, and satisfaction, while the rate of change (increase in school extraversion predicted cross-cultural adjustment and (lower withdrawal cognitions. We further modeled global extraversion and cross-cultural motivation as antecedents and explored within-person change in school extraversion as a proximal factor that affects adjustment outcomes. The findings highlight the malleability of contextualized personality, and more importantly, the importance of understanding within-person change in contextualized personality in a cross-cultural adjustment context. The study points to more research that explicate the process of personality change in other contexts.

  10. Cross-cultural adjustment to the United States: the role of contextualized extraversion change.

    Science.gov (United States)

    Liu, Mengqiao; Huang, Jason L

    2015-01-01

    Personality traits can predict how well-sojourners and expatriates adjust to new cultures, but the adjustment process remains largely unexamined. Based on recent findings that reveal personality traits predict as well as respond to life events and experiences, this research focuses on within-person change in contextualized extraversion and its predictive validity for cross-cultural adjustment in international students who newly arrived in US colleges. We proposed that the initial level as well as the rate of change in school extraversion (i.e., contextualized extraversion that reflects behavioral tendency in school settings) will predict cross-cultural adjustment, withdrawal cognitions, and school satisfaction. Latent growth modeling of three-wave longitudinal surveys of 215 new international students (54% female, M age = 24 years) revealed that the initial level of school extraversion significantly predicted cross-cultural adjustment, (lower) withdrawal cognitions, and satisfaction, while the rate of change (increase) in school extraversion predicted cross-cultural adjustment and (lower) withdrawal cognitions. We further modeled global extraversion and cross-cultural motivation as antecedents and explored within-person change in school extraversion as a proximal factor that affects adjustment outcomes. The findings highlight the malleability of contextualized personality, and more importantly, the importance of understanding within-person change in contextualized personality in a cross-cultural adjustment context. The study points to more research that explicate the process of personality change in other contexts.

  11. Cross-cultural adjustment to the United States: the role of contextualized extraversion change

    Science.gov (United States)

    Liu, Mengqiao; Huang, Jason L.

    2015-01-01

    Personality traits can predict how well-sojourners and expatriates adjust to new cultures, but the adjustment process remains largely unexamined. Based on recent findings that reveal personality traits predict as well as respond to life events and experiences, this research focuses on within-person change in contextualized extraversion and its predictive validity for cross-cultural adjustment in international students who newly arrived in US colleges. We proposed that the initial level as well as the rate of change in school extraversion (i.e., contextualized extraversion that reflects behavioral tendency in school settings) will predict cross-cultural adjustment, withdrawal cognitions, and school satisfaction. Latent growth modeling of three-wave longitudinal surveys of 215 new international students (54% female, Mage = 24 years) revealed that the initial level of school extraversion significantly predicted cross-cultural adjustment, (lower) withdrawal cognitions, and satisfaction, while the rate of change (increase) in school extraversion predicted cross-cultural adjustment and (lower) withdrawal cognitions. We further modeled global extraversion and cross-cultural motivation as antecedents and explored within-person change in school extraversion as a proximal factor that affects adjustment outcomes. The findings highlight the malleability of contextualized personality, and more importantly, the importance of understanding within-person change in contextualized personality in a cross-cultural adjustment context. The study points to more research that explicate the process of personality change in other contexts. PMID:26579033

  12. Role of nuclear energy in the establishment of smart electricity networks in the United States

    International Nuclear Information System (INIS)

    Harding, Margaret

    2012-01-01

    The concept that smart grids are separate from, and conflict with, traditional grids has been discussed in recent times. A key fact that has to be understood is that in the current electricity grid of the US, electricity is generated as it is demanded. With the advent of intermittent power suppliers like wind and solar, and changing load curves due to increasing electricity usage (electric cars, more electrical appliances and equipment), the traditional methods of managing the grid are being significantly stressed. There are significant losses of electricity occurring in the current US transmission and distribution system as well as inflexibility for transmission of electricity across long distance required to use intermittent sources that are generally more available in the west at major population and industrial centers in the east. Smart grid is really about improving the reliability of the overall electricity supply. This entails managing supply as well as demand, but most importantly, the transmission and distribution of electricity. Nuclear energy tends to be used as base load supply. The reasons for this are primarily economic, though technology does play a role. The economic reasons center around the fact that nuclear is a capital intensive energy source. Nuclear and solar can work together in some interesting and more optimal ways. Because solar is tied to hours of daylight and tends to peak at midday when demand is starting to rise to peak as well, nuclear and solar can work as base load and peak demand response effectively.

  13. Clearing the air: the evolution of organized labor's role in tobacco control in the United States.

    Science.gov (United States)

    Zelnick, Jennifer; Campbell, Richard; Levenstein, Charles; Balbach, Edith

    2008-01-01

    As efforts to make U.S. worksites smoke-free took shape in the 1980s, the tobacco industry sought to defeat them by forming alliances with organized labor. The alliance between the tobacco industry and organized labor was based on framing the regulation of environmental tobacco smoke (ETS) as a threat to jobs, an example of management unilateralism, and an issue that divided smoking and nonsmoking union members. The dynamics of organized labor and tobacco control began to change in the late 1980s with attempts to ban smoking on airlines and in the hospitality industry. Flight attendants, bar and restaurant workers, and casino dealers-all subject to ETS in their work environments-confronted ETS as an occupational health issue. Against the backdrop of increasing awareness of the hazards of ETS, and the acceptance of tobacco control policy, this framing changed the basis of organized labor's role in tobacco control. Because service workers share the workplace with the general public, their occupational health issues are also public health issues. This fact presents new opportunities for coalition building to protect the health of service workers and the public alike.

  14. Springtime high surface ozone events over the western United States: Quantifying the role of stratospheric intrusions

    Science.gov (United States)

    Fiore, A. M.; Lin, M.; Cooper, O. R.; Horowitz, L. W.; Naik, V.; Levy, H.; Langford, A. O.; Johnson, B. J.; Oltmans, S. J.; Senff, C. J.

    2011-12-01

    As the National Ambient Air Quality (NAAQS) standard for ozone (O_{3}) is lowered, it pushes closer to policy-relevant background levels (O_{3} concentrations that would exist in the absence of North American anthropogenic emissions), making attainment more difficult with local controls. We quantify the Asian and stratospheric components of this North American background, with a primary focus on the western United States. Prior work has identified this region as a hotspot for deep stratospheric intrusions in spring. We conduct global simulations at 200 km and 50 km horizontal resolution with the GFDL AM3 model, including a stratospheric O_{3} tracer and two sensitivity simulations with anthropogenic emissions from Asia and North America turned off. The model is evaluated with a suite of in situ and satellite measurements during the NOAA CalNex campaign (May-June 2010). The model reproduces the principle features in the observed surface to near tropopause distribution of O_{3} along the California coast, including its latitudinal variation and the development of regional high-O_{3} episodes. Four deep tropopause folds are diagnosed and we find that the remnants of these stratospheric intrusions are transported to the surface of Southern California and Western U.S. Rocky Mountains, contributing 10-30 ppbv positive anomalies relative to the simulated campaign mean stratospheric component in the model surface layer. We further examine the contribution of North American background, including its stratospheric and Asian components, to the entire distribution of observed MDA8 O_{3} at 12 high-elevation CASTNet sites in the Mountain West. We find that the stratospheric O_{3} tracer constitutes 50% of the North American background, and can enhance surface maximum daily 8-hour average (MDA8) O_{3} by 20 ppb when observed surface O_{3} is in the range of 60-80 ppbv. Our analysis highlights the potential for natural sources such as deep stratospheric intrusions to contribute

  15. The relationship between drug use settings, roles in the drug economy, and witnessing a drug overdose in Baltimore, Maryland.

    Science.gov (United States)

    Latkin, Carl A; Edwards, Catie; Davey-Rothwell, Melissa A; Yang, Cui; Tobin, Karin E

    2018-02-12

    There has been a dramatic increase in drug overdose deaths in the United States. In the current study, the authors examined factors associated with witnessing a drug overdose. A sample of 450 substance users in Baltimore, Maryland, were recruited for a behavioral intervention and were administered a survey. Multinomial logistic regression models were used to compare participants who never witnessed a drug overdose with those who witnessed one in the prior 6 months and those who witnessed an overdose over 6 months ago. Most (58%) participants were male, 40% experienced homelessness in the prior 6 months, 63% reported a history of heroin injecting, 84% had snorted heroin, 75% reported witnessing a drug overdose, and 38% experienced an overdose. In multinomial logistic regression models, witnessing an overdose in the past 6 months was associated with number of different types of places where drugs were used (adjusted odds ratio [aOR] = 1.34), history of experiencing an overdose (aOR = 1.80), injecting heroin and/or speedball (aOR = 1.78), and snorting heroin (aOR = 1.54). Witnessing an overdose more than 6 months ago was associated with number of different places where drugs were used (aOR = 1.25), history of experiencing an overdose (aOR = 1.61), snorting heroin (aOR = 1.42), and injecting heroin or speedball (aOR = 1.47). These data suggest that people who engage in more public and frequent drug use, and hence are more likely to witness an overdose, should be targeted for interventions to prevent and treat drug overdose.

  16. Burnout in officers of the prison service units. The role of personality and selected professional characteristics

    Directory of Open Access Journals (Sweden)

    Ewa Sygit-Kowalkowska

    2017-02-01

    Full Text Available Background: The researchers involved in the studies of burnout indicate its 3 sources: the structure of the personality, the specificity of interpersonal relationships, and the organizational factors. The aim of this study was to evaluate the occurrence of burnout and personality characteristics of prison officers, as well as to determine predictors of burnout in this occupational group. Material and Methods: The study was conducted among prison officers, who were divided into 2 groups, the officers working in direct contact with prisoners (group I and those employed in the prison administration (group II. The study used 2 tools: NEO-Five Factor Inventory (NEO-FFI and Link Burnout Questionnaire (LBQ. Results: Analysis of personality traits in the study group showed high severity traits of neuroticism, extraversion, openness, agreeableness and conscientiousness. However, the best results were obtained in terms of extraversion and the lowest in the range of conscientiousness. The level of burnout in both groups was found to be within the upper limit of the average results, without statistically significant differences between the groups. The results showed that people working in direct contact with prisoners experience greater disappointments and psychophysical exhaustion at work. The analyses showed that the level of exhaustion and disappointment of the employees surveyed increases with increasing seniority. It was also shown that the level of neuroticism, extraversion and agreeableness is the predictor of effectiveness. Conclusions: The level of burnout in the study group falls within the upper limit of the average results. Personality traits are an important determinant for the development of symptoms of burnout in the penitentiary officers, and their role changes over the years of continuous prison service. The position at work diversifies the degree of experiencing symptoms of burnout. Med Pr 2017;68(1:85–94

  17. [Burnout in officers of the prison service units. The role of personality and selected professional characteristics].

    Science.gov (United States)

    Sygit-Kowalkowska, Ewa; Weber-Rajek, Magdalena; Herkt, Martyna; Ossowski, Roman

    2017-02-28

    The researchers involved in the studies of burnout indicate its 3 sources: the structure of the personality, the specificity of interpersonal relationships, and the organizational factors. The aim of this study was to evaluate the occurrence of burnout and personality characteristics of prison officers, as well as to determine predictors of burnout in this occupational group. The study was conducted among prison officers, who were divided into 2 groups, the officers working in direct contact with prisoners (group I) and those employed in the prison administration (group II). The study used 2 tools: NEO-Five Factor Inventory (NEO-FFI) and Link Burnout Questionnaire (LBQ). Analysis of personality traits in the study group showed high severity traits of neuroticism, extraversion, openness, agreeableness and conscientiousness. However, the best results were obtained in terms of extraversion and the lowest in the range of conscientiousness. The level of burnout in both groups was found to be within the upper limit of the average results, without statistically significant differences between the groups. The results showed that people working in direct contact with prisoners experience greater disappointments and psychophysical exhaustion at work. The analyses showed that the level of exhaustion and disappointment of the employees surveyed increases with increasing seniority. It was also shown that the level of neuroticism, extraversion and agreeableness is the predictor of effectiveness. The level of burnout in the study group falls within the upper limit of the average results. Personality traits are an important determinant for the development of symptoms of burnout in the penitentiary officers, and their role changes over the years of continuous prison service. The position at work diversifies the degree of experiencing symptoms of burnout. Med Pr 2017;68(1):85-94. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

  18. Role Models and Teachers: medical students perception of teaching-learning methods in clinical settings, a qualitative study from Sri Lanka.

    Science.gov (United States)

    Jayasuriya-Illesinghe, Vathsala; Nazeer, Ishra; Athauda, Lathika; Perera, Jennifer

    2016-02-09

    Medical education research in general, and those focusing on clinical settings in particular, have been a low priority in South Asia. This explorative study from 3 medical schools in Sri Lanka, a South Asian country, describes undergraduate medical students' experiences during their final year clinical training with the aim of understanding the teaching-learning experiences. Using qualitative methods we conducted an exploratory study. Twenty eight graduates from 3 medical schools participated in individual interviews. Interview recordings were transcribed verbatim and analyzed using qualitative content analysis method. Emergent themes reveled 2 types of teaching-learning experiences, role modeling, and purposive teaching. In role modelling, students were expected to observe teachers while they conduct their clinical work, however, this method failed to create positive learning experiences. The clinical teachers who predominantly used this method appeared to be 'figurative' role models and were not perceived as modelling professional behaviors. In contrast, purposeful teaching allowed dedicated time for teacher-student interactions and teachers who created these learning experiences were more likely to be seen as 'true' role models. Students' responses and reciprocations to these interactions were influenced by their perception of teachers' behaviors, attitudes, and the type of teaching-learning situations created for them. Making a distinction between role modeling and purposeful teaching is important for students in clinical training settings. Clinical teachers' awareness of their own manifest professional characterizes, attitudes, and behaviors, could help create better teaching-learning experiences. Moreover, broader systemic reforms are needed to address the prevailing culture of teaching by humiliation and subordination.

  19. Successful language learning in a corporate setting: The role of attribution theory and its relation to intrinsic and extrinsic motivation

    Directory of Open Access Journals (Sweden)

    Csaba Kálmán

    2015-12-01

    Full Text Available Attribution theory (Weiner, 1985 and self-determination theory (Deci & Ryan, 1985 have been explored as contributors to L2 motivation (cf. Dörnyei, 2001 but have never been studied quantitatively in concert. In addition, students’ attributions for success in learning a foreign language have never been measured through the use of a questionnaire. The aim of this paper is therefore (a to develop a questionnaire with reliable constructs that allows to measure adult learners’ attributions for their success in learning English in a corporate setting, (b to investigate these learners’ attributions, and (c to investigate the relationship between students’ attributions and the constructs of Intrinsic and Extrinsic motivation central to self-determination theory. Our main results show that among the attributions measured, interest, effort and corporate culture seemed to be the main causes that students recognised as directly involved in their success in learning English. Of all the attributional scales, interest and ability appeared to importantly contribute to intrinsic motivation, while corporate culture, encounters with foreign professionals and ability contributed to a lower extent to extrinsic motivation. It must be noted, however, that attributions for success to teacher and task were so consistently high that they could not be reliably measured with the questionnaire.

  20. Critical role of developing national strategic plans as a guide to strengthen laboratory health systems in resource-poor settings.

    Science.gov (United States)

    Nkengasong, John N; Mesele, Tsehaynesh; Orloff, Sherry; Kebede, Yenew; Fonjungo, Peter N; Timperi, Ralph; Birx, Deborah

    2009-06-01

    Medical laboratory services are an essential, yet often neglected, component of health systems in developing countries. Their central role in public health, disease control and surveillance, and patient management is often poorly recognized by governments and donors. However, medical laboratory services in developing countries can be strengthened by leveraging funding from other sources of HIV/AIDS prevention, care, surveillance, and treatment programs. Strengthening these services will require coordinated efforts by national governments and partners and can be achieved by establishing and implementing national laboratory strategic plans and policies that integrate laboratory systems to combat major infectious diseases. These plans should take into account policy, legal, and regulatory frameworks; the administrative and technical management structure of the laboratories; human resources and retention strategies; laboratory quality management systems; monitoring and evaluation systems; procurement and maintenance of equipment; and laboratory infrastructure enhancement. Several countries have developed or are in the process of developing their laboratory plans, and others, such as Ethiopia, have implemented and evaluated their plan.

  1. Some problems raised by the operation of large nuclear turbo-generator sets. Automatic control system for steam turbo-generator units

    International Nuclear Information System (INIS)

    Cecconi, F.

    1976-01-01

    The design of an appropriate automatic system was found to be useful to improve the control of large size turbo-generator units so as to provide easy and efficient control and monitoring. The experience of the manufacturer of these turbo-generator units allowed a system well suited for this function to be designed [fr

  2. United role of radon decay products and nano-aerosols in radon dosimetry

    Science.gov (United States)

    Smerajec, M.; Vaupotič, J.

    2012-04-01

    The major part of human exposure to natural radiation originates from inhalation of radon (Rn) and radon short-lived decay products (RnDP: 218Po, 214Pb, 214Bi and 214Po). RnDP are formed as a result of α-transformation of radon. In the beginning they are positive ions which neutralize and form clusters with air molecules, and later partly attach to background aerosol particles in indoor air. Eventually, they appear as radioactive nano-aerosols with a bimodal size distribution in ranges of 1-10 nm (unattached RnDP) and of 200-800 nm (attached RnDP). When inhaled, they are deposited in the respiratory tract. Deposition is more efficient for smaller particles. Therefore, the fraction (fun) of the unattached RnDP, which appears to be influenced by the number concentration and size distribution of general (background) aerosols in the ambient air, has a crucial role in radon dosimetry. Radon, radon decay products and general aerosols have been monitored simultaneously in the kitchen of a typical rural house under real living conditions, also comprising four human activities generating particular matter: cooking and baking, as two typical activities in kitchen, and cigarette smoking and candle burning. In periods without any human activity, the total number concentration of general aerosol ranged from 1000 to 3000 cm-3,with the geometric mean of particle diameter in the range of 60-68 nm and with 0.1-1 % of particles smaller than 10 nm. Preparation of coffee changed the concentration to 193,000 cm-3, the geometric mean of diameter to 20 nm and fraction of particles smaller than 10 nm to 11 %. The respective changes were for baking cake: 503,000 cm-3, 17 nm and 19 %, for smoking:423,000 cm-3, 83 nm and 0.4 %, and forcandle burning: 945,000 cm-3, 8 nm and 85 %. While, as expected, a reduction of fun was observed during cooking, baking and smoking, when larger particles were emitted, fun did not increase during candle burning with mostly particles smaller than 10 nm

  3. The role of personnel marketing in the process of building corporate social responsibility strategy of a scientific unit

    Directory of Open Access Journals (Sweden)

    Sylwia Jarosławska-Sobór

    2015-09-01

    Full Text Available The goal of this article is to discuss the significance of human capital in the process of building the strategy of social responsibility and the role of personnel marketing in the process. Dynamically changing social environment has enforced a new way of looking at non-material resources. Organizations have understood that it is human capital and social competences that have a significant impact on the creation of an organization’s value, generating profits, as well as gaining competitive advantage in the 21st century. Personnel marketing is now a key element in the process of implementation of the CSR concept and building the value of contemporary organizations, especially such unique organizations as scientific units. In this article you will find a discussion concerning the basic values regarded as crucial by the Central Mining Institute in the context of their significance for the paradigm of social responsibility. Such an analysis was carried out on the basis of the experiences of Central Mining Institute (GIG in the development of strategic CSR, which takes into consideration the specific character of the Institute as a scientific unit.

  4. The role of histopathologic subtype in the setting of hippocampal sclerosis-associated mesial temporal lobe epilepsy.

    Science.gov (United States)

    Gales, Jordan M; Jehi, Lara; Nowacki, Amy; Prayson, Richard A

    2017-05-01

    Hippocampal sclerosis (HS) and focal cortical dysplasia (FCD) are among the most common neuropathological findings in those undergoing surgery for refractory mesial temporal lobe epilepsy. Existing data regarding differences among the most recent International League Against Epilepsy (ILAE) HS subtypes remain limited. This study sought to characterize the roles of HS subtype and coexistent FCD. Epilepsy surgery pathologic specimens in 307 cases of temporal lobe epilepsy with HS were reviewed (mean age±SD, 37±15years; 56% women). HS and coexistent FCD were classified according to ILAE guidelines. Medical records were reviewed for data on seizure recurrence and seizure burden (clinical follow-up mean duration ± SD, 5±4years). Cases of typical HS (ILAE type I) predominated (ILAE type Ia: 41%, Ib: 47%, II: 11%, and III: 0.7%]. The HS subtypes shared similar demographic and etiologic characteristics, as well as associated pathology and postoperative seizure outcomes. Individuals with type Ib HS were more likely to remain seizure free at long-term follow-up when compared with other subtypes, and they had a later age of seizure onset. Two hundred forty-three cases (79%) demonstrated FCD within the adjacent temporal lobe. Its presence was associated with a significantly decreased risk of seizure recurrence (P=.02). When present, FCD was predominantly type I (98%). HS subtype does not appear to affect epilepsy surgery outcomes despite some clinical differences between the subgroups. FCD is often observed in association with HS in mesial temporal lobe epilepsy; the finding of FCD was associated with better postoperative outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Benefits and costs of Channel One in a middle school setting and the role of media-literacy training.

    Science.gov (United States)

    Austin, Erica Weintraub; Chen, Yi-Chun Yvonnes; Pinkleton, Bruce E; Quintero Johnson, Jessie

    2006-03-01

    Channel One is a public-affairs program that includes 10 minutes of news and 2 minutes of paid product advertising or public service announcements. Advocates assert that it increases public-affairs knowledge, but critics charge that it garners a captive audience for teen-targeted advertising. This experiment analyzed the differential effects of Channel One depending on whether early-adolescent viewers received a media-literacy lesson in conjunction with viewing the program. Outcomes included perceptions of Channel One news programming, recall of program content and advertising, materialism, and political efficacy. Researchers used a posttest-only field experiment (N = 240) of seventh- and eighth-grade students using random assignment to conditions. Conditions included a control group, a group that received a fact-based lesson, and a group that received the same lesson content using a more emotive teaching style. It was expected that the emotion-added lesson condition would be more effective than the logic-only lesson condition because of its motivational component. On average, students remembered more ads from Channel One than news stories. Participants in the control group remembered fewer news stories than did the groups that received the lessons. Students reported having purchased during the preceding 3 months an average of 2.5 items advertised on the program. Both fact-based and affect-added training increased student skepticism toward advertisers. As expected, student liking of the program enhanced their learning from it and was associated with higher levels of political efficacy. Students held misconceptions about the role of their school in the production of Channel One. The use of Channel One by schools can have benefits, but these come with risk that some may consider unacceptable. On the positive side, student liking of the program was associated with their political efficacy. Although those who responded positively to program content and presentation

  6. Accounting for medical communication: parents' perceptions of communicative roles and responsibilities in the pediatric intensive care unit.

    Science.gov (United States)

    Gordon, Cynthia; Barton, Ellen; Meert, Kathleen L; Eggly, Susan; Pollacks, Murray; Zimmerman, Jerry; Anand, K J S; Carcillo, Joseph; Newth, Christopher J L; Dean, J Michael; Willson, Douglas F; Nicholson, Carol

    2009-01-01

    Through discourse analysis of transcribed interviews conducted over the phone with parents whose child died in the Pediatric Intensive Care Unit (PICU) (n = 51), this study uncovers parents' perceptions of clinicians' and their own communicative roles and responsibilities in the context of team-based care. We examine parents' descriptions and narratives of communicative experiences they had with PICU clinicians, focusing on how parents use accounts to evaluate the communicative behaviors they report (n = 47). Findings indicate that parental perceptions of communicative responsibilities are more nuanced than assumed in previous research: Parents identified their own responsibilities as participating as part of the team of care, gathering information, interacting with appropriate affect, and working to understand complex and uncertain medical information. Complementarily, parents identified clinician responsibilities as communicating professionally, providing medical information clearly, managing parents' hope responsibly, and communicating with appropriate affect. Through the accounts they provide, parents evaluate both parental and clinician role-responsibilities as fulfilled and unfulfilled. Clinicians' management of prognostic uncertainty and parents' struggles to understand that uncertainty emerged as key, complementary themes with practical implications for incorporating parents into the PICU care team. The study also highlights insights retrospective interview data bring to the examination of medical communication.

  7. Future shift of the relative roles of precipitation and temperature in controlling annual runoff in the conterminous United States

    Science.gov (United States)

    Duan, Kai; Sun, Ge; McNulty, Steven G.; Caldwell, Peter V.; Cohen, Erika C.; Sun, Shanlei; Aldridge, Heather D.; Zhou, Decheng; Zhang, Liangxia; Zhang, Yang

    2017-11-01

    This study examines the relative roles of climatic variables in altering annual runoff in the conterminous United States (CONUS) in the 21st century, using a monthly ecohydrological model (the Water Supply Stress Index model, WaSSI) driven with historical records and future scenarios constructed from 20 Coupled Model Intercomparison Project Phase 5 (CMIP5) climate models. The results suggest that precipitation has been the primary control of runoff variation during the latest decades, but the role of temperature will outweigh that of precipitation in most regions if future climate change follows the projections of climate models instead of the historical tendencies. Besides these two key factors, increasing air humidity is projected to partially offset the additional evaporative demand caused by warming and consequently enhance runoff. Overall, the projections from 20 climate models suggest a high degree of consistency on the increasing trends in temperature, precipitation, and humidity, which will be the major climatic driving factors accounting for 43-50, 20-24, and 16-23 % of the runoff change, respectively. Spatially, while temperature rise is recognized as the largest contributor that suppresses runoff in most areas, precipitation is expected to be the dominant factor driving runoff to increase across the Pacific coast and the southwest. The combined effects of increasing humidity and precipitation may also surpass the detrimental effects of warming and result in a hydrologically wetter future in the east. However, severe runoff depletion is more likely to occur in the central CONUS as temperature effect prevails.

  8. Barriers to the Role of the Head Athletic Trainer for Women in National Collegiate Athletic Association Division II and III Settings.

    Science.gov (United States)

    Mazerolle, Stephanie M; Eason, Christianne M

    2016-07-01

    Very few women assume the role of head athletic trainer (AT). Reasons for this disparity include discrimination, motherhood, and a lack of interest in the position. However, data suggest that more women seek the head AT position in National Collegiate Athletic Association Division II and III settings. To examine the barriers female ATs face as they transition to the role of head AT. Qualitative study. Divisions II and III. In total, 77 female ATs participated in our study. Our participants (38 ± 9 years old) were employed as head ATs at the Division II or III level. We conducted online interviews with all participants. They journaled their reflections to a series of open-ended questions pertaining to their experiences as head ATs. Data were analyzed following a general inductive approach. Credibility was secured by peer review and researcher triangulation. Organizational and personal factors emerged as the 2 major themes that described challenges for women assuming the role of the head AT. Organizational barriers were defined by gender stereotyping and the "good old boys" network. Personal influences included a lack of leadership aspirations, motherhood and family, and a lack of mentors. Female ATs working in Divisions II or III experienced similar barriers to assuming the role of the head AT as those working in the Division I setting. Stereotyping still exists within collegiate athletics, which limits the number of women in higher-ranking positions; however, a lack of desire to assume a higher position and the desire to balance work and home inhibit some women from moving up.

  9. Role of the B Allele of Influenza A Virus Segment 8 in Setting Mammalian Host Range and Pathogenicity.

    Science.gov (United States)

    Turnbull, Matthew L; Wise, Helen M; Nicol, Marlynne Q; Smith, Nikki; Dunfee, Rebecca L; Beard, Philippa M; Jagger, Brett W; Ligertwood, Yvonne; Hardisty, Gareth R; Xiao, Haixia; Benton, Donald J; Coburn, Alice M; Paulo, Joao A; Gygi, Steven P; McCauley, John W; Taubenberger, Jeffery K; Lycett, Samantha J; Weekes, Michael P; Dutia, Bernadette M; Digard, Paul

    2016-10-15

    burden on farming and health care sectors. Host adaptation likely involves multiple viral factors. Here, we investigated the role of IAV segment 8. Segment 8 has evolved into two distinct clades: the A and B alleles. The B-allele genes have previously been suggested to be restricted to avian virus species. We introduced a selection of avian virus A- and B-allele segment 8s into human H1N1 and H3N2 virus backgrounds and found that these reassortant viruses were fully competent in mammalian host systems. We also analyzed the currently available public data on the segment 8 gene distribution and found surprisingly little evidence for specific avian host restriction of the B-clade segment. We conclude that B-allele segment 8 genes are, in fact, capable of supporting infection in mammals and that they should be considered during the assessment of the pandemic risk of zoonotic influenza A viruses. Copyright © 2016 Turnbull et al.

  10. Simulation-based evaluation of the performance of the F test in a linear multilevel model setting with sparseness at the level of the primary unit.

    Science.gov (United States)

    Bruyndonckx, Robin; Aerts, Marc; Hens, Niel

    2016-09-01

    In a linear multilevel model, significance of all fixed effects can be determined using F tests under maximum likelihood (ML) or restricted maximum likelihood (REML). In this paper, we demonstrate that in the presence of primary unit sparseness, the performance of the F test under both REML and ML is rather poor. Using simulations based on the structure of a data example on ceftriaxone consumption in hospitalized children, we studied variability, type I error rate and power in scenarios with a varying number of secondary units within the primary units. In general, the variability in the estimates for the effect of the primary unit decreased as the number of secondary units increased. In the presence of singletons (i.e., only one secondary unit within a primary unit), REML consistently outperformed ML, although even under REML the performance of the F test was found inadequate. When modeling the primary unit as a random effect, the power was lower while the type I error rate was unstable. The options of dropping, regrouping, or splitting the singletons could solve either the problem of a high type I error rate or a low power, while worsening the other. The permutation test appeared to be a valid alternative as it outperformed the F test, especially under REML. We conclude that in the presence of singletons, one should be careful in using the F test to determine the significance of the fixed effects, and propose the permutation test (under REML) as an alternative. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  11. Achieving Work-Life Balance in the National Collegiate Athletic Association Division I Setting, Part I: The Role of the Head Athletic Trainer

    Science.gov (United States)

    Mazerolle, Stephanie M.; Goodman, Ashley; Pitney, William A.

    2015-01-01

    Context: Supervisor support has been identified as key to the fulfillment of work-life balance for the athletic trainer (AT), yet limited literature exists on the perspectives of supervisors. Objective: To investigate how the head AT facilitates work-life balance among staff members within the National Collegiate Athletic Association Division I setting. Design: Qualitative study. Setting: Web-based management system. Patients or Other Participants: A total of 18 head ATs (13 men, 5 women; age = 44 ± 8 years, athletic training experience = 22 ± 7 years) volunteered for an asynchronous, Web-based interview. Data Collection and Analysis: Participants responded to a series of questions by journaling their thoughts and experiences. We included multiple-analyst triangulation, stakeholder checks, and peer review to establish data credibility. We analyzed the data via a general inductive approach. Results: Four prevailing themes emerged from the data: modeling work-life balance, encouraging disengagement from the AT role, cooperation and community workplace, and administrative support and understanding. Conclusions: Head ATs at the Division I level recognized the need to promote work-life balance among their staffs. They not only were supportive of policies that promote work-life balance, including spending time away from the role of the AT and teamwork among staff members, but also modeled and practiced the strategies that they promoted. PMID:25343530

  12. Prevalence and Correlates of Fire-Setting in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions

    OpenAIRE

    Vaughn, Michael G.; Fu, Qiang; DeLisi, Matt; Wright, John Paul; Beaver, Kevin M.; Perron, Brian E.; Howard, Matthew O.

    2009-01-01

    Fire-setting is a serious and costly form of antisocial behavior. Our objective in this study was to examine the prevalence and correlates of intentional fire-setting behavior in the U. S. Data were derived from a nationally representative sample of U.S. residents 18 years and older. Structured psychiatric interviews (N = 43,093) were completed by trained lay interviewers between 2001-2002. Fire-setting and DSM-IV mood, anxiety, substance use and personality disorders were assessed with the A...

  13. Comparative genomics of an IncA/C multidrug resistance plasmid from Escherichia coli and Klebsiella isolates from intensive care unit patients and the utility of whole-genome sequencing in health care settings.

    Science.gov (United States)

    Hazen, Tracy H; Zhao, LiCheng; Boutin, Mallory A; Stancil, Angela; Robinson, Gwen; Harris, Anthony D; Rasko, David A; Johnson, J Kristie

    2014-08-01

    The IncA/C plasmids have been implicated for their role in the dissemination of β-lactamases, including gene variants that confer resistance to expanded-spectrum cephalosporins, which are often the treatment of last resort against multidrug-resistant, hospital-associated pathogens. A bla(FOX-5) gene was detected in 14 Escherichia coli and 16 Klebsiella isolates that were cultured from perianal swabs of patients admitted to an intensive care unit (ICU) of the University of Maryland Medical Center (UMMC) in Baltimore, MD, over a span of 3 years. Four of the FOX-encoding isolates were obtained from subsequent samples of patients that were initially negative for an AmpC β-lactamase upon admission to the ICU, suggesting that the AmpC β-lactamase-encoding plasmid was acquired while the patient was in the ICU. The genomes of five E. coli isolates and six Klebsiella isolates containing bla(FOX-5) were selected for sequencing based on their plasmid profiles. An ∼ 167-kb IncA/C plasmid encoding the FOX-5 β-lactamase, a CARB-2 β-lactamase, additional antimicrobial resistance genes, and heavy metal resistance genes was identified. Another FOX-5-encoding IncA/C plasmid that was nearly identical except for a variable region associated with the resistance genes was also identified. To our knowledge, these plasmids represent the first FOX-5-encoding plasmids sequenced. We used comparative genomics to describe the genetic diversity of a plasmid encoding a FOX-5 β-lactamase relative to the whole-genome diversity of 11 E. coli and Klebsiella isolates that carry this plasmid. Our findings demonstrate the utility of whole-genome sequencing for tracking of plasmid and antibiotic resistance gene distribution in health care settings. Copyright © 2014, American Society for Microbiology. All Rights Reserved.

  14. Antiferromagnetic vs. non-magnetic ε phase of solid oxygen. Periodic density functional theory studies using a localized atomic basis set and the role of exact exchange.

    Science.gov (United States)

    Ramírez-Solís, A; Zicovich-Wilson, C M; Hernández-Lamoneda, R; Ochoa-Calle, A J

    2017-01-25

    The question of the non-magnetic (NM) vs. antiferromagnetic (AF) nature of the ε phase of solid oxygen is a matter of great interest and continuing debate. In particular, it has been proposed that the ε phase is actually composed of two phases, a low-pressure AF ε 1 phase and a higher pressure NM ε 0 phase [Crespo et al., Proc. Natl. Acad. Sci. U. S. A., 2014, 111, 10427]. We address this problem through periodic spin-restricted and spin-polarized Kohn-Sham density functional theory calculations at pressures from 10 to 50 GPa using calibrated GGA and hybrid exchange-correlation functionals with Gaussian atomic basis sets. The two possible configurations for the antiferromagnetic (AF1 and AF2) coupling of the 0 ≤ S ≤ 1 O 2 molecules in the (O 2 ) 4 unit cell were studied. Full enthalpy-driven geometry optimizations of the (O 2 ) 4 unit cells were done to study the pressure evolution of the enthalpy difference between the non-magnetic and both antiferromagnetic structures. We also address the evolution of structural parameters and the spin-per-molecule vs. pressure. We find that the spin-less solution becomes more stable than both AF structures above 50 GPa and, crucially, the spin-less solution yields lattice parameters in much better agreement with experimental data at all pressures than the AF structures. The optimized AF2 broken-symmetry structures lead to large errors of the a and b lattice parameters when compared with experiments. The results for the NM model are in much better agreement with the experimental data than those found for both AF models and are consistent with a completely non-magnetic (O 2 ) 4 unit cell for the low-pressure regime of the ε phase.

  15. A cost effective model for appropriate administration of red cell units and salvaging un-transfused red cell units by using temperature sensitive indicators for blood component transportation in a hospital setting

    Directory of Open Access Journals (Sweden)

    Aseem K Tiwari

    2015-01-01

    Full Text Available Background: A rule called "30-min rule" defines that red cell unit cannot be used if it has been out of blood bank refrigerator for over 30 min. This rule is useful to guide initiation of transfusion, but is inadequate for deciding whether to reuse or discard units received-back at blood transfusion services (BTS. A simple cost-effective temperature-sensitive indicator was evaluated to decide upon reuse (cold chain was uninterrupted or discard (where cold chain was interrupted in a simulation exercise. Materials and Methods: Temperature-sensitive indicators TH-F™ that irreversibly changed color from white to red demonstrated that heat excursion has occurred and the cumulative temperature has exceeded 10°C for over 30 min, were used in outdated red cells for simulating units, which are not used and received-back. These units were also tagged with a standard temperature monitoring device, which was a re-usable credit card sized device, which would log the actual time and temperature. In few units percent hemolysis was also calculated. Results: Statistically insignificant elevation in average temperature was noted in 102 simulated units at the time of return to BTS (Δ 0.04°C, despite the fact that these units were in the transport box for over 4 h. The average supernatant hemoglobin in these units was 0.24%, much below the prescribed threshold. Conclusion: Transportation of blood in controlled conditions with temperature-sensitive indicator is a cost-effective model to save blood, a precious human resource.

  16. Hanford Site environmental setting data developed for the unit risk factor methodology in support of the Programmatic Environmental Impact Statement (PEIS)

    International Nuclear Information System (INIS)

    Schramke, J.A.; Glantz, C.S.; Holdren, G.R.

    1994-05-01

    This report describes the environmental settings identified for the Hanford Site in support of the US Department of Energy's (DOE's) Programmatic Environmental Impact Study (PEIS). The objective of the PEIS is to provide the public with information about the types of waste and contamination problems associated with major DOE facilities across the country and to assess the relative risks that these wastes pose to the public, onsite workers, and the environment. The environmental setting information consists of the site-specific data required to model (using the Multimedia Environmental Pollutant Assessment System) the atmospheric, groundwater, and surface-water transport of contaminants within the boundaries of the Hanford Site. The environmental setting data describes the climate, atmospheric dispersion, hydrogeology, and surface-water characteristics of the Site. The number of environmental settings developed for the Hanford Site was the fewest that could provide accurate results when used in the risk assessment modeling. Environmental settings for Hanford were developed in conjunction with local experts in the fields of meteorology, geology, hydrology, and geochemistry. Site experts participated in the initial development, fine-tuning, and final review of Hanford's PEIS environmental settings

  17. Future shift of the relative roles of precipitation and temperature in controlling annual runoff in the conterminous United States

    Directory of Open Access Journals (Sweden)

    K. Duan

    2017-11-01

    Full Text Available This study examines the relative roles of climatic variables in altering annual runoff in the conterminous United States (CONUS in the 21st century, using a monthly ecohydrological model (the Water Supply Stress Index model, WaSSI driven with historical records and future scenarios constructed from 20 Coupled Model Intercomparison Project Phase 5 (CMIP5 climate models. The results suggest that precipitation has been the primary control of runoff variation during the latest decades, but the role of temperature will outweigh that of precipitation in most regions if future climate change follows the projections of climate models instead of the historical tendencies. Besides these two key factors, increasing air humidity is projected to partially offset the additional evaporative demand caused by warming and consequently enhance runoff. Overall, the projections from 20 climate models suggest a high degree of consistency on the increasing trends in temperature, precipitation, and humidity, which will be the major climatic driving factors accounting for 43–50, 20–24, and 16–23 % of the runoff change, respectively. Spatially, while temperature rise is recognized as the largest contributor that suppresses runoff in most areas, precipitation is expected to be the dominant factor driving runoff to increase across the Pacific coast and the southwest. The combined effects of increasing humidity and precipitation may also surpass the detrimental effects of warming and result in a hydrologically wetter future in the east. However, severe runoff depletion is more likely to occur in the central CONUS as temperature effect prevails.

  18. Forest products research and development organizations in a worldwide setting: A review of structure, governance, and measures of performance of organizations outside the United States

    Science.gov (United States)

    Paul V. Ellefson; Michael A. Kilgore; Kenneth E. Skog; Christopher D. Risbrudt

    2007-01-01

    Located in 23 countries, 40 forest-products research and development organizations outside the United States were reviewed in 2004 and 2005. The intent was to obtain a better understanding of how such organizations are structured and administered and their performance judged. Investing over $600 million annually, the 40 organizations employed 7,000 to 7,500 scientists...

  19. The specchio unit (northern apennines, Italy): An ancient mass transport complex originated from near-coastal areas in an intra-slope setting

    NARCIS (Netherlands)

    Ogata, Kei; Tinterri, Roberto; Pini, Gian Andrea; Mutti, Emiliano

    2012-01-01

    Within the Eocene-Oligocene syn-orogenic deposits of the Epiligurian succession (Northern Apennines of Italy), a field-based study of the Specchio Unit (lower Rupelian) reveals that this complex is made up of three distinct but amalgamated mass-transport deposits (MTDs), the largest of which reaches

  20. Healthy kids out of school: using mixed methods to develop principles for promoting healthy eating and physical activity in out-of-school settings in the United States.

    Science.gov (United States)

    Sliwa, Sarah A; Sharma, Shanti; Dietz, William H; Dolan, Peter R; Nelson, Miriam E; Newman, Molly B; Rockeymoore, Maya; Economos, Christina D

    2014-12-31

    Widespread practices supporting availability of healthful foods, beverages, and physical activity in out-of-school-time (OST) settings would further obesity prevention efforts. The objective of this article was to describe principles to guide policy development in support of healthy eating and physical activity practices in out-of-school settings to promote obesity prevention. The Institute of Medicine's L.E.A.D. framework (Locate Evidence, Evaluate it, Assemble it, and Inform Decisions) was used to identify practices relevant to children's healthful eating in most OST settings: 1) locate and evaluate information from a national survey of children's perceptions of healthful-food access; published research, reports, policies and guidelines; and roundtables with OST organizations' administrators; 2) assemble information to prioritize actionable practices; and 3) inform programmatic direction. Three evidence-informed guiding principles for short-duration OST resulted: 1) drink right: choose water instead of sugar-sweetened beverages; 2) move more: boost movement and physical activity in all programs; and 3) snack smart: fuel up on fruits and vegetables. Healthy Kids Out of School was launched to support the dissemination and implementation of these guiding principles in short-duration OST settings, complementing efforts in other OST settings to shift norms around eating and physical activity.

  1. Development and validation of an observation tool for the assessment of nursing pain management practices in intensive care unit in a standardized clinical simulation setting.

    Science.gov (United States)

    Gosselin, Emilie; Bourgault, Patricia; Lavoie, Stephan; Coleman, Robin-Marie; Méziat-Burdin, Anne

    2014-12-01

    Pain management in the intensive care unit is often inadequate. There is no tool available to assess nursing pain management practices. The aim of this study was to develop and validate a measuring tool to assess nursing pain management in the intensive care unit during standardized clinical simulation. A literature review was performed to identify relevant components demonstrating optimal pain management in adult intensive care units and to integrate them in an observation tool. This tool was submitted to an expert panel and pretested. It was then used to assess pain management practice during 26 discrete standardized clinical simulation sessions with intensive care nurses. The Nursing Observation Tool for Pain Management (NOTPaM) contains 28 statements grouped into 8 categories, which are grouped into 4 dimensions: subjective assessment, objective assessment, interventions, and reassessment. The tool's internal consistency was calculated at a Cronbach's alpha of 0.436 for the whole tool; the alpha varies from 0.328 to 0.518 for each dimension. To evaluate the inter-rater reliability, intra-class correlation coefficient was used, which was calculated at 0.751 (p nurses' pain management in a standardized clinical simulation. The NOTPaM is the first tool created for this purpose. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  2. The nursing role during end-of-life care in the intensive care unit related to the interaction between patient, family and professional: an integrative review

    NARCIS (Netherlands)

    Noome, M.; Beneken genaamd Kolmer, D.M.; Leeuwen, E. van; Dijkstra, B.M.; Vloet, L.C.M.

    2016-01-01

    AIM: The aim of this study was to explore how intensive care unit (ICU) nurses describe their role during End-of-Life Care (EOLC) in the ICU, related to the interaction between patient, family and professionals (care triad). METHOD: Three electronic databases, PubMed, CINAHL and EMBASE, and

  3. The nursing role during end-of-life care in the intensive care unit related to the interaction between patient, family and professional : An integrative review

    NARCIS (Netherlands)

    Noome, M.; Beneken genaamd Kolmer, D.M.; van Leeuwen, E.; Dijkstra, B.M.; Vloet, L.

    2016-01-01

    Aim The aim of this study was to explore how intensive care unit (ICU) nurses describe their role during End-of-Life Care (EOLC) in the ICU, related to the interaction between patient, family and professionals (care triad). Method Three electronic databases, PubMed, CINAHL and EMBASE, and reference

  4. Achieving work-life balance in the National Collegiate Athletic Association Division I setting, part I: the role of the head athletic trainer.

    Science.gov (United States)

    Mazerolle, Stephanie M; Goodman, Ashley; Pitney, William A

    2015-01-01

    Supervisor support has been identified as key to the fulfillment of work-life balance for the athletic trainer (AT), yet limited literature exists on the perspectives of supervisors. To investigate how the head AT facilitates work-life balance among staff members within the National Collegiate Athletic Association Division I setting. Qualitative study. Web-based management system. A total of 18 head ATs (13 men, 5 women; age = 44 ± 8 years, athletic training experience = 22 ± 7 years) volunteered for an asynchronous, Web-based interview. Participants responded to a series of questions by journaling their thoughts and experiences. We included multiple-analyst triangulation, stakeholder checks, and peer review to establish data credibility. We analyzed the data via a general inductive approach. Four prevailing themes emerged from the data: modeling work-life balance, encouraging disengagement from the AT role, cooperation and community workplace, and administrative support and understanding. Head ATs at the Division I level recognized the need to promote work-life balance among their staffs. They not only were supportive of policies that promote work-life balance, including spending time away from the role of the AT and teamwork among staff members, but also modeled and practiced the strategies that they promoted.

  5. Participants' engagement with and reactions to the use of on-line action learning sets to support advanced nursing role development.

    Science.gov (United States)

    Currie, Kay; Biggam, John; Palmer, Janette; Corcoran, Terry

    2012-04-01

    Professional role development in nursing is occurring at a rapid pace in the UK as elsewhere. Internationally, finding relevant, flexible, sustainable educational solutions to support the preparation of nurses for new roles presents significant challenges for Higher Education Institutions, health service managers and the clinical practitioners who are would-be students. The use of on-line learning is frequently advocated as one means of resolving these difficulties. This paper discusses participants' engagement with, and reactions to, the use of on-line Action Learning Sets (ALS) as part of a national pilot development pathway for Advanced Nursing Practice in Scotland. Data collection included: survey of participants' views of on-line ALS; survey comparing perceptions of ALS with other educational experiences within the pathway; in-depth interviews with case-site participants. A range of benefits and limitations of on-line ALS was identified. The benefit of flexible access and sharing experiences with others was emphasised. Conversely, multiple commitments and lack of group cohesiveness significantly interfered with the effectiveness of this process. Key recommendations for future implementation acknowledge participants' preference for a blended approach, with face-to-face sessions to provide 'getting-to-know-you' opportunities, enhancing commitment to the group process. Copyright © 2011 Elsevier Ltd. All rights reserved.

  6. Strengthening close to community provision of maternal health services in fragile settings: an exploration of the changing roles of TBAs in Sierra Leone and Somaliland.

    Science.gov (United States)

    Orya, Evelyn; Adaji, Sunday; Pyone, Thidar; Wurie, Haja; van den Broek, Nynke; Theobald, Sally

    2017-07-05

    Efforts to take forward universal health coverage require innovative approaches in fragile settings, which experience particularly acute human resource shortages and poor health indicators. For maternal and newborn health, it is important to innovate with new partnerships and roles for Traditional Birth Attendants (TBAs) to promote maternal health. We explore perspectives on programmes in Somaliland and Sierra Leone which link TBAs to health centres as part of a pathway to maternal health care. Our study aims to understand the perceptions of communities, stakeholder and TBAs themselves who have been trained in new roles to generate insights on strategies to engage with TBAs and to promote skilled birth attendance in fragile affected settings. A qualitative study was carried out in two chiefdoms in Bombali district in Sierra Leone and the Maroodi Jeex region of Somaliland. Purposively sampled participants consisted of key players from the Ministries of Health, programme implementers, trained TBAs and women who benefitted from the services of trained TBAs. Data was collected through key informants and in-depth interviews and focus group discussions. Data was transcribed, translated and analyzed using the framework approach. For the purposes of this paper, a comparative analysis was undertaken reviewing similarities and differences across the two different contexts. Analysis of multiple viewpoints reveal that with appropriate training and support it is possible to change TBAs practices so they support pregnant women in new ways (support and referral rather than delivery). Participants perceived that trained TBAs can utilize their embedded and trusted community relationships to interact effectively with their communities, help overcome barriers to acceptability, utilization and contribute to effective demand for maternal and newborn services and ultimately enhance utilization of skilled birth attendants. Trained TBAs appreciated cordial relationship at the health

  7. Patterns and Predictors of Depression Treatment among Older Adults with Parkinson’s Disease and Depression in Ambulatory Care Settings in the United States

    OpenAIRE

    Bhattacharjee, Sandipan; Vadiei, Nina; Goldstone, Lisa; Alrabiah, Ziyad; Sherman, Scott J.

    2018-01-01

    Little is known regarding depression treatment patterns and predictors among older adults with comorbid Parkinson's disease and depression (dPD) in the United States (US). The objective of this study was to assess the patterns and predictors of depression treatment among older adults with dPD in the US. We adopted a cross-sectional study design by pooling multiple-year data (2005–2011) from the National Ambulatory Medical Care Survey (NAMCS) and the outpatient department of the National Hospi...

  8. The late provision of medical care to coolies in Indochinese rubber tree plantations: the Michelin model health unit set up in 1925–1939.

    OpenAIRE

    Panthou , Eric

    2014-01-01

    International audience; More than ten years after the British experience in Malaysia, the medical protection of farm workers, in particular the fight against malaria, became in the mid-1920s an economic and social issue in Indochina, in order to protect the future of the huge rubber trees plantations set up shortly before by major industrial and financial groups, where losses due to death, repatriation or escape could amount to over half of the workforce within two years. This situation spark...

  9. Nurses' and nurse assistants' beliefs, attitudes and actions related to role and function in an inpatient stroke rehabilitation unit-A qualitative study

    DEFF Research Database (Denmark)

    Loft, Mia I; Poulsen, Ingrid; Esbensen, Bente A

    2017-01-01

    AIMS AND OBJECTIVES: To explore nurses' and nurse assistants' beliefs, attitudes and actions related to their function in an inpatient stroke rehabilitation unit. BACKGROUND: Several attempts have been made to describe nurses' roles and functions in inpatient neurorehabilitation. However, current...... understandings of the contributions that nurses and nurse assistants make to neurorehabilitation remain sparse. DESIGN: Descriptive, interpretive qualitative study. METHODS: Participant observations were conducted during 1 month in a stroke rehabilitation unit at a university hospital in the Capital Region...... stroke rehabilitation. We obtained insights into nursing staff's beliefs and attitudes about rehabilitation-as well as their own role and function-and furthermore how the latter affects their actions in daily practice. RELEVANCE TO CLINICAL PRACTICE: The nursing role and function are still not clearly...

  10. The role of family planning in achieving safe pregnancy for serodiscordant couples: commentary from the United States government's interagency task force on family planning and HIV service integration.

    Science.gov (United States)

    Mason, Jennifer; Medley, Amy; Yeiser, Sarah; Nightingale, Vienna R; Mani, Nithya; Sripipatana, Tabitha; Abutu, Andrew; Johnston, Beverly; Watts, D Heather

    2017-03-08

    People living with HIV (PLHIV) have the right to exercise voluntary choices about their health, including their reproductive health. This commentary discusses the integral role that family planning (FP) plays in helping PLHIV, including those in serodiscordant relationships, achieve conception safely. The United States (US) President's Emergency Plan for AIDS Relief (PEPFAR) is committed to meeting the reproductive health needs of PLHIV by improving their access to voluntary FP counselling and services, including prevention of unintended pregnancy and counselling for safer conception. Inclusion of preconception care and counselling (PCC) as part of routine HIV services is critical to preventing unintended pregnancies and perinatal infections among PLHIV. PLHIV not desiring a current pregnancy should be provided with information and counselling on all available FP methods and then either given the method onsite or through a facilitated referral process. PLHIV, who desire children should be offered risk reduction counselling, support for HIV status disclosure and partner testing, information on safer conception options to reduce the risk of HIV transmission to the partner and the importance of adhering to antiretroviral treatment during pregnancy and breastfeeding to reduce the risk of vertical transmission to the infant. Integration of PCC, HIV and FP services at the same location is recommended to improve access to these services for PLHIV. Other considerations to be addressed include the social and structural context, the health system capacity to offer these services, and stigma and discrimination of providers. Evaluation of innovative service delivery models for delivering PCC services is needed, including provision in community-based settings. The US Government will continue to partner with local organizations, Ministries of Health, the private sector, civil society, multilateral and bilateral donors, and other key stakeholders to strengthen both the policy and

  11. The role of emergency medicine clerkship e-Portfolio to monitor the learning experience of students in different settings: a prospective cohort study.

    Science.gov (United States)

    Cevik, Arif Alper; Shaban, Sami; El Zubeir, Margret; Abu-Zidan, Fikri M

    2018-04-12

    Although emergency departments provide acute care learning opportunities for medical students, student exposure to recommended curriculum presentations and procedures are limited. In this perspective, clinical environments providing learning opportunities for students should be monitored as part of an ongoing quality improvement process. This study aims to analyze student exposures and their involvement levels in two different hospitals (Tawam and Al Ain) so as to improve the teaching and learning activities. This is a prospective study on all 76 final year medical students' electronic logbooks (e-Portfolio) of the academic year 2016/2017. Students recorded 5087 chief complaints and 3721 procedures. The average patient and procedure exposure in a shift per student in Al Ain Hospital compared with Tawam Hospital were 7.2 vs 6.4 and 5.8 vs 4.3, respectively. The highest full involvement with presentations was seen in the pediatric unit (67.1%, P portfolio has proven to be a very useful tool in defining the learning activities of final year medical students during their emergency medicine clerkship and in comparing activities in two different clinical settings. Data collected and analyzed using this e-Portfolio has the potential to help medical educators and curriculum designers improve emergency medicine teaching and learning activities.

  12. The Role of Social Media in the Acculturation of South Asian Immigrants in the United States: A Phenomenological Study

    Science.gov (United States)

    Dayani, Dilshad

    2017-01-01

    Some South Asian immigrants in the United States experience acculturative stress as a result of sociocultural differences. Social media is a tool that can facilitate the process of acculturation of some ethnic groups in the United States such as Hispanics. The specific problem that the researcher examined in this study was that the use of social…

  13. The role of point-of-care tests in antibiotic stewardship for urinary tract infections in a resource-limited setting on the Thailand-Myanmar border.

    Science.gov (United States)

    Chalmers, Lauren; Cross, Jessica; Chu, Cindy S; Phyo, Aung Pyae; Trip, Margreet; Ling, Clare; Carrara, Verena; Watthanaworawit, Wanitda; Keereecharoen, Lily; Hanboonkunupakarn, Borimas; Nosten, François; McGready, Rose

    2015-10-01

    Published literature from resource-limited settings is infrequent, although urinary tract infections (UTI) are a common cause of outpatient presentation and antibiotic use. Point-of-care test (POCT) interpretation relates to antibiotic use and antibiotic resistance. We aimed to assess the diagnostic accuracy of POCT and their role in UTI antibiotic stewardship. One-year retrospective analysis in three clinics on the Thailand-Myanmar border of non-pregnant adults presenting with urinary symptoms. POCT (urine dipstick and microscopy) were compared to culture with significant growth classified as pure growth of a single organism >10(5)  CFU/ml. In 247 patients, 82.6% female, the most common symptoms were dysuria (81.2%), suprapubic pain (67.8%) and urinary frequency (53.7%). After excluding contaminated samples, UTI was diagnosed in 52.4% (97/185); 71.1% (69/97) had a significant growth on culture, and >80% of these were Escherichia coli (20.9% produced extended-spectrum β-lactamase (ESBL)). Positive urine dipstick (leucocyte esterase ≥1 and/or nitrate positive) compared against positive microscopy (white blood cell >10/HPF, bacteria ≥1/HPF, epithelial cells sensitivity (99% vs. 57%) but a lower specificity (47% vs. 89%), respectively. Combined POCT resulted in the best sensitivity (98%) and specificity (81%). Nearly one in ten patients received an antimicrobial to which the organism was not fully sensitive. One rapid, cost-effective POCT was too inaccurate to be used alone by healthcare workers, impeding antibiotic stewardship in a high ESBL setting. Appropriate prescribing is improved with concurrent use and concordant results of urine dipstick and microscopy. © 2015 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

  14. Potential role of a pharmacist to enhance medication-related aspects of clinical trials conducted in a dedicated clinical research unit

    Directory of Open Access Journals (Sweden)

    Kimberly A. Redic, PharmD

    2017-06-01

    Conclusions: This pilot study showed potential roles for pharmacy personnel involvement in medication reconciliation in the clinical research setting. Pharmacists have the opportunity to ensure that IDs are accurately included in patient medication lists and to identify the use of potential protocol prohibited concomitant medications.

  15. Counting SET-free sets

    OpenAIRE

    Harman, Nate

    2016-01-01

    We consider the following counting problem related to the card game SET: How many $k$-element SET-free sets are there in an $n$-dimensional SET deck? Through a series of algebraic reformulations and reinterpretations, we show the answer to this question satisfies two polynomiality conditions.

  16. Patterns and Predictors of Depression Treatment among Older Adults with Parkinson’s Disease and Depression in Ambulatory Care Settings in the United States

    Directory of Open Access Journals (Sweden)

    Sandipan Bhattacharjee

    2018-01-01

    Full Text Available Little is known regarding depression treatment patterns and predictors among older adults with comorbid Parkinson's disease and depression (dPD in the United States (US. The objective of this study was to assess the patterns and predictors of depression treatment among older adults with dPD in the US. We adopted a cross-sectional study design by pooling multiple-year data (2005–2011 from the National Ambulatory Medical Care Survey (NAMCS and the outpatient department of the National Hospital Ambulatory Medical Care Survey (NHAMCS. The final study sample consisted of visits by older adults with dPD. Depression treatment was defined as antidepressant use with or without psychotherapy. To identify predictors of depression treatment, multivariate logistic regression analysis was conducted adjusting for predisposing, enabling, and need factors. Individuals with dPD and polypharmacy were 74% more likely to receive depression treatment (odds ratio = 1.743, 95% CI 1.376–2.209, while dPD subjects with comorbid chronic conditions were 44% less likely (odds ratio = 0.559, 95% CI 0.396–0.790 to receive depression treatment. Approximately six out of ten older adults with PD and depression received depression treatment. Treatment options for dPD are underutilized in routine clinical practice, and further research should explore how overall medical complexity presents a barrier to depression treatment.

  17. Integrating Million Hearts into nursing and interprofessional educational curricula and community settings: a key strategy for improving population health across the United States.

    Science.gov (United States)

    Sustersic Gawlik, Kate; Mazurek Melnyk, Bernadette

    2015-01-01

    Million Hearts is a national initiative to prevent 1 million heart attacks and strokes by 2017 by screening and educating the public on the "ABCS" of cardiovascular health. Million Hearts is an innovative platform for educating nursing and health sciences students on the importance of population health and interprofessional teamwork. The National Interprofessional Education and Practice Consortium to Advance Million Hearts was created, and a free on-line educational module was developed to help health care professionals and health sciences faculty and students learn about the Million Hearts initiative, conduct community screenings, and refer people who screen positive to appropriate resources. After completion of the module, individuals receive certification as a Million Hearts Fellow. More than 2,500 individuals from 80 colleges across the United States have accessed the module. More than 20,000 people have been screened. The module and screenings have been incorporated into health sciences curricula and community activities. Academic institutions and health science professions partnering together as part of the National Interprofessional Education and Practice Consortium to Advance Million Hearts provide a unique opportunity to demonstrate the impact that a unified approach can have on improving population health through the use of screening, education, and prevention. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Body mass index and depressive symptoms in primary care settings: examining the moderating roles of smoking status, alcohol consumption and vigorous exercise.

    Science.gov (United States)

    Hooker, S A; MacGregor, K L; Funderburk, J S; Maisto, S A

    2014-02-01

    Depressive symptoms and obesity are highly prevalent in primary care settings. Depressive symptoms and obesity are positively related; as body weight increases, individuals are more likely to display depressive symptoms. This study examines the moderating roles of health behaviours (alcohol use, smoking status and vigorous exercise) on the relationship between body mass index and depressive symptoms. Exercise attenuates the relationship between depressive symptoms and obesity. Primary care patients often report multiple health risk behaviours and symptoms, including obesity and depressive symptomatology. This study examined the relationship between body mass index (BMI) and depressive symptomatology among primary care patients and tested its moderation by health behaviours. Primary care patients (n = 497) completed self-report questionnaires. Using three multilevel models, we tested the moderation of health behaviours on the BMI-depressive symptoms relationship. After controlling for relevant covariates, BMI was positively related to depressive symptoms. Smokers reported more depressive symptoms (P exercisers reported fewer (P  0.05). Only vigorous exercise significantly moderated the BMI-depression relationship (P < 0.05). BMI is positively related to depressive symptoms among patients who do not participate in vigorous activity, suggesting that vigorous activity reduces the risk for depressive symptoms among patients with higher BMI. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.

  19. The PR/SET Domain Zinc Finger Protein Prdm4 Regulates Gene Expression in Embryonic Stem Cells but Plays a Nonessential Role in the Developing Mouse Embryo

    Science.gov (United States)

    Bogani, Debora; Morgan, Marc A. J.; Nelson, Andrew C.; Costello, Ita; McGouran, Joanna F.; Kessler, Benedikt M.

    2013-01-01

    Prdm4 is a highly conserved member of the Prdm family of PR/SET domain zinc finger proteins. Many well-studied Prdm family members play critical roles in development and display striking loss-of-function phenotypes. Prdm4 functional contributions have yet to be characterized. Here, we describe its widespread expression in the early embryo and adult tissues. We demonstrate that DNA binding is exclusively mediated by the Prdm4 zinc finger domain, and we characterize its tripartite consensus sequence via SELEX (systematic evolution of ligands by exponential enrichment) and ChIP-seq (chromatin immunoprecipitation-sequencing) experiments. In embryonic stem cells (ESCs), Prdm4 regulates key pluripotency and differentiation pathways. Two independent strategies, namely, targeted deletion of the zinc finger domain and generation of a EUCOMM LacZ reporter allele, resulted in functional null alleles. However, homozygous mutant embryos develop normally and adults are healthy and fertile. Collectively, these results strongly suggest that Prdm4 functions redundantly with other transcriptional partners to cooperatively regulate gene expression in the embryo and adult animal. PMID:23918801

  20. The Role of Hydrodynamic Processes on Anchovy Eggs and Larvae Distribution in the Sicily Channel (Mediterranean Sea): A Case Study for the 2004 Data Set

    Science.gov (United States)

    Falcini, Federico; Palatella, Luigi; Cuttitta, Angela; Buongiorno Nardelli, Bruno; Lacorata, Guglielmo; Lanotte, Alessandra S.; Patti, Bernardino; Santoleri, Rosalia

    2015-01-01

    Knowledge of the link between ocean hydrodynamics and distribution of small pelagic fish species is fundamental for the sustainable management of fishery resources. Both commercial and scientific communities are indeed seeking to provide services that could “connect the dots” among in situ and remote observations, numerical ocean modelling, and fisheries. In the Mediterranean Sea and, in particular, in the Sicily Channel the reproductive strategy of the European Anchovy (Engraulis encrasicolus) is strongly influenced by the oceanographic patterns, which are often visible in sea surface temperature satellite data. Based on these experimental evidences, we propose here a more general approach where the role of ocean currents, wind effects, and mesoscale activity are tied together. To investigate how these features affect anchovy larvae distribution, we pair ichthyoplankton observations to a wide remote sensing data set, and to Lagrangian numerical simulations for larval transport. Our analysis shows that while the wind-induced coastal current is able to transport anchovy larvae from spawning areas to the recruiting area off the Sicilian south-eastern tip, significant cross-shore transport due to the combination of strong northwesterly mistral winds and topographic effects delivers larvae away from the coastal conveyor belt. We then use a potential vorticity approach to describe the occurrence of larvae cross-shore transport. We conclude that monitoring and quantifying the upwelling on the southern Sicilian coast during the spawning season allows to estimate the cross-shore transport of larvae and the consequent decrease of individuals within the recruiting area. PMID:25915489

  1. Real-life setting in data collection. The role of nutrition knowledge whilst selecting food products for weight management purposes in a supermarket environment.

    Science.gov (United States)

    Saarela, Anna-Maria; Lapveteläinen, Anja T; Mykkänen, Hannu M; Kantanen, Teuvo T; Rissanen, Riitta L

    2013-12-01

    The aim was to explore the role of consumers' nutrition knowledge while selecting foods for weight management and the predominating food selection factors by combining quantitative and qualitative methodology in a real-life setting during two consecutive shopping tasks given in a supermarket. Thirty-six consumers were given a list of 11 products and asked to think-aloud while selecting (i) a product they usually buy and (ii) a product they use for weight management. After the consecutive shopping tasks, the subjects were interviewed and asked to answer a nutrition knowledge questionnaire. The subjects were categorized by the difference in the energy contents of their selections and the food selection criteria. The energy contents of the selections for weight management were reduced by 10-46%. Ten subjects with the greatest difference between the energy contents of their selections had higher level in nutrition knowledge and mentioned less nutritional issues during the selections than ten subjects with the smallest such differences. Taste was an important product selection criterion by the former group, while the latter focused primarily on price. Nutrition knowledge is interrelated with personal factors and selection goals. It is not necessarily utilized consistently when selecting food products. Copyright © 2013 Elsevier Ltd. All rights reserved.

  2. The role of hydrodynamic processes on anchovy eggs and larvae distribution in the sicily channel (mediterranean sea: a case study for the 2004 data set.

    Directory of Open Access Journals (Sweden)

    Federico Falcini

    Full Text Available Knowledge of the link between ocean hydrodynamics and distribution of small pelagic fish species is fundamental for the sustainable management of fishery resources. Both commercial and scientific communities are indeed seeking to provide services that could "connect the dots" among in situ and remote observations, numerical ocean modelling, and fisheries. In the Mediterranean Sea and, in particular, in the Sicily Channel the reproductive strategy of the European Anchovy (Engraulis encrasicolus is strongly influenced by the oceanographic patterns, which are often visible in sea surface temperature satellite data. Based on these experimental evidences, we propose here a more general approach where the role of ocean currents, wind effects, and mesoscale activity are tied together. To investigate how these features affect anchovy larvae distribution, we pair ichthyoplankton observations to a wide remote sensing data set, and to Lagrangian numerical simulations for larval transport. Our analysis shows that while the wind-induced coastal current is able to transport anchovy larvae from spawning areas to the recruiting area off the Sicilian south-eastern tip, significant cross-shore transport due to the combination of strong northwesterly mistral winds and topographic effects delivers larvae away from the coastal conveyor belt. We then use a potential vorticity approach to describe the occurrence of larvae cross-shore transport. We conclude that monitoring and quantifying the upwelling on the southern Sicilian coast during the spawning season allows to estimate the cross-shore transport of larvae and the consequent decrease of individuals within the recruiting area.

  3. Vancomycin-Resistant Enterococci (VRE) in The Intensive Care Unit in a Nonoutbreak Setting: Identification of Potential Reservoirs and Epidemiological Associations Between Patient and Environmental VRE.

    Science.gov (United States)

    McDermott, Hélène; Skally, Mairead; O'Rourke, James; Humphreys, Hilary; Fitzgerald-Hughes, Deirdre

    2018-01-01

    OBJECTIVE Among nosocomial bloodstream infections caused by enterococcal species, Ireland has the highest proportion caused by vancomycin-resistant enterococci (VRE) in Europe at 45.8%. The contribution of the near-patient environment to VRE transmission outside of outbreaks was investigated. DESIGN A prospective observational study was conducted during 7 sampling periods. METHODS Recovery of VRE isolates by swabbing the near-patient environment and patients in the intensive care unit (ICU) was conducted to identify reservoirs, clinical and molecular epidemiological associations, and the success of active surveillance cultures (ASCs). RESULTS Of 289 sampling occasions involving 157 patients and their bed spaces, VRE isolates were recovered from patient bed spaces, clinical samples, or both on 114 of 289 sampling occasions (39.4%). The patient and their bed space were positive for VRE on 34 of 114 VRE-associated sampling occasions (29.8%). Of 1,647 environment samples, 107 sites (6.5%) were VRE positive, with significantly greater VRE recovery from isolation rooms than from the open-plan area (9.1% vs 4.1%; P < .0001). The most frequently VRE-contaminated sites were the drip stand, bed control panel, and chart holders, which together accounted for 61% of contaminated sites. The use of ASCs resulted in a 172% increase in identification of VRE-colonized patients. Molecular typing revealed 2 environmental clusters, 1 cluster involving 3 patients and generally greater heterogeneity of patient isolates compared to environmental isolates. CONCLUSION Even outside of outbreaks, near-patient ICU environmental contamination with VRE is common. Better infection control policies that limit environmental transmission of VRE in the ICU and that are supported by molecular epidemiological studies, in real time, are needed. Infect Control Hosp Epidemiol 2018;39:40-45.

  4. Measuring communication competence and effectiveness of ASHAs (accredited social health activist) in their leadership role at rural settings of Uttar Pradesh (India).

    Science.gov (United States)

    Shrivastava, Archana; Srivastava, Arun

    2016-01-01

    Purpose - This paper aims to find out accredited social health activists' (ASHA) communication competence and effectiveness while working as leaders with groups in the rural setting. ASHA, as the "first point of contact" for pregnant women in rural areas, plays a significant role in building awareness and disseminating key information at critical times (e.g. antenatal and post-natal period), promotes healthy maternal and newborn care practices and facilitates identification and referral of maternal and newborn complications. ASHA plays critical role of a leader in bridging the gap between health system and community. In the entire process, effective communication competency is the key to her effectiveness. Design/methodology/approach - The study adopts seven items from the farmers communication (FACOM) scale of communication measures developed by Udai Pareek and Y.P Singh. Preliminary editing of the items was done keeping certain points in mind such as the items should not be judgemental, should be acts of behaviour, should be observable and should be simple. This scale was adopted for the study, as it was designed to measure farmers' communication competence and suited the context. The evaluation criteria included the seven essential elements of communication identified in the FACOM scale. Findings - Results from the study identified a need to sensitise ASHAs on the critical role of effective communication and need for investing more in building her capacity for health communication. The trainings being imparted to ASHAs have to be strengthened in terms of communication skills. They should focus upon developing all three variables of communication skills equally and integrating them to get desired results. Research limitations/implications - The study was conducted in one state while the programme is running across the country. The sample size was small. Practical implications - The learning of the study will help in developing a better understanding of the

  5. Social Set Analysis

    DEFF Research Database (Denmark)

    Vatrapu, Ravi; Mukkamala, Raghava Rao; Hussain, Abid

    2016-01-01

    , conceptual and formal models of social data, and an analytical framework for combining big social data sets with organizational and societal data sets. Three empirical studies of big social data are presented to illustrate and demonstrate social set analysis in terms of fuzzy set-theoretical sentiment...... automata and agent-based modeling). However, when it comes to organizational and societal units of analysis, there exists no approach to conceptualize, model, analyze, explain, and predict social media interactions as individuals' associations with ideas, values, identities, and so on. To address...... analysis, crisp set-theoretical interaction analysis, and event-studies-oriented set-theoretical visualizations. Implications for big data analytics, current limitations of the set-theoretical approach, and future directions are outlined....

  6. Gender Roles Revisited: The Development of the "Woman's Place" among African American Women in the United States.

    Science.gov (United States)

    Burgess, Norma J.

    1994-01-01

    Examines the black female's role in U.S. society, particularly with regard to working outside the home, and argues that one cannot understand what African American women are today without having a historical perspective for what their ancestors and their ancestors' roles, functions, and responsibilities were. An Afrocentric perspective is…

  7. Women׳s birthplace decision-making, the role of confidence: Part of the Evaluating Maternity Units study, New Zealand.

    Science.gov (United States)

    Grigg, Celia P; Tracy, Sally K; Schmied, Virginia; Daellenbach, Rea; Kensington, Mary

    2015-06-01

    to explore women׳s birthplace decision-making and identify the factors which enable women to plan to give birth in a freestanding midwifery-led primary level maternity unit rather than in an obstetric-led tertiary level maternity hospital in New Zealand. a mixed methods prospective cohort design. data from eight focus groups (37 women) and a six week postpartum survey (571 women, 82%) were analysed using thematic analysis and descriptive statistics. The qualitative data from the focus groups and survey were the primary data sources and were integrated at the analysis stage; and the secondary qualitative and quantitative data were integrated at the interpretation stage. Christchurch, New Zealand, with one tertiary maternity hospital and four primary level maternity units (2010-2012). well (at 'low risk' of developing complications), pregnant women booked to give birth in one of the primary units or the tertiary hospital. All women received midwifery continuity of care, regardless of their intended or actual birthplace. five core themes were identified: the birth process, women׳s self-belief in their ability to give birth, midwives, the health system and birth place. 'Confidence' was identified as the overarching concept influencing the themes. Women who chose to give birth in a primary maternity unit appeared to differ markedly in their beliefs regarding their optimal birthplace compared to women who chose to give birth in a tertiary maternity hospital. The women who planned a primary maternity unit birth expressed confidence in the birth process, their ability to give birth, their midwife, the maternity system and/or the primary unit itself. The women planning to give birth in a tertiary hospital did not express confidence in the birth process, their ability to give birth, the system for transfers and/or the primary unit as a birthplace, although they did express confidence in their midwife. birthplace is a profoundly important aspect of women׳s experience of

  8. Automatic sets and Delone sets

    International Nuclear Information System (INIS)

    Barbe, A; Haeseler, F von

    2004-01-01

    Automatic sets D part of Z m are characterized by having a finite number of decimations. They are equivalently generated by fixed points of certain substitution systems, or by certain finite automata. As examples, two-dimensional versions of the Thue-Morse, Baum-Sweet, Rudin-Shapiro and paperfolding sequences are presented. We give a necessary and sufficient condition for an automatic set D part of Z m to be a Delone set in R m . The result is then extended to automatic sets that are defined as fixed points of certain substitutions. The morphology of automatic sets is discussed by means of examples

  9. Treatment Dosing Patterns and Clinical Outcomes for Patients with Type 2 Diabetes Starting or Switching to Treatment with Insulin Glargine (300 Units per Milliliter) in a Real-World Setting: A Retrospective Observational Study.

    Science.gov (United States)

    Gupta, Shaloo; Wang, Hongwei; Skolnik, Neil; Tong, Liyue; Liebert, Ryan M; Lee, Lulu K; Stella, Peter; Cali, Anna; Preblick, Ronald

    2018-01-01

    Usage patterns and effectiveness of a longer-acting formulation of insulin glargine at a strength of 300 units per milliliter (Gla-300) have not been studied in real-world clinical practice. This study evaluated differences in dosing and clinical outcomes before and after Gla-300 treatment initiation in patients with type 2 diabetes starting or switching to treatment with Gla-300 to assess whether the benefits observed in clinical trials translate into real-world settings. This was a retrospective observational study using medical record data obtained by physician survey for patients starting treatment with insulin glargine at a strength of 100 units per milliliter (Gla-100) or Gla-300, or switching to treatment with Gla-300 from treatment with another basal insulin (BI). Differences in dosing and clinical outcomes before versus after treatment initiation or switching were examined by generalized linear mixed-effects models. Among insulin-naive patients starting BI treatment, no difference in the final titrated dose was observed in patients starting Gla-300 treatment versus those starting Gla-100 treatment [least-squares (LS) mean 0.43 units per kilogram vs 0.44 units per kilogram; P = 0.77]. Both groups had significant hemoglobin A 1c level reductions (LS mean 1.21 percentage points for Gla-300 and 1.12 percentage points for Gla-100 ; both P per kilogram before switch vs 0.58 units per kilogram after switch; P = 0.02). The mean hemoglobin A 1c level was significantly lower after switching than before switching (adjusted difference - 0.95 percentage points, 95% CI - 1.13 to - 0.78 percentage points ; P per patient-year were significantly lower (relative risk 0.17, 95% CI 0.11-0.26; P < 0.0001). Insulin-naive patients starting Gla-300 treatment had fewer hypoglycemic events, a similar hemoglobin A 1c level reduction, and no difference in insulin dose versus patients starting Gla-100 treatment. Patients switching to Gla-300 treatment from treatment with

  10. The role of total cell-free DNA in predicting outcomes among trauma patients in the intensive care unit

    DEFF Research Database (Denmark)

    Gögenur, Mikail; Burcharth, Jakob; Gögenur, Ismail

    2017-01-01

    searched Pubmed, Embase, Scopus and the Cochrane Central Register for Controlled Trials and reference lists of relevant articles for studies that assessed the prognostic value of cell-free DNA detection in trauma patients in the intensive care unit. Outcomes of interest included survival, posttraumatic...

  11. The Role of the Sheffield Model on the Minimum Unit Pricing of Alcohol Debate: The Importance of a Rhetorical Perspective

    Science.gov (United States)

    Katikireddi, Srinivasa Vittal; Hilton, Shona; Bond, Lyndal

    2016-01-01

    The minimum unit pricing (MUP) alcohol policy debate has been informed by the Sheffield model, a study which predicts impacts of different alcohol pricing policies. This paper explores the Sheffield model's influences on the policy debate by drawing on 36 semi-structured interviews with policy actors who were involved in the policy debate.…

  12. Wildfire risk reduction in the United States: Leadership staff perceptions of local fire department roles and responsibilities

    Science.gov (United States)

    Rachel S. Madsen; Hylton J. G. Haynes; Sarah M. McCaffrey

    2018-01-01

    As wildland fires have had increasing negative impacts on a range of human values, in many parts of the United States (U.S.) and around the world, collaborative risk reduction efforts among agencies, homeowners, and fire departments are needed to improve wildfire safety and mitigate risk. Using interview data from 46 senior officers from local fire departments around...

  13. The Role of Parents' Control in Early Adolescents' Psychological Functioning: A Longitudinal Investigation in the United States and China

    Science.gov (United States)

    Wang, Qian; Pomerantz, Eva M.; Chen, Huichang

    2007-01-01

    This research compared the effects over time of parents' control and autonomy support on children's functioning in the United States and China. American and Chinese (N = 806) seventh graders (mean age = 12.73 years) participated in a 6-month longitudinal study. Children reported on their parents' psychological control, psychological autonomy…

  14. The Role of the United Nations in the 21st Century: A Case for an International Police Force

    National Research Council Canada - National Science Library

    Kersten, Jeffrey

    2002-01-01

    As the United Nations (UN) enters the 21st Century, it is faced with security challenges that were not seen by its creators, The end of the Cold War, globalization, intra-state conflict, and a desire to achieve universal human...

  15. Modelling the potential role of forest thinning in maintaining water supplies under a changing climate across the conterminous United States

    Science.gov (United States)

    Ge Sun; Peter V. Caldwell; Steven G. McNulty

    2015-01-01

    The goal of this study was to test the sensitivity of water yield to forest thinning and other forest management/disturbances and climate across the conterminous United States (CONUS). Leaf area index (LAI) was selected as a key parameter linking changes in forest ecosystem structure and functions. We used the Water Supply Stress Index model to examine water yield...

  16. Assessing the role of federal community assistance programs to develop biomass utilization capacity in the Western United States

    Science.gov (United States)

    Dennis R. Becker; Mark Nechodom; Adam Barnett; Tad Mason; Eini C. Lowell; John Shelly; Dean Graham

    2008-01-01

    As forest biomass utilization becomes cost effective to harvest, more areas at risk of catastrophic wildfire can be thinned of dense brush and small-diameter trees. In an effort to increase biomass utilization, the USDA Forest Service granted more than $36 million in National Fire Plan-Economic Action Program funds in the Western United States during fiscal years 2001...

  17. Eroticizing inequality in the United States: the consequences and determinants of traditional gender role adherence in intimate relationships.

    Science.gov (United States)

    Sanchez, Diana T; Fetterolf, Janell C; Rudman, Laurie A

    2012-01-01

    This article reviews the research on traditional gender-role adherence and sexuality for heterosexual men and women. Specifically, the consequences and predictors of following traditional gender roles of female submissiveness and male dominance in sexual relationships is examined. Despite evidence that men and women's sexual roles are becoming more egalitarian over time, empirical evidence suggests that the traditional sexual roles continue to dominate heterosexual relations. This article explores whether the sexual context is one in which both men and women feel particularly compelled to engage in gender stereotypic behavior, and why. In addition, this article reports on research that finds that men and women have automatic associations between sexuality and power that reinforce their gender stereotypic behavior in sexual contexts. The negative effects of traditional gender-role adherence for women's sexual problems and satisfaction is demonstrated. This article concludes that traditional sexual scripts are harmful for both women's and men's ability to engage in authentic, rewarding sexual expression, although the female submissive role may be particularly debilitating. Future directions of research are suggested, including interventions to reduce women's adherence to the sexually submissive female script.

  18. Role of the team of scientific and technical commissioning support (TSTCS) during Mochovce NPP unit 3 and 4 commissioning

    International Nuclear Information System (INIS)

    Hermansky, J.; Prachar, M.; Sedlacek, M.; Petenyi, V.

    2011-01-01

    The Team of Scientific and Technical Commissioning Support (TSTCS) shall provide an independent support for the Mochovce NPP 3 and 4 Commissioning Department during Mochovce Units 3 and 4 commissioning. This independent support will be in line with the Mochovce NPP 3 and 4 Directive 'Non-active tests and commissioning' and it will be carried out in form of professional and expert works focusing on supervision of fulfilment of requirements for nuclear safety observance. The TSTCS duty to provide for such services during NPP commissioning is specified by Slovak Regulatory Body legislation. The independent TSTCS will supervise; - fulfilment of requirements for nuclear safety during preparation and implementation of commissioning tests; -scientific and technical level of commissioning programmes, and reflection on nuclear safety requirements in commissioning programmes,- commissioning process and test results. Main standpoints of the Team activities for individual unit commissioning stages will be; - assesment of the selected programs of functional tests in installations having an impact on nuclear safety and evaluation of the results of these tests; - assesment of the programs of physics and power commissioning, - assesment of the unit preparedness before fuel loading start; - assesment of the unit preparedness for performing initial criticality and low power commissioning and power commissioning stages; - evaluation of the results of physics and power commissioning stages and sub-stages; - final evaluation of the results from implementing the physics and power commissioning stages. The paper also presents a short description of the Team scope activities, the Team organisation, and a procedure for issuing of standpoints to individual unit commissioning stages. (Authors)

  19. Bus crash severity in the United-States: The role of driver behavior, service type, road factors and environmental conditions

    DEFF Research Database (Denmark)

    Kaplan, Sigal; Prato, Carlo Giacomo

    current study investigates the underlying risk factors of bus accident severity in the United States. A generalized ordered logit model is estimated in order to account for the ordered nature of severity, while allowing the violation of the proportional odds assumption across severity categories. Data...... for the analysis are retrieved from the General Estimates System (GES) database for the years 2005-2009. Results show that accident severity increases: (i) for young bus drivers under the age of 25; (ii) for drivers beyond the age of 55, and most prominently for drivers over 65 years old; (iii) for female drivers......Recent years have witnessed a growing interest in improving bus safety operations worldwide. While in the United States buses are considered relatively safe, the number of bus accidents is far from being negligible, triggering the introduction of the Motor-coach Enhanced Safety Act of 2011.The...

  20. The role of the United Nations Scientific Committee on the Effects of Atomic Radiation in relation to medical radiation exposures

    International Nuclear Information System (INIS)

    Shrimpton, P.C.

    2001-01-01

    In 1955, growing global concerns about ionizing radiation led the General Assembly of the United Nations to establish the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR). The mandate of this committee, which presently includes 21 Member States, is to assess and report on the levels and effects of exposure to ionizing radiation. Accordingly, UNSCEAR applies scientific judgement in undertaking comprehensive reviews and evaluations concerning radiation and maintains an independent and neutral position in drawing its conclusions. These are published in authoritative reports to the UN General Assembly, with there having been 14 such substantive reports, with technical annexes, since 1958. The information provided by UNSCEAR assists the General Assembly in making recommendations in relation, for example, to international collaboration in the field of health. Governments and organizations all over the world rely on the committee's evaluations as the scientific basis for estimating radiation risk, establishing radiation protection and safety standards, and regulating radiation sources

  1. Textiles, Guano and Railroads: The Role of the United States in the Early Development Failures of Peru, 1818-1876

    OpenAIRE

    Bollinger, William

    2012-01-01

    Peru's importance to the United States in the nineteenth century has been underappreciated because there were few instances of sharp conflict between the two nations. But, beginning with U.S. export of coarse cloth from new cotton mills just after Peruvian independence, continuing during the influence of Peruvian guano on U.S. "scientific agriculture," and then in the period of Peru's extraordinary effort to build trans-Andean railways, Peru exercised important influence on U.S. economy and ...

  2. “Seeing the Life”: Redefining self-worth and family roles among Iraqi refugee families resettled in the United States

    Science.gov (United States)

    Nelson, Matthew; Hess, Julia Meredith; Isakson, Brian; Goodkind, Jessica

    2017-01-01

    Social and geographic displacement is a global phenomenon that precipitates novel stressors and disruptions that intersect with longstanding familial and social roles. Among the displaced are war-torn Iraqi refugee families, who must address these new obstacles in unconventional ways. This study explores how such disruptions have influenced associations between gender and apparent self-worth experienced by Iraqi refugee families upon relocation to the United States. Further, the psychosocial mechanisms requisite of any novel approach to a new social construct are explored and reveal that production in the family is at the core of instability and shifting power dynamics during resettlement, preventing family members from “seeing the life” in the United States that they had envisioned prior to immigration. Over 200 semi-structured qualitative interviews with Iraqi participants and mental health providers were conducted over the course of the study, and demonstrate a plasticity among social roles in the family and community that transcends the notion of a simple role reversal, and illustrate the complex positionalities that families under stress must approximate during such physical and social displacement. PMID:28966556

  3. Teachers' Perceptions of Their Mentoring Role in Three Different Clinical Settings: Student Teaching, Early Field Experiences, and Entry Year Teaching

    Science.gov (United States)

    Gut, Dianne M.; Beam, Pamela C.; Henning, John E.; Cochran, Deborah C.; Knight, Rhonda Talford

    2014-01-01

    The purpose of this study was to determine the differences in mentoring across three different clinical settings: student teaching, early field experiences, and entry year teachers. Eighteen teachers with mentoring experience in all three clinical settings were selected and interviewed. The teachers' expectations for teacher development,…

  4. A Between- and Within-Person Analysis of Parenting And Time Spent in Criminogenic Settings during Adolescence: The Role of Self-Control And Delinquent Attitudes

    Science.gov (United States)

    Janssen, Heleen J.; Bruinsma, Gerben J. N.; Dekovic, Maja; Eichelsheim, Veroni I.

    2018-01-01

    Although spending time in criminogenic settings is increasingly recognized as an explanation for adolescent delinquency, little is known about its determinants. The current study aims to examine the extent to which (change in) self-control and (change in) delinquent attitudes relate to (change in) time spent in criminogenic settings, and the…

  5. The Role of Ultrasound in Graduate Anatomy Education: Current State of Integration in the United States and Faculty Perceptions

    Science.gov (United States)

    Royer, Danielle F.

    2016-01-01

    Ultrasound (US) is increasingly taught in medical schools, where it has been shown to be a valuable adjunct to anatomy training. To determine the extent of US training in nonmedical anatomy programs, and evaluate anatomists' perceptions on the role of US in anatomy education, an online survey was distributed to faculty in anatomy Master's and…

  6. Making a Global Impact: The United States' Role in Training International Students as Rehabilitation Counselors and Educators

    Science.gov (United States)

    Chen, Roy K.; Ong, Lee Za; Brodwin, Martin G.

    2008-01-01

    The World Health Organization (WHO) has estimated that about 10% of the world's population has some kind of disability (Poverty and Disability, 2000), yet many of the individuals who live in developing nations lack access to rehabilitation services. In this paper the authors share their concerns and rationale regarding the role of the United…

  7. The role of international institutions in the formation of international bioethical law: UNESCO and the United Nations General Assembly attempt to govern human cloning.

    Science.gov (United States)

    Kuppuswamy, Chamundeeswari

    2007-01-01

    This article analyses the international governance of human reproductive cloning. Noting that bioethics is a new field of engagement for international lawyers, it recounts some of the institutional developments in bioethical law making. The role of UNESCO and the United Nations General Assembly is scrutinized and the author discusses the relative merits of the institutions' governance of human reproductive cloning. The author suggests that some international institutions and mechanisms are better suited than others for bioethical law making. The 2005 General Assembly resolution on human cloning is analysed in this context.

  8. Density functional theory calculations of the lowest energy quintet and triplet states of model hemes: role of functional, basis set, and zero-point energy corrections.

    Science.gov (United States)

    Khvostichenko, Daria; Choi, Andrew; Boulatov, Roman

    2008-04-24

    We investigated the effect of several computational variables, including the choice of the basis set, application of symmetry constraints, and zero-point energy (ZPE) corrections, on the structural parameters and predicted ground electronic state of model 5-coordinate hemes (iron(II) porphines axially coordinated by a single imidazole or 2-methylimidazole). We studied the performance of B3LYP and B3PW91 with eight Pople-style basis sets (up to 6-311+G*) and B97-1, OLYP, and TPSS functionals with 6-31G and 6-31G* basis sets. Only hybrid functionals B3LYP, B3PW91, and B97-1 reproduced the quintet ground state of the model hemes. With a given functional, the choice of the basis set caused up to 2.7 kcal/mol variation of the quintet-triplet electronic energy gap (DeltaEel), in several cases, resulting in the inversion of the sign of DeltaEel. Single-point energy calculations with triple-zeta basis sets of the Pople (up to 6-311G++(2d,2p)), Ahlrichs (TZVP and TZVPP), and Dunning (cc-pVTZ) families showed the same trend. The zero-point energy of the quintet state was approximately 1 kcal/mol lower than that of the triplet, and accounting for ZPE corrections was crucial for establishing the ground state if the electronic energy of the triplet state was approximately 1 kcal/mol less than that of the quintet. Within a given model chemistry, effects of symmetry constraints and of a "tense" structure of the iron porphine fragment coordinated to 2-methylimidazole on DeltaEel were limited to 0.3 kcal/mol. For both model hemes the best agreement with crystallographic structural data was achieved with small 6-31G and 6-31G* basis sets. Deviation of the computed frequency of the Fe-Im stretching mode from the experimental value with the basis set decreased in the order: nonaugmented basis sets, basis sets with polarization functions, and basis sets with polarization and diffuse functions. Contraction of Pople-style basis sets (double-zeta or triple-zeta) affected the results

  9. Closing the gap between behavior and models in route choice: The role of spatiotemporal constraints and latent traits in choice set formation

    DEFF Research Database (Denmark)

    Kaplan, Sigal; Prato, Carlo Giacomo

    2012-01-01

    not account for individual-related spatiotemporal constraints. This paper reduces the gap by proposing a route choice model incorporating spatiotemporal constraints and latent traits. The proposed approach combines stochastic route generation with a latent variable semi-compensatory model representing......A considerable gap exists between the behavioral paradigm of choice set formation in route choice and its representation in route choice modeling. While travelers form their viable choice set by retaining routes that satisfy spatiotemporal constraints, existing route generation techniques do...

  10. Patient safety climate (PSC) perceptions of frontline staff in acute care hospitals: examining the role of ease of reporting, unit norms of openness, and participative leadership.

    Science.gov (United States)

    Zaheer, Shahram; Ginsburg, Liane; Chuang, You-Ta; Grace, Sherry L

    2015-01-01

    Increased awareness regarding the importance of patient safety issues has led to the proliferation of theoretical conceptualizations, frameworks, and articles that apply safety experiences from high-reliability industries to medical settings. However, empirical research on patient safety and patient safety climate in medical settings still lags far behind the theoretical literature on these topics. The broader organizational literature suggests that ease of reporting, unit norms of openness, and participative leadership might be important variables for improving patient safety. The aim of this empirical study is to examine in detail how these three variables influence frontline staff perceptions of patient safety climate within health care organizations. A cross-sectional study design was used. Data were collected using a questionnaire composed of previously validated scales. The results of the study show that ease of reporting, unit norms of openness, and participative leadership are positively related to staff perceptions of patient safety climate. Health care management needs to involve frontline staff during the development and implementation stages of an error reporting system to ensure staff perceive error reporting to be easy and efficient. Senior and supervisory leaders at health care organizations must be provided with learning opportunities to improve their participative leadership skills so they can better integrate frontline staff ideas and concerns while making safety-related decisions. Finally, health care management must ensure that frontline staff are able to freely communicate safety concerns without fear of being punished or ridiculed by others.

  11. A national survey of pain clinics within the United Kingdom and Ireland focusing on the multidisciplinary team and the incorporation of the extended nursing role.

    Science.gov (United States)

    Kailainathan, Pungavi; Humble, Stephen; Dawson, Helen; Cameron, Fiona; Gokani, Shyam; Lidder, Gursimren

    2018-02-01

    Inconsistencies in the availability and quality of pain service provision have been noted nationally, as have lengthy waiting times for appointments and lack of awareness of the Pain Clinic role. The 2013 NHS England report stated that specialist pain services must offer multispecialty and multidisciplinary pain clinics. This national survey of multidisciplinary pain service provision in the United Kingdom and Ireland provides a snapshot of pain service provision in order to review and highlight what variations exist in multidisciplinary team (MDT) provision and working patterns. A common perception among clinicians is that financial pressures have led to alternate ways of staff utilisation with variable degrees of success. The survey included 143 pain clinics, focusing principally on MDT working patterns, MDT composition and adoption of the extended role. The results identified that the majority of Pain Clinics utilise the MDT approach. However, provision of critical components such as regular MDT meetings is highly variable as is the composition of the MDT itself and also working patterns of the individual clinicians. The survey reports the successful use of the extended roles for specialist nurses in follow up clinics. In contrast, the survey highlights that a large proportion of clinicians surveyed have reservations about both the effectiveness and the safety of utilising specialist nurses in the extended role to see new referrals of complex pain patients to pain clinics. This survey underlines the essential requirement for incorporation of greater MDT working locally and nationally and allocation of appropriate resources to facilitate this.

  12. Unit Cost Compendium Calculations

    Data.gov (United States)

    U.S. Environmental Protection Agency — The Unit Cost Compendium (UCC) Calculations raw data set was designed to provide for greater accuracy and consistency in the use of unit costs across the USEPA...

  13. Erythroplasia of Queyrat Treated with 5% Imiquimod Cream — Case Report Emphasizing the Role of Human Papilloma Virus Testing in a Clinical Setting

    Directory of Open Access Journals (Sweden)

    Chiriac Anca

    2017-03-01

    Full Text Available Background: Anogenital premalignancies and malignancies often affect females and males, and human papillomavirus infection plays a crucial role in their etiopathogenesis. These lesions are very important and represent an immense public health burden.

  14. The Role of the United Nations Committee on the Peaceful Uses of Outer Space in Building Capacity

    Science.gov (United States)

    Haubold, Hans

    The Office for Outer Space Affairs (OOSA) will provide an overview of achievements of UN- COPUOS, UNISPACE Conferences, particularly the establishment of the Programme on Space Applications and its priority thematic areas, UN-affiliated Regional Centres for Space Science and Technology Education, the International Committee on Global Navigation Satellite Systems (ICG), the UN Platform for Space-based Information for Disaster Management and Emergency Response (UN-Spider), and legal framework governing space activities of UN Member States. OOSA will review results of the United Nations Basic Space Science Initiative, particularly the development of networks of astronomical telescope facilities, planetariums, and instrument arrays for space research in developing nations. The mission of OOSA, implemented through on-going programmes developed for the International Heliophysical Year 2007 (IHY2007) and the International Year of Astronomy 2009 (IYA2009) will be highlighted.

  15. Aging in a cultural context: cross-national differences in disability and the moderating role of personal control among older adults in the United States and England.

    Science.gov (United States)

    Clarke, Philippa; Smith, Jacqui

    2011-07-01

    We investigate cross-national differences in late-life health outcomes and focus on an intriguing difference in beliefs about personal control found between older adult populations in the U.K. and United States. We examine the moderating role of control beliefs in the relationship between physical function and self-reported difficulty with daily activities. Using national data from the United States (Health and Retirement Study) and England (English Longitudinal Study on Ageing), we examine the prevalence in disability across the two countries and show how it varies according to the sense of control. Poisson regression was used to examine the relationship between objective measures of physical function (gait speed) and disability and the modifying effects of control. Older Americans have a higher sense of personal control than the British, which operates as a psychological resource to reduce disability among older Americans. However, the benefits of control are attenuated as physical impairments become more severe. These results emphasize the importance of carefully considering cross-national differences in the disablement process as a result of cultural variation in underlying psychosocial resources. This paper highlights the role of culture in shaping health across adults aging in different sociopolitical contexts.

  16. Coping with information style and family burden: Possible roles of self-stigma and hope among parents of children in a psychiatric inpatient unit.

    Science.gov (United States)

    Hasson-Ohayon, I; Pijnenborg, G H M; Ben-Pazi, A; Taitel, S; Goldzweig, G

    2017-05-01

    Parents of children who are hospitalized in inpatient psychiatric units must cope with significant challenges. One of these challenges relates to the way in which they cope with illness-related information. The current study examined the relationship between two such coping styles - monitoring and blunting - and family burden among parents of children in a psychiatric inpatient unit. Moreover, the possible moderating roles played by hope and self-stigma in these associations were also examined. Questionnaires regarding coping with information style, self-stigma, hope and family burden were administered to 70 parents. A main positive effect of hope and a main negative effect of self-stigma were uncovered. An interaction between self-stigma and monitoring was also revealed, suggesting that for parents with high self-stigma, compared to those with low self-stigma, more monitoring was related to more burden. Tailoring family interventions according to coping style and self-stigma is highly recommended as a mean to reduce the family burden of parents whose child is hospitalized in a psychiatric inpatient unit. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  17. The role of surgery in global health: analysis of United States inpatient procedure frequency by condition using the Global Burden of Disease 2010 framework.

    Directory of Open Access Journals (Sweden)

    John Rose

    Full Text Available The role of surgical care in promoting global health is the subject of much debate. The Global Burden of Disease 2010 study (GBD 2010 offers a new opportunity to consider where surgery fits amongst global health priorities. The GBD 2010 reinforces the DALY as the preferred methodology for determining the relative contribution of disease categories to overall global burden of disease without reference to the likelihood of each category requiring surgery. As such, we hypothesize that the GBD framework underestimates the role of surgery in addressing the global burden of disease.We compiled International Classification of Diseases, Version 9, codes from the United States Nationwide Inpatient Sample from 2010. Using the primary diagnosis code for each hospital admission, we aggregated admissions into GBD 2010 disease sub-categories. We queried each hospitalization for a major operation to determine the frequency of admitted patients whose care required surgery. Major operation was defined according to the Agency for Healthcare Research and Quality (AHRQ. In 2010, 10 million major inpatient operations were performed in the United States, associated with 28.6% of all admissions. Major operations were performed in every GBD disease subcategory (range 0.2%-84.0%. The highest frequencies of operation were in the subcategories of Musculoskeletal (84.0%, Neoplasm (61.4%, and Transport Injuries (43.2%. There was no disease subcategory that always required an operation; nor was there any disease subcategory that never required an operation.Surgical care cuts across the entire spectrum of GBD disease categories, challenging dichotomous traditional classifications of 'surgical' versus 'nonsurgical' diseases. Current methods of measuring global burden of disease do not reflect the fundamental role operative intervention plays in the delivery of healthcare services. Novel methodologies should be aimed at understanding the integration of surgical services into

  18. Improving the Understanding of Progressing and Emerging Health Informatics Roles and Skill Sets among Health Information Management Professionals: An Action Research Study

    Science.gov (United States)

    Palkie, Brooke N.

    2013-01-01

    The Health Information Management (HIM) profession is evolving to meet the technology demands of the current healthcare landscape. The 2009 enactment of the HITECH Act has placed unprecedented emphasis on utilizing technology to improve the quality of care and to decrease healthcare costs. Expectations of deep analytical skills have set the stage…

  19. Does Geographic Setting Alter the Roles of Academically Supportive Factors? African American Adolescents' Friendships, Math Self-Concept, and Math Performance

    Science.gov (United States)

    Jones, Martin H.; Irvin, Matthew J.; Kibe, Grace W.

    2012-01-01

    The study is one of few to examine how living in rural, suburban, or urban settings may alter factors supporting African Americans adolescents' math performance. The study examines the relationship of math self-concept and perceptions of friends' academic behaviors to African American students' math performance. Participants (N = 1,049) are…

  20. Do Mexican immigrants substitute health care in Mexico for health insurance in the United States? The role of distance.

    Science.gov (United States)

    Brown, Henry Shelton

    2008-12-01

    Although language and culture are important contributors to uninsurance among immigrants, one important contributor may have been overlooked - the ability of immigrants to return to their home country for health care. This paper examines the extent to which uninsurance (private insurance and Medicaid) is related to the ability of immigrants to return to Mexico for health care, as measured by spatial proximity. The data for this study are from the Mexican Migration Project. After controlling for household income, acculturation and demographic characteristics, arc distance to the place of origin plays a role in explaining uninsurance rates. Distance within Mexico is quite important, indicating that immigrants from the South of Mexico are more likely to seek care in their communities of origin (hometowns).

  1. A Multilevel Conceptual Framework to Understand the Role of Food Insecurity on Antiretroviral Therapy Adherence in Low-Resource Settings: From Theory to Practice

    Science.gov (United States)

    Masa, Rainier; Chowa, Gina

    2018-01-01

    The objective of this study was to describe a multilevel conceptual framework to understand the role of food insecurity on antiretroviral therapy adherence. The authors illustrated an example of how they used the multilevel framework to develop an intervention for poor people living with HIV in a rural and low-resource community. The framework incorporates intra-personal, interpersonal, and structural-level theories of understanding and changing health behaviors. The framework recognizes the role of personal, social, and environmental factors on cognition and behavior, with particular attention to ways in which treatment adherence is enabled or prevented by structural conditions, such as food insecurity. PMID:28368779

  2. Outcomes of nighttime refusal of admission to the intensive care unit: The role of the intensivist in triage.

    Science.gov (United States)

    Hinds, Nicholas; Borah, Amit; Yoo, Erika J

    2017-06-01

    To compare outcomes of patients refused medical intensive care unit (MICU) admission overnight to those refused during the day and to examine the impact of the intensivist in triage. Retrospective, observational study of patients refused MICU admission at an urban university hospital. Of 294 patients, 186 (63.3%) were refused admission overnight compared to 108 (36.7%) refused during the day. Severity-of-illness by the Mortality Probability Model was similar between the two groups (P=.20). Daytime triage refusals were more likely to be staffed by an intensivist (P=.01). After risk-adjustment, daytime refusals had a lower odds of subsequent ICU admission (OR 0.46, 95% CI 0.22-0.95, P=.04) than patients triaged at night. There was no evidence for interaction between time of triage and intensivist staffing of the patient (P=.99). Patients refused MICU admission overnight are more likely to be later admitted to an ICU than patients refused during the day. However, the mechanism for this observation does not appear to depend on the intensivist's direct evaluation of the patient. Further investigation into the clinician-specific effects of ICU triage and identification of potentially modifiable hospital triage practices will help to improve both ICU utilization and patient safety. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Uncovering the role of the East Asian jet stream and heterogeneities in atmospheric rivers affecting the western United States.

    Science.gov (United States)

    Zhang, Wei; Villarini, Gabriele

    2018-01-30

    Atmospheric rivers (ARs) exert major socioeconomic repercussions along the US West Coast by inducing heavy rainfall, flooding, strong winds, and storm surge. Despite the significant societal and economic repercussions of these storms, our understanding of the physical drivers responsible for their interannual variability is limited, with different climate modes identified as possible mechanisms. Here we show that the Pacific-Japan (PJ) teleconnections/patterns and the East Asian subtropical jet (EASJ) exhibit a strong linkage with the total frequency of ARs making landfall over the western United States, much stronger than the other potential climate modes previously considered. While our findings indicate that the PJ pattern and EASJ are the most relevant climate modes driving the overall AR activity, we also uncover heterogeneities in AR tracks. Specifically, we show that not all ARs making landfall along the West Coast come from a single population, but rather that it is possible to stratify these storms into three clusters. While the PJ pattern and EASJ are major drivers of AR activity for two clusters, the cluster that primarily affects the US Southwest is largely driven by other climate modes [El Niño Southern Oscillation (ENSO), the Atlantic meridional mode (AMM), the Pacific-North America (PNA) teleconnection pattern, and the North Pacific Gyre Oscillation (NPGO)]. Therefore, important regional differences exist and this information can substantially enhance our ability to predict and prepare for these storms and their impacts.

  4. Understanding the role of the news media in HPV vaccine uptake in the United States: Synthesis and commentary.

    Science.gov (United States)

    Gollust, Sarah E; LoRusso, Susan M; Nagler, Rebekah H; Fowler, Erika Franklin

    2016-06-02

    Vaccination rates for the human papillomavirus (HPV) vaccine fall below targets and only 2 states and the District of Columbia require the vaccine for middle school-age children. Messages conveyed through news media-to parents, providers, policymakers, and the general public-may contribute to sluggish vaccination rates and policy action. In this commentary, we review the findings from 13 published studies of news media coverage of the HPV vaccine in the United States since FDA licensure in 2006. We find 2 important themes in news coverage: a rising focus on political controversy and a consistent emphasis on the vaccine as for girls, even beyond the point when the vaccine was recommended for boys. These political and gendered messages have consequences for public understanding of the vaccine. Future research should continue to monitor news media depictions of the HPV vaccine to assess whether political controversy will remain a pronounced theme of coverage or whether the media ultimately depict the vaccine as a routine public health service.

  5. Public acceptance of nuclear power in the United States - the role of the national environmental policy act

    International Nuclear Information System (INIS)

    Jellinek, S.D.; Brubaker, G.L.

    1977-01-01

    The passage of the National Environmental Policy Act (NEPA) in 1969, required all U.S. Federal agencies to build consideration of the environmental impacts of their proposed activities into their decisionmaking process. It also established the Council on Environmental Quality (CEQ) within the Executive Office of the President to oversee its implementation, and to serve as the principle environmental policy adviser to the President. Agency environmental analyses are documented in an environmental impact statement (EIS) which is prepared prior to deciding if a project or a proposal is to be approved. Today the EIS is the foremost document used by both the Energy Research and Development Administration and the Nuclear Regulatory Commission to achieve public understanding and acceptance of nuclear power facilities in the U.S. At the center of the NEPA process is the opportunity for public comment on proposed projects. Initial public concern was with thermal pollution and the traditional environmental impacts related to power plant construction and operation. Recent interests, however, have been with larger policy issues related to safeguards and management of radioactive wastes. The role of the EIS in resolving these current issues and its role in the debate over future nuclear development in the U.S. is discussed. The provisions of NEPA are representative of the increasing trend worldwide toward greater public involvement in decisions on technology which can affect the future. The development and integration of the EIS into the U.S. nuclear decisionmaking process can provide interesting and valuable insights to other nations concerning the achievement of better public understanding and acceptance of nuclear power through public involvement in the decision process

  6. What role can child-care settings play in obesity prevention? A review of the evidence and call for research efforts.

    Science.gov (United States)

    Larson, Nicole; Ward, Dianne S; Neelon, Sara Benjamin; Story, Mary

    2011-09-01

    Given the widespread use of out-of-home child care and an all-time high prevalence of obesity among US preschool-aged children, it is imperative to consider the opportunities that child-care facilities may provide to reduce childhood obesity. This review examines the scientific literature on state regulations, practices and policies, and interventions for promoting healthy eating and physical activity, and for preventing obesity in preschool-aged children attending child care. Research published between January 2000 and July 2010 was identified by searching PubMed and MEDLINE databases, and by examining the bibliographies of relevant studies. Although the review focused on US child-care settings, interventions implemented in international settings were also included. In total, 42 studies were identified for inclusion in this review: four reviews of state regulations, 18 studies of child-care practices and policies that may influence eating or physical activity behaviors, two studies of parental perceptions and practices relevant to obesity prevention, and 18 evaluated interventions. Findings from this review reveal that most states lack strong regulations for child-care settings related to healthy eating and physical activity. Recent assessments of child-care settings suggest opportunities for improving the nutritional quality of food provided to children, the time children are engaged in physical activity, and caregivers' promotion of children's health behaviors and use of health education resources. A limited number of interventions have been designed to address these concerns, and only two interventions have successfully demonstrated an effect on child weight status. Recommendations are provided for future research addressing opportunities to prevent obesity in child-care settings. Copyright © 2011 American Dietetic Association. Published by Elsevier Inc. All rights reserved.

  7. The role of parents in public views of strategies to address childhood obesity in the United States.

    Science.gov (United States)

    Wolfson, Julia A; Gollust, Sarah E; Niederdeppe, Jeff; Barry, Colleen L

    2015-03-01

    POLICY POINTS: The American public--both men and women and those with and without children in the household--holds parents highly responsible and largely to blame for childhood obesity. High attributions of responsibility to parents for reducing childhood obesity did not universally undermine support for broader policy action. School-based obesity prevention policies were strongly supported, even among those viewing parents as mostly to blame for childhood obesity. Americans who viewed sectors outside the family (such as the food and beverage industry, schools, and the government) as helping address childhood obesity were more willing to support a wider range of population-based obesity prevention policies. The public's views of parents' behaviors and choices--and the attitudes held by parents themselves--are likely to influence the success of efforts to reverse obesity rates. We analyzed data from 2 US national public opinion surveys fielded in 2011 and 2012 to examine attributions of blame and responsibility to parents for obesity, both among the general public and parents themselves, and we also explored the relationship between views of parents and support for obesity prevention policies. We found that attribution of blame and responsibility to parents was consistently high, regardless of parental status or gender. Support for policies to curb childhood obesity also did not differ notably by parental status or gender. Multivariable analyses revealed consistent patterns in the association between public attitudes toward parents' responsibility and support for policies to curb childhood obesity. High parental responsibility was linked to higher support for school-targeted policies but generally was not associated with policies outside the school setting. Attribution of greater responsibility to entities external to children and their parents (schools, the food and beverage industry, and the government) was associated with greater support for both school

  8. Divorcing Marriage from Sex: Radically Rethinking the Role of Sex in Marriage Law in the United States

    Directory of Open Access Journals (Sweden)

    Sally Goldfarb

    2016-12-01

    Full Text Available In 2015, the U.S. Supreme Court required all states to permit same-sex couples to marry. Many people assume that marriage equality for gay, lesbian, bisexual and transgender people has been achieved simply by eliminating the requirement that two individuals entering a marriage must be of different sexes. However, family law in the United States has traditionally required not only that married people are of different sexes, but also that they perform heterosexual intercourse. This focus on heterosexual performance threatens to undermine the legal marriages of gay, lesbian, bisexual and transgender people. It also threatens the dignity, privacy, and legal validity of some heterosexual couples’ marriages. Contrary to current practice, the law should make no assumptions about the existence or type of sexual behavior between spouses that is necessary to create and sustain a marriage. En 2015, la Corte Suprema de los Estados Unidos obligó a todos los estados a permitir que las parejas del mismo sexo se casaran. Muchas personas asumen que se ha logrado la igualdad de matrimonio para personas gays, lesbianas, bisexuales y transexuales simplemente eliminando el requisito de que dos personas que contraen matrimonio deben ser de diferente sexo. Sin embargo, el derecho de familia en los Estados Unidos tradicionalmente ha requerido no sólo que las personas casadas sean de sexo diferente, sino también que mantengan relaciones sexuales heterosexuales. Este enfoque en el comportamiento heterosexual amenaza con minar los matrimonios legales de personas gays, lesbianas, bisexuales y transexuales. También amenaza la dignidad, privacidad y validez legal de los matrimonios de algunas parejas heterosexuales. Contrariamente a la práctica actual, el derecho no debe hacer suposiciones sobre la existencia o el tipo de comportamiento sexual entre los cónyuges que es necesario para crear y mantener un matrimonio.DOWNLOAD THIS PAPER FROM SSRN: https

  9. The role of hormones in the differences in the incidence of breast cancer between Mongolia and the United Kingdom.

    Directory of Open Access Journals (Sweden)

    Rebecca Troisi

    Full Text Available There are striking differences in breast cancer incidence between Asian and western women. Rates vary substantially within Asia also, with Mongolia's even lower than China's. These profound differences have been speculated to be due in part to diet, mediated by circulating hormone concentrations.Sex steroid hormone concentrations were measured in women living in Ulaanbaatar, Mongolia and the United Kingdom (U.K.. Diet was obtained by interview and national survey data. Mean hormone differences were compared by country, and systematic variation by number of days since last menstrual period was modeled and adjusted for age and parity; difference in overall area under the curves was assessed.The diet in Mongolia was higher in meat and dairy than in the U.K. Mean testosterone concentrations were 18.5% lower (p<0.0001 while estradiol concentrations were 19.1% higher (p = 0.02 in Mongolian than British women, adjusted for age and parity. Progesterone was almost 50% higher in Mongolian women (p = 0.04, particularly during the follicular phase and early luteal surge. Hormone concentrations generally were similar in Mongolian women born in Ulaanbaatar compared with those born in rural areas, although there was a decreasing progesterone trend by degree of westernization (rural Mongolia; urban Mongolia; U.K.. Mean hormone differences were similar when restricted to parous women, and with further adjustment for body mass index, height, and smoking status.These data augment accumulating evidence that circulating estrogens are unlikely to explain reduced breast cancer rates in Asia compared with the west, and suggest casting a wider net with respect to biomarkers. Lower testosterone and higher progesterone in Mongolian women raise the possibility that these hormones may be important to consider. In addition, the almost exclusive dietary reliance of Mongolians on meat and dairy argues against beneficial effects of a low-fat diet on circulating hormones

  10. Role of the community pharmacist in emergency contraception counseling and delivery in the United States: current trends and future prospects

    Directory of Open Access Journals (Sweden)

    Rafie S

    2017-03-01

    Full Text Available Sally Rafie,1 Rebecca H Stone,2 Tracey A Wilkinson,3 Laura M Borgelt,4,5 Shareen Y El-Ibiary,6 Denise Ragland7 1Department of Pharmacy, UC San Diego Health, San Diego, CA, 2Department of Clinical and Administrative Pharmacy, University of Georgia, College of Pharmacy, Athens, GA, 3Children’s Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, 4Department of Clinical Pharmacy, 5Department of Family Medicine, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, 6Department of Pharmacy Practice, College of Pharmacy, Midwestern University, Glendale, AZ, 7Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA Abstract: Women and couples continue to experience unintended pregnancies at high rates. In the US, 45% of all pregnancies are either mistimed or unwanted. Mishaps with contraceptives, such as condom breakage, missed pills, incorrect timing of patch or vaginal ring application, contraceptive nonuse, forced intercourse, and other circumstances, place women at risk of unintended pregnancy. There is a critical role for emergency contraception (EC in preventing those pregnancies. There are currently three methods of EC available in the US. Levonorgestrel EC pills have been available with a prescription for over 15 years and over-the-counter since 2013. In 2010, ulipristal acetate EC pills became available with a prescription. Finally, the copper intrauterine device remains the most effective form of EC. Use of EC is increasing over time, due to wider availability and accessibility of EC methods. One strategy to expand access for both prescription and nonprescription EC products is to include pharmacies as a point of access and allow pharmacist prescribing. In eight states, pharmacists are able to prescribe and provide EC directly to women: levonorgestrel EC in eight states and ulipristal

  11. Role of the nurse in the short stay immunotherapy Unit during the administration of intravenous anda subcutaneous gammaglobulin

    Directory of Open Access Journals (Sweden)

    Rosales Sánchez Isis

    2014-07-01

    Full Text Available With the increasing development of medical specialties, an urgent necessity of parallel specialties in the laboratories and nursing fields becomes evident. Immunology is the field of science responsible for the study of defense responses developed by an individual in the face of aggression by microorganisms or foreign particles as well as those coming from the internal environment such as neoplastic cells.1 Immunology is considered as a young discipline with an spectacular development that took place in the second half of 20th century. From then till date, there have been many important spectacular advances in the area leading to its consolidation as an independent science separate from microbiology. As part of the Immunology Service at the Instituto Nacional de Pediatria (INP, the Short-Stay Immunotherapy Unity (SSI was established. This unity has been fundamental in ensuring adequate treatment for patients with primary immunodeficiency and autoim- mune in the long term. We highlight the roles of the nursing staff of SSI in the area of drug preparation and patient care.

  12. Power in global health agenda-setting: the role of private funding Comment on "Knowledge, moral claims and the exercise of power in global health".

    Science.gov (United States)

    Levine, Ruth E

    2015-03-04

    The editorial by Jeremy Shiffman, "Knowledge, moral claims and the exercise of power in global health", highlights the influence on global health priority-setting of individuals and organizations that do not have a formal political mandate. This sheds light on the way key functions in global health depend on private funding, particularly from the Bill & Melinda Gates Foundation. © 2015 by Kerman University of Medical Sciences.

  13. Understanding the meaning and role of gifts given to Ugandan mothers in maternity care settings: 'The help they give when they've seen how different you are'.

    Science.gov (United States)

    Rudrum, Sarah; Brown, Helen; Oliffe, John L

    2016-11-01

    The provision of gifts to new mothers in Uganda is laden with significance that varies by the social location of the giver and receiver and the context and conditions under which the gift is made available. Here, we examine the act of gift giving and receiving within a Ugandan maternity care setting, describing the connections between these material objects and social relations. A study investigating the social organisation of maternity care in post-conflict northern Uganda found that gift-giving to new mothers functioned to create a material and discursive context wherein women's desire to access these goods was leveraged to create an incentive to attend formal maternity care during pregnancy and for delivery. In this article we describe the material and discursive processes surrounding gift-giving to new mothers in this global South health care setting. This article contributes critical analyses of the function of gifts in healthcare settings as constructing shared identities, social differences and normative values about health citizenship, and an incentive politic that affects equitable access to maternity care. Drawing on intersectional theory and analysis of how specific practices function ideologically to reward or incentivise pregnant women, we integrate material culture studies into the sociology of women's reproductive health. © 2016 Foundation for the Sociology of Health & Illness.

  14. Electricity without carbon dioxide: Assessing the role of carbon capture and sequestration in United States electric markets

    Science.gov (United States)

    Johnson, Timothy Lawrence

    2002-09-01

    Stabilization of atmospheric greenhouse gas concentrations will likely require significant cuts in electric sector carbon dioxide (CO2) emissions. The ability to capture and sequester CO2 in a manner compatible with today's fossil-fuel based power generating infrastructure offers a potentially low-cost contribution to a larger climate change mitigation strategy. This thesis fills a niche between economy-wide studies of CO 2 abatement and plant-level control technology assessments by examining the contribution that carbon capture and sequestration (CCS) might make toward reducing US electric sector CO2 emissions. The assessment's thirty year perspective ensures that costs sunk in current infrastructure remain relevant and allows time for technological diffusion, but remains free of assumptions about the emergence of unidentified radical innovations. The extent to which CCS might lower CO2 mitigation costs will vary directly with the dispatch of carbon capture plants in actual power-generating systems, and will depend on both the retirement of vintage capacity and competition from abatement alternatives such as coal-to-gas fuel switching and renewable energy sources. This thesis therefore adopts a capacity planning and dispatch model to examine how the current distribution of generating units, natural gas prices, and other industry trends affect the cost of CO2 control via CCS in an actual US electric market. The analysis finds that plants with CO2 capture consistently provide significant reductions in base-load emissions at carbon prices near 100 $/tC, but do not offer an economical means of meeting peak demand unless CO2 reductions in excess of 80 percent are required. Various scenarios estimate the amount by which turn-over of the existing generating infrastructure and the severity of criteria pollutant constraints reduce mitigation costs. A look at CO2 sequestration in the seabed beneath the US Outer Continental Shelf (OCS) complements this model

  15. Inhibition linearizes firing rate responses in human motor units: implications for the role of persistent inward currents.

    Science.gov (United States)

    Revill, Ann L; Fuglevand, Andrew J

    2017-01-01

    Motor neurons are the output neurons of the central nervous system and are responsible for controlling muscle contraction. When initially activated during voluntary contraction, firing rates of motor neurons increase steeply but then level out at modest rates. Activation of an intrinsic source of excitatory current at recruitment onset may underlie the initial steep increase in firing rate in motor neurons. We attempted to disable this intrinsic excitatory current by artificially activating an inhibitory reflex. When motor neuron activity was recorded while the inhibitory reflex was engaged, firing rates no longer increased steeply, suggesting that the intrinsic excitatory current was probably responsible for the initial sharp rise in motor neuron firing rate. During graded isometric contractions, motor unit (MU) firing rates increase steeply upon recruitment but then level off at modest rates even though muscle force continues to increase. The mechanisms underlying such firing behaviour are not known although activation of persistent inward currents (PICs) might be involved. PICs are intrinsic, voltage-dependent currents that activate strongly when motor neurons (MNs) are first recruited. Such activation might cause a sharp escalation in depolarizing current and underlie the steep initial rise in MU firing rate. Because PICs can be disabled with synaptic inhibition, we hypothesized that artificial activation of an inhibitory pathway might curb this initial steep rise in firing rate. To test this, human subjects performed slow triangular ramp contractions of the ankle dorsiflexors in the absence and presence of tonic synaptic inhibition delivered to tibialis anterior (TA) MNs by sural nerve stimulation. Firing rate profiles (expressed as a function of contraction force) of TA MUs recorded during these tasks were compared for control and stimulation conditions. Under control conditions, during the ascending phase of the triangular contractions, 93% of the firing

  16. The role of primary care in service provision for people with severe mental illness in the United Kingdom.

    Directory of Open Access Journals (Sweden)

    Siobhan Reilly

    Full Text Available Severe mental illness is a serious and potentially life changing set of conditions. This paper describes and analyses patient characteristics and service usage over one year of a representative cohort of people with a diagnosis of severe mental illness across England, including contacts with primary and secondary care and continuity of care.Data were collected from primary care patient notes (n = 1150 by trained nurses from 64 practices in England, covering all service contacts from 1(st April 2008 to 31st March 2009. The estimated national rate of patients seen only in primary care in the period was 31.1% (95% C.I. 27.2% to 35.3% and the rates of schizophrenia and bipolar disorder were 56.8% (95% C.I. 52.3% to 61.2% and 37.9% (95% C.I. 33.7% to 42.2%. In total, patients had 7,961 consultations within primary care and 1,993 contacts with mental health services (20% of the total. Unemployed individuals diagnosed more recently were more likely to have contact with secondary care. Of those seen in secondary care, 61% had at most two secondary care contacts in the period. Median annual consultation rates with GPs were lower than have been reported for previous years and were only slightly above the general population. Relational continuity in primary care was poor for 21% of patients (Modified Modified Continuity Index = <0.5, and for almost a third of new referrals to mental health services the primary care record contained no information on the referral outcome.Primary care is centrally involved in the care of people with serious mental illness, but primary care and cross-boundary continuity is poor for a substantial proportion. Research is needed to determine the impact of poor continuity on patient outcomes, and above all, the impact of new collaborative ways of working at the primary/secondary care interface.

  17. The role of policy actors and contextual factors in policy agenda setting and formulation: maternal fee exemption policies in Ghana over four and a half decades.

    Science.gov (United States)

    Koduah, Augustina; van Dijk, Han; Agyepong, Irene Akua

    2015-05-30

    Development of health policy is a complex process that does not necessarily follow a particular format and a predictable trajectory. Therefore, agenda setting and selecting of alternatives are critical processes of policy development and can give insights into how and why policies are made. Understanding why some policy issues remain and are maintained whiles others drop off the agenda is an important enquiry. This paper aims to advance understanding of health policy agenda setting and formulation in Ghana, a lower middle-income country, by exploring how and why the maternal (antenatal, delivery and postnatal) fee exemption policy agenda in the health sector has been maintained over the four and half decades since a 'free antenatal care in government facilities' policy was first introduced in October 1963. A mix of historical and contemporary qualitative case studies of nine policy agenda setting and formulation processes was used. Data collection methods involved reviews of archival materials, contemporary records, media content, in-depth interviews, and participant observation. Data was analysed drawing on a combination of policy analysis theories and frameworks. Contextual factors, acting in an interrelating manner, shaped how policy actors acted in a timely manner and closely linked policy content to the intended agenda. Contextual factors that served as bases for the policymaking process were: political ideology, economic crisis, data about health outcomes, historical events, social unrest, change in government, election year, austerity measures, and international agendas. Nkrumah's socialist ideology first set the agenda for free antenatal service in 1963. This policy trajectory taken in 1963 was not reversed by subsequent policy actors because contextual factors and policy actors created a network of influence to maintain this issue on the agenda. Politicians over the years participated in the process to direct and approve the agenda. Donors increasingly

  18. REBOA at Role 2 Afloat: resuscitative endovascular balloon occlusion of the aorta as a bridge to damage control surgery in the military maritime setting.

    Science.gov (United States)

    Rees, Paul; Waller, B; Buckley, A M; Doran, C; Bland, S; Scott, T; Matthews, J

    2018-05-01

    Role 2 Afloat provides a damage control resuscitation and surgery facility in support of maritime, littoral and aviation operations. Resuscitative endovascular balloon occlusion of the aorta (REBOA) offers a rapid, effective solution to exsanguinating haemorrhage from pelvic and non-compressible torso haemorrhage. It should be considered when the patient presents in a peri-arrest state, if surgery is likely to be delayed, or where the single operating table is occupied by another case. This paper will outline the data in support of endovascular haemorrhage control, describe the technique and explore how REBOA could be delivered using equipment currently available in the Royal Navy Role 2 Afloat equipment module. Also discussed are potential future directions in endovascular resuscitation. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  19. Improving the Functionality of Dictionary Definitions for Lexical Sets: The Role of Definitional Templates, Definitional Consistency, Definitional Coherence and the Incorporation of Lexical Conceptual Models

    Directory of Open Access Journals (Sweden)

    Piet Swanepoel

    2011-10-01

    Full Text Available

    ABSTRACT: This article focuses on some of the problems raised by Atkins and Rundell's (2008 approach to the design of lexicographic definitions for members of lexical sets. The questions raised are how to define and identify lexical sets, how lexical conceptual models (LCMs can support definitional consistency and coherence in defining members of lexical sets, and what the ideal content and structure of LCMs could be. Although similarity of meaning is proposed as the defining feature of lexical sets, similarity of meaning is only one dimension of the broader concept of lexical coherence. The argument is presented that numerous conceptual lexical models (e.g. taxonomies, folk models, frames, etc. in fact indicate, justify or explain how lexical items cohere (and thus form sets. In support of Fillmore's (2003 suggestion that definitions of the lexical items of cohering sets should be linked to such explanatory models, additional functionally-orientated arguments are presented for the incorporation of conceptual lexical models in electronic monolingual learners' dictionaries. Numerous resources exist to support the design of LCMs which can improve the functionality of definitions of members of lexical sets. A few examples are discussed of how such resources can be used to design functionally justified LCMs.

    OPSOMMING: Verbetering van die funksionaliteit van woordeboekdefinisies vir leksikale versamelings: Die rol van definisiematryse, definisie-eenvormigheid, definisiesamehang en die inkorporering van leksikale konseptuele modelle. Hierdie artikel fokus op sommige van die probleme wat ter sprake kom deur Atkins en Rundell (2008 se benadering tot die ontwerp van leksikografiese definisies vir lede van leksikale versamelings. Die vrae wat gestel word, is hoe leksikale versamelings gedefinieer en geïdentifiseer moet word, hoe leksikale konseptuele modelle (LKM's definisie-eenvormigheid en-samehang kan ondersteun by die definiëring van lede

  20. APPLICATION OF GOAL SETTING THEORY

    OpenAIRE

    Yurtkoru, E. Serra; Bozkurt, Tulay; Bekta, Fatos; Ahmed, Mahir Jibril; Kola, Vehap

    2017-01-01

    The purpose of this study is to test the goal theorymodel originally developed by Locke and Latham in organizational setting inTurkey, and explain its influence on job satisfaction and affective commitment.Also mediating role of task specific strategy and moderating role ofselfefficacy are examined. Locke and Latham’s goal setting measure is adaptedto Turkish. Survey method is employed to collect data from 222 respondents fromautomotive industry. Goal setting dimensions predicted affective co...

  1. The role of sex, gender, and education on depressive symptoms among young adults in the United States.

    Science.gov (United States)

    Gibson, Philip A; Baker, Elizabeth H; Milner, Adrienne N

    2016-01-01

    Men are less likely to experience depression and both women and men who self-assess as high in traits associated with masculinity are less likely to experience depression. Recent theoretical developments stress that the context of gender construction varies by other aspects of social status such as education. Data come from the National Longitudinal Study of Adolescent Health Wave III, romantic relationship sub-sample, a nationally representative sample of middle and high school students in the U.S. in 1997. Wave III data were collected in 2001-2002 when they are ages 18-26. A subsample of individuals who were or currently are in a romantic relationship (N=4302) were administered the Bem Sex Role Inventory (BSRI). We find that femininity, not masculinity, results in less depressive symptoms among women regardless of education. Femininity is associated with less depressive symptoms among college educated men, but masculinity is associated with less depressive symptoms among non-college educated men. Sex differences in the association between gender traits and depression symptoms are smaller among those who have attended college. Results stress the importance of context for understanding the relationship between sex, gender, and depression. Individuals benefit more from both masculinity and femininity with increased education. Conversely, those with less education may be penalized for sex-gender incongruent traits in terms of mental health. These analyses are cross-sectional, making causal inference impossible. This sample is limited to young adults who were or had been in a romantic relationship at the time of the survey. Copyright © 2015. Published by Elsevier B.V.

  2. The Limited English Proficiency Patient Family Advocate Role: Fostering Respectful and Effective Care Across Language and Culture in a Pediatric Oncology Setting.

    Science.gov (United States)

    Gil, Stephanie; Hooke, Mary C; Niess, Dawn

    2016-01-01

    Patients and families with limited English proficiency (LEP) face a multitude of barriers both inside and outside the hospital walls. These barriers can contribute to difficulty accessing care and understanding/adhering to treatment recommendations, ultimately placing them at higher risk for poorer outcomes than their English-speaking counterparts. The LEP Patient Family Advocate role was created with the aim of improving access, promoting effective communication, and equalizing care for children with cancer from families with LEP. The goal of this mixed methods study was to describe the level of satisfaction and experiences of parents and health care providers who used the LEP Patient Family Advocate while receiving or providing care. Twelve parents and 15 health care providers completed quantitative surveys and an open-ended question about their experiences. High levels of satisfaction were reported. Themes about the role from qualitative responses included its positive effect on communication, trust, and connectedness between parents and staff. Continuity of care and safety were improved, and parents thought the role helped decrease their stress. The LEP Patient Family Advocate has a positive influence on family-centered cultural care. © 2015 by Association of Pediatric Hematology/Oncology Nurses.

  3. Leaching properties of slag generated by a gasification/vitrification unit: the role of pH, particle size, contact time and cooling method used.

    Science.gov (United States)

    Moustakas, K; Mavropoulos, A; Katsou, E; Haralambous, K J; Loizidou, M

    2012-03-15

    The environmental impact from the operation of thermal waste treatment facilities mainly originates from the air emissions, as well as the generated solid residues. The objective of this paper is to examine the slag residue generated by a demonstration plasma gasification/vitrification unit and investigate the composition, the leaching properties of the slag under different conditions, as well as the role of the cooling method used. The influence of pH, particle size and contact time on the leachability of heavy metals are discussed. The main outcome is that the vitrified slag is characterized as inert and stable and can be safely disposed at landfills or used in the construction sector. Finally, the water-cooled slag showed better resistance in relation to heavy metal leachability compared to the air-cooled slag. Copyright © 2011 Elsevier B.V. All rights reserved.

  4. Defining and Redefining American Indian Identity: an Examination of the Role of the Museum in Contemporary Ethnogenesis in the United States

    Directory of Open Access Journals (Sweden)

    Katelyn L. Bolhofner

    2013-11-01

    Full Text Available As a platform for the display of cultures and a structuring agent in their formation, museums play a unique role in the negotiation of social identities. A museum’s approach to the interpretation of identity is shaped by the socio-political climate in which it exists. In the United States, a nation-state atmosphere celebratory of diversity, but not quite post-colonial, acts as the lens through which museums engage with issues of identity. Here, notions of difference, immigration, an indigenous past, and emerging ethnic identities are all at play in the negotiation of social identities. In this context, the acceptance of the generalized designation ‘American Indian’ as an ethnic identity is seen not only in national museums, but also in private museum exhibits and in local museums constructed by source communities. Through the definition, display, and reinforcement of specific cultural traits, these museums are contributing to the ethnogenesis of an American Indian identity.

  5. Lipopolysaccharide-induced blood-brain barrier disruption: roles of cyclooxygenase, oxidative stress, neuroinflammation, and elements of the neurovascular unit.

    Science.gov (United States)

    Banks, William A; Gray, Alicia M; Erickson, Michelle A; Salameh, Therese S; Damodarasamy, Mamatha; Sheibani, Nader; Meabon, James S; Wing, Emily E; Morofuji, Yoichi; Cook, David G; Reed, May J

    2015-11-25

    to be dependent on COX but not on oxidative stress. Based on in vivo and in vitro measures of neuroinflammation, it appears that astrocytes, microglia/macrophages, and pericytes play little role in the LPS-mediated disruption of the BBB.

  6. Daily negative affect and smoking after a self-set quit attempt: The role of dyadic invisible social support in a daily diary study.

    Science.gov (United States)

    Lüscher, Janina; Stadler, Gertraud; Ochsner, Sibylle; Rackow, Pamela; Knoll, Nina; Hornung, Rainer; Scholz, Urte

    2015-11-01

    Social support receipt from one's partner is assumed to be beneficial for successful smoking cessation. However, support receipt can have costs. Recent research suggests that the most effective support is unnoticed by the receiver (i.e., invisible). Therefore, this study examined the association between everyday levels of dyadic invisible emotional and instrumental support, daily negative affect, and daily smoking after a self-set quit attempt in smoker-non-smoker couples. Overall, 100 smokers (72.0% men, mean age M = 40.48, SD = 9.82) and their non-smoking partners completed electronic diaries from a self-set quit date on for 22 consecutive days, reporting daily invisible emotional and instrumental social support, daily negative affect, and daily smoking. Same-day multilevel analyses showed that at the between-person level, higher individual mean levels of invisible emotional and instrumental support were associated with less daily negative affect. In contrast to our assumption, more receipt of invisible emotional and instrumental support was related to more daily cigarettes smoked. The findings are in line with previous results, indicating invisible support to have beneficial relations with affect. However, results emphasize the need for further prospective daily diary approaches for understanding the dynamics of invisible support on smoking cessation. Statement of contribution What is already known on this subject? Social support receipt from a close other has proven to have emotional costs. According to current studies, the most effective social support is unnoticed by the receiver (i.e., invisible). There is empirical evidence for beneficial effects of invisible social support on affective well-being. What does this study add? Confirming benefits of invisible social support for negative affect in a health behaviour change setting Providing first evidence for detrimental effects of invisible social support on smoking. © 2015 The British Psychological Society.

  7. Individualized Treatment for Tobacco Dependence in Addictions Treatment Settings: The Role of Current Depressive Symptoms on Outcomes at 3 and 6 Months.

    Science.gov (United States)

    Zawertailo, Laurie A; Baliunas, Dolly; Ivanova, Anna; Selby, Peter L

    2015-08-01

    Individuals with concurrent tobacco dependence and other addictions often report symptoms of low mood and depression and as such may have more difficulty quitting smoking. We hypothesized that current symptoms of depression would be a significant predictor of quit success among a group of smokers receiving individualized treatment for tobacco dependence within addiction treatment settings. Individuals in treatment for other addictions were enrolled in a smoking cessation program involving brief behavioral counseling and individualized dosing of nicotine replacement therapy. The baseline assessment included the Patient Health Questionnaire (PHQ9) for depression. Smoking cessation outcomes were measured at 3 and 6 months post-enrollment. Bivariate associations between cessation outcomes and PHQ9 score were analyzed. Of the 1,196 subjects enrolled to date, 1,171 (98%) completed the PHQ9. Moderate to severe depression (score >9) was reported by 28% of the sample, and another 29% reported mild depression (score between 5 and 9). Contrary to the extant literature and other findings by our own group, there was no association between current depression and cessation outcome at either 3 months (n = 1,171) (17.0% in those with PHQ9 > 9 vs. 19.8% in those with PHQ9 addictions treatment setting. These data indicate that patients in an addictions treatment setting can successfully quit smoking regardless of current depressive symptoms. © The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  8. Preventing transmission of infectious agents in the pediatric in-patients hematology–oncology setting: what is the role for non-pharmacological prophylaxis?

    Directory of Open Access Journals (Sweden)

    Désirée Caselli

    2011-03-01

    Full Text Available Despite a continuous will to protect the immune compromised host from infections, evidence based indications for intervention by non-pharmacological toools are still lacking in oncology. Nevertheless, guidelines on standard precaution and trasmission base precaution are available. They may be important in order to reduce the risk of trasmission of infection in selected healthcare settings, such as the pediatric hematology-oncology wards. . AIEOP Centers agree that for children treated with chemotherapy both of these approaches should be implemented and vigorously enforced, while additional policies, including strict environmental isolation should be restricetd to patients with selected clinical conditions or complications.

  9. The role of protected areas in land use/land cover change and the carbon cycle in the conterminous United States

    Energy Technology Data Exchange (ETDEWEB)

    Lu, Xiaoliang [The Ecosystems Center, Marine Biological Laboratory, Woods Hole MA USA; Zhou, Yuyu [Departments of Geological and Atmospheric Sciences, Iowa State University, Ames IA USA; Liu, Yaling [Pacific Northwest National Laboratory, Joint Global Change Research Institute, College Park MD USA; Le Page, Yannick [Department Tapada da Ajuda, Centro de Estudos Florestais, Instituto Superior de Agronomia, Universidade de Lisboa, Lisbon Portugal

    2017-08-08

    Protected areas (PAs) cover about 22% of the conterminous United States. Understanding their role on historical land use and land cover change (LULCC) and on the carbon cycle is essential to provide guidance for environmental policies. In this study, we compiled historical LULCC and PAs data to explore these interactions within the terrestrial ecosystem model (TEM). We found that intensive LULCC occurred in the conterminous United States from 1700 to 2005. More than 3 million km2 of forest, grassland and shrublands were converted into agricultural lands, which caused 10,607 Tg C release from land ecosystems to atmosphere. PAs had experienced little LULCC as they were generally established in the 20th century after most of the agricultural expansion had occurred. PAs initially acted as a carbon source due to land use legacies, but their accumulated carbon budget switched to a carbon sink in the 1960s, sequestering an estimated 1,642 Tg C over 1700–2005, or 13.4% of carbon losses in non-PAs. We also find that PAs maintain larger carbon stocks and continue sequestering carbon in recent years (2001–2005), but at a lower rate due to increased heterotrophic respiration as well as lower productivity associated to aging ecosystems. It is essential to continue efforts to maintain resilient, biodiverse ecosystems and avoid large-scale disturbances that would release large amounts of carbon in PAs.

  10. Molecular Properties by Quantum Monte Carlo: An Investigation on the Role of the Wave Function Ansatz and the Basis Set in the Water Molecule

    Science.gov (United States)

    Zen, Andrea; Luo, Ye; Sorella, Sandro; Guidoni, Leonardo

    2014-01-01

    Quantum Monte Carlo methods are accurate and promising many body techniques for electronic structure calculations which, in the last years, are encountering a growing interest thanks to their favorable scaling with the system size and their efficient parallelization, particularly suited for the modern high performance computing facilities. The ansatz of the wave function and its variational flexibility are crucial points for both the accurate description of molecular properties and the capabilities of the method to tackle large systems. In this paper, we extensively analyze, using different variational ansatzes, several properties of the water molecule, namely, the total energy, the dipole and quadrupole momenta, the ionization and atomization energies, the equilibrium configuration, and the harmonic and fundamental frequencies of vibration. The investigation mainly focuses on variational Monte Carlo calculations, although several lattice regularized diffusion Monte Carlo calculations are also reported. Through a systematic study, we provide a useful guide to the choice of the wave function, the pseudopotential, and the basis set for QMC calculations. We also introduce a new method for the computation of forces with finite variance on open systems and a new strategy for the definition of the atomic orbitals involved in the Jastrow-Antisymmetrised Geminal power wave function, in order to drastically reduce the number of variational parameters. This scheme significantly improves the efficiency of QMC energy minimization in case of large basis sets. PMID:24526929

  11. Explaining technological change of wind power in China and the United States: Roles of energy policies, technological learning, and collaboration

    Science.gov (United States)

    Tang, Tian

    The following dissertation explains how technological change of wind power, in terms of cost reduction and performance improvement, is achieved in China and the US through energy policies, technological learning, and collaboration. The objective of this dissertation is to understand how energy policies affect key actors in the power sector to promote renewable energy and achieve cost reductions for climate change mitigation in different institutional arrangements. The dissertation consists of three essays. The first essay examines the learning processes and technological change of wind power in China. I integrate collaboration and technological learning theories to model how wind technologies are acquired and diffused among various wind project participants in China through the Clean Development Mechanism (CDM)--an international carbon trade program, and empirically test whether different learning channels lead to cost reduction of wind power. Using pooled cross-sectional data of Chinese CDM wind projects and spatial econometric models, I find that a wind project developer's previous experience (learning-by-doing) and industrywide wind project experience (spillover effect) significantly reduce the costs of wind power. The spillover effect provides justification for subsidizing users of wind technologies so as to offset wind farm investors' incentive to free-ride on knowledge spillovers from other wind energy investors. The CDM has played such a role in China. Most importantly, this essay provides the first empirical evidence of "learning-by-interacting": CDM also drives wind power cost reduction and performance improvement by facilitating technology transfer through collaboration between foreign turbine manufacturers and local wind farm developers. The second essay extends this learning framework to the US wind power sector, where I examine how state energy policies, restructuring of the electricity market, and learning among actors in wind industry lead to

  12. The role of ethnicity and travel on Hepatitis A vaccination coverage and disease incidence in Arizona at the United States–Mexico Border

    Science.gov (United States)

    Ernst, Kacey C; Erhart, Laura M

    2014-01-01

    Background: Hepatitis A (HAV) incidence has decreased in the United States, yet regional disparities persist. The role of international travel has become increasingly important in HAV transmission. We compared the relative burden of HAV in border and non-border regions in Arizona and examined the role of travel in sustaining HAV transmission. Methods: HAV vaccination coverage was calculated by age and region, using Arizona State Immunization Information System data. Incidence, demographics, and risk factors of cases reported through Arizona’s infectious disease surveillance system between 2006 and 2011 were analyzed. Results: Hepatitis A incidence was higher in the border region of Arizona. Compared with the rest of Arizona, one-dose coverage in children <15 years was lower in the border region until 2008. Second dose coverage was lower in the border region, particularly among Spanish speakers. International travel among cases was generally high; however, in the border region cases were more likely to visit Mexico or South/Central America (94% vs. 80%, P value = 0.01) and be Hispanic (68% vs. 42%, P value = 0.0003). Conclusions: Rates of HAV continue to be higher in the Arizona border region; the risk appears particularly high among Hispanics with recent travel in the Americas. Border surveillance should be emphasized, along with vaccination of all travelers, to continue to decrease and control HAV. PMID:24603091

  13. Development of short questionnaire to measure an extended set of role expectation conflict, coworker support and work-life balance: The new job stress scale

    Directory of Open Access Journals (Sweden)

    Abhishek Shukla

    2016-12-01

    Full Text Available This study aimed to investigate the reliability and validity of a new version of job stress scale, which measures the extended set of psychosocial stressors by adding new scales to the current version of the job stress scale. Additional scales were extensively collected from theoretical job stress models and similar questionnaire from different countries. Items were tested in workplace and refined through a pilot survey (n = 400 to examine the reliability and construct validity. Most scales showed acceptable levels of internal consistency, intra-class reliability, and test–retest reliability. Factor analysis and correlation analysis showed that these scales fit the theoretical expectations. These findings provided enough evidences that the new job stress scale is reliable and valid. Although confirmatory analysis should be examined in future studies. The new job stress scale is a useful instrument for organization and academicians to evaluate job stress in modern Indian workplace.

  14. The Role of Credibility In the Design of Mobile Solutions To Enhance the Social Skill-Set of Teenagers Diagnosed with Autism

    DEFF Research Database (Denmark)

    Gerdes, Anne; Øhrstrøm, Peter

    2011-01-01

    Purpose – Helping Autism-diagnosed teenagers navigate and develop socially (HANDS) is an EU research project in progress. The aim of HANDS is to investigate the potential of persuasive technology as a tool to help young people diagnosed, to whatever degree, as autistic. The HANDS project set out...... the necessity of certain preconditions requisite for evaluating the credibility of a system; and, in this way, seek to establish an ethically sound evaluation procedure for analysing credibility, by combining quantitative (i.e. electronic footprints) and qualitative assessments (i.e. dialogue between teacher...... to develop mobile ICT solutions to help young people with autism become more fully integrated into society and the purpose of this paper is to present an overview of the design behind the HANDS toolset. Design/methodology/approach – The topic of credibility is approached from an analytical, as well...

  15. The Role of Near-Shore Bathymetry During Tsunami Inundation in a Reef Island Setting: A Case Study of Tutuila Island

    Science.gov (United States)

    Dilmen, Derya I.; Roe, Gerard H.; Wei, Yong; Titov, Vasily V.

    2018-04-01

    On September 29, 2009 at 17:48 UTC, an M w = 8.1 earthquake in the Tonga Trench generated a tsunami that caused heavy damage across Samoa, American Samoa, and Tonga. One of the worst hits was the volcanic island of Tutuila in American Samoa. Tutuila has a typical tropical island bathymetry setting influenced by coral reefs, and so the event provided an opportunity to evaluate the relationship between tsunami dynamics and the bathymetry in that typical island environment. Previous work has come to differing conclusions regarding how coral reefs affect tsunami dynamics through their influence on bathymetry and dissipation. This study presents numerical simulations of this event with a focus on two main issues: first, how roughness variations affect tsunami run-up and whether different values of Manning's roughness parameter, n, improve the simulated run-up compared to observations; and second, how depth variations in the shelf bathymetry with coral reefs control run-up and inundation on the island coastlines they shield. We find that no single value of n provides a uniformly good match to all observations; and we find substantial bay-to-bay variations in the impact of varying n. The results suggest that there are aspects of tsunami wave dissipation which are not captured by a simplified drag formulation used in shallow-water waves model. The study also suggests that the primary impact of removing the near-shore bathymetry in coral reef environment is to reduce run-up, from which we conclude that, at least in this setting, the impact of the near-shore bathymetry is to increase run-up and inundation.

  16. The Role of Near-Shore Bathymetry During Tsunami Inundation in a Reef Island Setting: A Case Study of Tutuila Island

    Science.gov (United States)

    Dilmen, Derya I.; Roe, Gerard H.; Wei, Yong; Titov, Vasily V.

    2018-02-01

    On September 29, 2009 at 17:48 UTC, an M w = 8.1 earthquake in the Tonga Trench generated a tsunami that caused heavy damage across Samoa, American Samoa, and Tonga. One of the worst hits was the volcanic island of Tutuila in American Samoa. Tutuila has a typical tropical island bathymetry setting influenced by coral reefs, and so the event provided an opportunity to evaluate the relationship between tsunami dynamics and the bathymetry in that typical island environment. Previous work has come to differing conclusions regarding how coral reefs affect tsunami dynamics through their influence on bathymetry and dissipation. This study presents numerical simulations of this event with a focus on two main issues: first, how roughness variations affect tsunami run-up and whether different values of Manning's roughness parameter, n, improve the simulated run-up compared to observations; and second, how depth variations in the shelf bathymetry with coral reefs control run-up and inundation on the island coastlines they shield. We find that no single value of n provides a uniformly good match to all observations; and we find substantial bay-to-bay variations in the impact of varying n. The results suggest that there are aspects of tsunami wave dissipation which are not captured by a simplified drag formulation used in shallow-water waves model. The study also suggests that the primary impact of removing the near-shore bathymetry in coral reef environment is to reduce run-up, from which we conclude that, at least in this setting, the impact of the near-shore bathymetry is to increase run-up and inundation.

  17. The role of long-term strain history on the generation and amplification of inherited heterogeneities in continental lithosphere extensional settings

    Science.gov (United States)

    Morena Salerno, V.; Capitanio, Fabio A.

    2017-04-01

    The Earth's lithosphere is characters by various types of heterogeneities, at different scales and located at variable depth. They can be represented at crustal level by remnants of earlier tectonics evolution, such as previous orogenetic structures, remains of passive margins and magmatic bodies intrusion, or at deeper level by mantle anisotropies. These heterogeneities can severely affect the stress and strain localization in subsequent continental lithospheric extension and rift basins evolution, hence contributing to the formation of diverse and complex rift basin types and architectures. In order to explain the difference in rift basin and passive margin types, their subsidence patterns and melt production, previous studies have exanimated the role of initial heterogeneities, rheological layering, geothermal gradients, and extension rates during a single rifting event. However, this approach does not consider the previous strain history of many basins that are characterized by multiple rifting events. In this study we use numerical models of a pristine lithosphere undergoing two rifting events separated by cooling, to show the effect of early events on later evolution. The strain histories are controlled by the variation of velocity of boundary displacement during two rifting events. We use both fast and slow first rifting events, followed by a cooling period, producing diverse mechanical heterogeneities at Moho level that represent inherited initial conditions for the second rifting event. These inherited heterogeneities range from several small perturbations distributed along the numerical domain at the end of the slowest first rifting event, to a single large perturbation at the end of first fastest rifting event. In the second rifting event, the inherited heterogeneities are amplified at different degree and time, depending on the velocity of boundary displacement used. To highlight the role of previous strain history, we parametrize the inherited

  18. Women's work roles and their impact on health, well-being, and career: comparisons between the United States, Sweden, and The Netherlands.

    Science.gov (United States)

    Gjerdingen, D; McGovern, P; Bekker, M; Lundberg, U; Willemsen, T

    2000-01-01

    As women have become more assimilated into the work-force over recent decades, they have realized considerable changes in their work roles which may contribute to health problems and other negative outcomes such as marital strain and diminished job status. The purpose of this review was threefold: (1) to synthesize data on the distribution of women's work efforts in the areas of paid employment, household chores, and childcare; (2) to outline research which addresses the impact of women's workload on their well-being and careers; and (3) to make international and gender comparisons regarding women's work responsibilities. Our findings showed that women from each of the three countries examined--the United States, Sweden, and The Netherlands--contribute more effort to household chores and childcare and less to the workplace than men do. As a result, their total workloads appear to be somewhat greater and more diffusely distributed than those of men. Heavy workloads may adversely affect women's health, especially in the presence of certain role characteristics (e.g., having a clerical, managerial, professional, or executive position, or caring for young children). Heavy work responsibilities may also undermine marital happiness, particularly if there is perceived inequity in the way partners share household work. Finally, women's total work responsibilities often impact their careers due to compensatory reductions in work commitment and job status. These observations point to the need for further research on women's workload and work roles, on the relationship of work to well-being, and on methods of preventing or alleviating adverse effects on overburdened workers.

  19. The role of neutron activation analysis and radioanalytical methods in dose-effect relationship studies for the setting of trace metal protection criteria

    International Nuclear Information System (INIS)

    Sabbioni, E.; Pietra, R.; Edel, J.; Goetz, L.

    1986-01-01

    In order to prepare a scientifically accurate health protection criteria documents for trace metals integrated multidisciplinary research is necessary. In particular, the rational for structuring the documents should be based primarily on the two major questions of exposure and response. Unfortunately, in a majority of cases there is a paucity of relevant data to the establishment of dose-effect relationships. This work intends to show the role that neutron activation analysis and radiotracers with very high specific radioactivity have in solving problems relevant for establishment dose-effect relationships for trace metals. Typical applications in the different research areas involved in the preparation of the protection criteria, from source and exposure to levels and forms of trace metals in humans, are presented. (author)

  20. The Factors that Affect Indian Migrants' Decision to Stay in or Counter Migrate from the United States: A Study with Special Reference to the Role of Tourism Related Imagery as a Determinant

    Directory of Open Access Journals (Sweden)

    Babu P. GEORGE

    2007-11-01

    Full Text Available In the light of the changing socio-economic realities of the presenttimes, this paper explores the complex dynamics underlying Indian immigrants' decision to continue to stay in the United States or to counter migrate back to India. In a reversal of fortunes, the specific set of conditions that once triggered a massive inflow of economic migrants from India to the US has been causing a counter migration to India. Based on a review of literature and an exploratory study involving focus groups the paper identifiessome of the major migration / counter migration related factors. Then, employing a survey, the relative importance of each of these factors is gauged for individuals associated with different professions. In addition, the study explores as a special case the role of tourism related images about the US being held by immigrants as determinants of their migration related decisions. Tourism images held by the migrants and the tourism opportunities provided by the US act more as hygiene factors than as motivators. In course of theexploration, a number of hypotheses are emerged that are of interest to future researchers. The study has got significant implications for migration / counter migration policy makers, industry practitioners, and the migrants themselves.

  1. Polish Phoneme Statistics Obtained On Large Set Of Written Texts

    Directory of Open Access Journals (Sweden)

    Bartosz Ziółko

    2009-01-01

    Full Text Available The phonetical statistics were collected from several Polish corpora. The paper is a summaryof the data which are phoneme n-grams and some phenomena in the statistics. Triphonestatistics apply context-dependent speech units which have an important role in speech recognitionsystems and were never calculated for a large set of Polish written texts. The standardphonetic alphabet for Polish, SAMPA, and methods of providing phonetic transcriptions are described.

  2. Magic, science and masculinity: marketing toy chemistry sets.

    Science.gov (United States)

    Al-Gailani, Salim

    2009-12-01

    At least since the late nineteenth century, toy chemistry sets have featured in standard scripts of the achievement of eminence in science, and they remain important in constructions of scientific identity. Using a selection of these toys manufactured in Britain and the United States, and with particular reference to the two dominant American brands, Gilbert and Chemcraft, this paper suggests that early twentieth-century chemistry sets were rooted in overlapping Victorian traditions of entertainment magic and scientific recreations. As chemistry set marketing copy gradually reoriented towards emphasising scientific modernity, citizenship, discipline and educational value, pre-twentieth-century traditions were subsumed within domestic-and specifically masculine-tropes. These developments in branding strategies point to transformations in both users' engagement with their chemistry sets and the role of scientific toys in domestic play. The chemistry set serves here as a useful tool for measuring cultural change and lay engagement with chemistry.

  3. The relationship between attendance at birth and maternal mortality rates: an exploration of United Nations' data sets including the ratios of physicians and nurses to population, GNP per capita and female literacy.

    Science.gov (United States)

    Robinson, J J; Wharrad, H

    2001-05-01

    The relationship between attendance at birth and maternal mortality rates: an exploration of United Nations' data sets including the ratios of physicians and nurses to population, GNP per capita and female literacy. This is the third and final paper drawing on data taken from United Nations (UN) data sets. The first paper examined the global distribution of health professionals (as measured by ratios of physicians and nurses to population), and its relationship to gross national product per capita (GNP) (Wharrad & Robinson 1999). The second paper explored the relationships between the global distribution of physicians and nurses, GNP, female literacy and the health outcome indicators of infant and under five mortality rates (IMR and u5MR) (Robinson & Wharrad 2000). In the present paper, the global distribution of health professionals is explored in relation to maternal mortality rates (MMRs). The proportion of births attended by medical and nonmedical staff defined as "attendance at birth by trained personnel" (physicians, nurses, midwives or primary health care workers trained in midwifery skills), is included as an additional independent variable in the regression analyses, together with the ratio of physicians and nurses to population, female literacy and GNP. To extend our earlier analyses by considering the relationships between the global distribution of health professionals (ratios of physicians and nurses to population, and the proportion of births attended by trained health personnel), GNP, female literacy and MMR. countries, regression analyses were performed using numbers of physicians, and numbers of nurses, per 1000 population, the proportion of births attended by trained health personnel, GNP per capita and female literacy as independent variables and MMRs as the dependent variable. Linear regression analyses show positive associations for MMRs and the ratios of physicians to population (73%, n=136), ratios of nurses to population (56%, n=137), and

  4. The strategic role of competency based medical education in health care reform: a case report from a small scale, resource limited, Caribbean setting.

    Science.gov (United States)

    Busari, Jamiu O; Duits, Ashley J

    2015-01-21

    Curaçao is a Dutch Caribbean island with a relatively high aging population, a high prevalence of chronic diseases and a health care system that is driven by cost-containment. In 2009 the development of a new value-based health care (VBHC) system was initiated on the island, and a key role was identified for the St. Elisabeth Hospital as a (model) platform for implementing this initiative. We therefore decided to investigate for the requirements needed to build a health care environment that is conducive for change and capable of facilitating the smooth migration of existent services into an effective and sustainable VBHC system. Our findings revealed that our chosen approach was well accepted by the stakeholders. We discovered that in order to achieve a new value based health care system based on a reliable and well-organized system, the competencies of health care providers and the quality of the health care system needs to be assured. For this, extra focus needs to be given to improving service and manpower development both during and after formal training. In order to achieve a VBHC system in a resource-limited environment, the standard of physicians' competencies and of the health care system need to be guaranteed. The quality of the educational process needs to be maintained and safeguarded within an integrated health care delivery system that offers support to all care delivery and teaching institutions within the community. Finally, collaborative efforts with international medical institutions are recommended.

  5. Developmental roles of 21 Drosophila transcription factors are determined by quantitative differences in binding to an overlapping set of thousands of genomic regions

    Energy Technology Data Exchange (ETDEWEB)

    MacArthur, Stewart; Li, Xiao-Yong; Li, Jingyi; Brown, James B.; Chu, Hou Cheng; Zeng, Lucy; Grondona, Brandi P.; Hechmer, Aaron; Simirenko, Lisa; Keranen, Soile V.E.; Knowles, David W.; Stapleton, Mark; Bickel, Peter; Biggin, Mark D.; Eisen, Michael B.

    2009-05-15

    BACKGROUND: We previously established that six sequence-specific transcription factors that initiate anterior/posterior patterning in Drosophila bind to overlapping sets of thousands of genomic regions in blastoderm embryos. While regions bound at high levels include known and probable functional targets, more poorly bound regions are preferentially associated with housekeeping genes and/or genes not transcribed in the blastoderm, and are frequently found in protein coding sequences or in less conserved non-coding DNA, suggesting that many are likely non-functional. RESULTS: Here we show that an additional 15 transcription factors that regulate other aspects of embryo patterning show a similar quantitative continuum of function and binding to thousands of genomic regions in vivo. Collectively, the 21 regulators show a surprisingly high overlap in the regions they bind given that they belong to 11 DNA binding domain families, specify distinct developmental fates, and can act via different cis-regulatory modules. We demonstrate, however, that quantitative differences in relative levels of binding to shared targets correlate with the known biological and transcriptional regulatory specificities of these factors. CONCLUSIONS: It is likely that the overlap in binding of biochemically and functionally unrelated transcription factors arises from the high concentrations of these proteins in nuclei, which, coupled with their broad DNA binding specificities, directs them to regions of open chromatin. We suggest that most animal transcription factors will be found to show a similar broad overlapping pattern of binding in vivo, with specificity achieved by modulating the amount, rather than the identity, of bound factor.

  6. Managing hip fracture and lower limb surgery in the emergency setting: Potential role of non-vitamin K antagonist oral anticoagulants.

    Science.gov (United States)

    Fisher, William

    2017-06-01

    Trauma, immobilization, and subsequent surgery of the hip and lower limb are associated with a high risk of developing venous thrombo-embolism (VTE). Individuals undergoing hip fracture surgery (HFS) have the highest rates of VTE among orthopedic surgery and trauma patients. The risk of VTE depends on the type and location of the lower limb injury. Current international guidelines recommend routine pharmacological thromboprophylaxis based on treatment with heparins, fondaparinux, dose-adjusted vitamin K antagonists and acetylsalicylic acid for patients undergoing emergency HFS; however, not all guidelines recommend pharmacological prophylaxis for patients with lower limb injuries. Non-vitamin K antagonist oral anticoagulants (NOACs) are indicated for VTE prevention after elective hip or knee replacement surgery, but at present are not widely recommended for other orthopedic indications despite their advantages over conventional anticoagulants and promising real-world evidence. In patients undergoing HFS or lower limb surgery, decisions on whether to anticoagulate and the most appropriate anti-coagulation strategy can be guided by weighing the risk of thromboprophylaxis against the benefit in relation to each patient's medical history and age. In addition, the nature and location of the fracture, operating times and times before fracture fixation should be considered. The current review discusses the need for anticoagulation in patients undergoing emergency HFS or lower limb surgery together with the current guidelines and available evidence on the use of NOACs in this setting. Appropriate thromboprophylactic strategies and practical advice on the peri-operative management of patients who present to the Emergency Department on a NOAC before emergency surgery are further outlined.

  7. CAUSES: On the Role of Surface Energy Budget Errors to the Warm Surface Air Temperature Error Over the Central United States

    Science.gov (United States)

    Ma, H.-Y.; Klein, S. A.; Xie, S.; Zhang, C.; Tang, S.; Tang, Q.; Morcrette, C. J.; Van Weverberg, K.; Petch, J.; Ahlgrimm, M.; Berg, L. K.; Cheruy, F.; Cole, J.; Forbes, R.; Gustafson, W. I.; Huang, M.; Liu, Y.; Merryfield, W.; Qian, Y.; Roehrig, R.; Wang, Y.-C.

    2018-03-01

    Many weather forecast and climate models simulate warm surface air temperature (T2m) biases over midlatitude continents during the summertime, especially over the Great Plains. We present here one of a series of papers from a multimodel intercomparison project (CAUSES: Cloud Above the United States and Errors at the Surface), which aims to evaluate the role of cloud, radiation, and precipitation biases in contributing to the T2m bias using a short-term hindcast approach during the spring and summer of 2011. Observations are mainly from the Atmospheric Radiation Measurement Southern Great Plains sites. The present study examines the contributions of surface energy budget errors. All participating models simulate too much net shortwave and longwave fluxes at the surface but with no consistent mean bias sign in turbulent fluxes over the Central United States and Southern Great Plains. Nevertheless, biases in the net shortwave and downward longwave fluxes as well as surface evaporative fraction (EF) are contributors to T2m bias. Radiation biases are largely affected by cloud simulations, while EF bias is largely affected by soil moisture modulated by seasonal accumulated precipitation and evaporation. An approximate equation based upon the surface energy budget is derived to further quantify the magnitudes of radiation and EF contributions to T2m bias. Our analysis ascribes that a large EF underestimate is the dominant source of error in all models with a large positive temperature bias, whereas an EF overestimate compensates for an excess of absorbed shortwave radiation in nearly all the models with the smallest temperature bias.

  8. Evaluation of the Architect HIV Ag/Ab Combo Assay in a low-prevalence setting: The role of samples with a low S/CO ratio.

    Science.gov (United States)

    Alonso, Roberto; Pérez-García, Felipe; Gijón, Paloma; Collazos, Ana; Bouza, Emilio

    2018-06-01

    The Architect HIV Ag/Ab Combo Assay, a fourth-generation ELISA, has proven to be highly reliable for the diagnosis of HIV infection. However, its high sensitivity may lead to false-positive results. To evaluate the diagnostic performance of Architect in a low-prevalence population and to assess the role of the sample-to-cutoff ratio (S/CO) in reducing the frequency of false-positive results. We conducted a retrospective study of samples analyzed by Architect between January 2015 and June 2017. Positive samples were confirmed by immunoblot (RIBA) or nucleic acid amplification tests (NAATs). Different S/CO thresholds (1, 2.5, 10, 25, and 100) were analyzed to determine sensitivity, specificity, and negative and positive predictive values (NPV, PPV). ROC analysis was used to determine the optimal S/CO. A total of 69,471 samples were analyzed. 709 (1.02%) were positive by Architect. Of these, 63 (8.89%) were false-positive results. Most of them (93.65%) were in samples with S/CO < 100. However, most confirmations by NAATs (12 out of 19 cases) were also recorded for these samples. The optimal S/CO was 2.5, which provided the highest area under the ROC curve (0.9998) and no false-negative results. With this S/CO, sensitivity and specificity were 100.0%, and PPV and NPV were 95.8% and 100.0%, respectively. In addition, the frequency of false-positive results decreased significantly to 4.15%. Although Architect generates a relatively high number of false-positive results, raising the S/CO limit too much to increase specificity can lead to false-negative results, especially in newly infected individuals. Copyright © 2018 Elsevier B.V. All rights reserved.

  9. The differential role of pain, work characteristics and pain-related fear in explaining back pain and sick leave in occupational settings.

    Science.gov (United States)

    Gheldof, Els L M; Vinck, Jan; Vlaeyen, Johan W S; Hidding, Alita; Crombez, Geert

    2005-01-01

    This cross-sectional questionnaire study investigated the role of pain (pain severity, radiating pain), work characteristics (physical workload, job stressors, job satisfaction), negative affect and pain-related fear in accounting for low back pain (LBP) and sick leave (SL) in 1294 employees from 10 companies in Belgium and the Netherlands. An increased risk for short-term LBP (1-30 days during the last year) was observed for workers reporting high physical workload (OR=2.39), high task exertion (OR=1.63) and high negative affect (OR=1.03). For prolonged LBP (>30 days during the last year) severe pain (OR=13.03), radiating pain (OR=2.37) and fear of work-related activities (OR=3.17) were significant risk factors. A lack of decision latitude decreased the risk of long-term LBP (OR=0.39). Short-term SL (1-30 days during the last year) was associated with severe pain (OR=2.83), high physical workload (OR=2.99) and high fear of movement/(re)injury (OR=1.88). A lack of decision latitude increased the risk of short-term SL (OR=1.92). Long-term SL (>30 days during the last year) was associated with radiating pain (OR=3.80) and high fear of movement/(re)injury (OR=6.35). A lack of co-worker support reduced the risk of long-term SL (OR=0.27). These results suggest that physical load factors are relatively more important in the process leading to short-term LBP and short-term SL, whereas job stressors, severe pain, radiation, and pain-related fear are more important in determining the further course and maintenance of the inability to work. The potential implications of these findings for primary and secondary prevention, and occupational rehabilitation are discussed.

  10. Set theory and physics

    Energy Technology Data Exchange (ETDEWEB)

    Svozil, K. [Univ. of Technology, Vienna (Austria)

    1995-11-01

    Inasmuch as physical theories are formalizable, set theory provides a framework for theoretical physics. Four speculations about the relevance of set theoretical modeling for physics are presented: the role of transcendental set theory (i) in chaos theory, (ii) for paradoxical decompositions of solid three-dimensional objects, (iii) in the theory of effective computability (Church-Turing thesis) related to the possible {open_quotes}solution of supertasks,{close_quotes} and (iv) for weak solutions. Several approaches to set theory and their advantages and disadvantages for physical applications are discussed: Cantorian {open_quotes}naive{close_quotes} (i.e., nonaxiomatic) set theory, contructivism, and operationalism. In the author`s opinion, an attitude, of {open_quotes}suspended attention{close_quotes} (a term borrowed from psychoanalysis) seems most promising for progress. Physical and set theoretical entities must be operationalized wherever possible. At the same time, physicists should be open to {open_quotes}bizarre{close_quotes} or {open_quotes}mindboggling{close_quotes} new formalisms, which need not be operationalizable or testable at the time of their creation, but which may successfully lead to novel fields of phenomenology and technology.

  11. Role of the urate transporter SLC2A9 gene in susceptibility to gout in New Zealand Māori, Pacific Island, and Caucasian case-control sample sets.

    Science.gov (United States)

    Hollis-Moffatt, Jade E; Xu, Xin; Dalbeth, Nicola; Merriman, Marilyn E; Topless, Ruth; Waddell, Chloe; Gow, Peter J; Harrison, Andrew A; Highton, John; Jones, Peter B B; Stamp, Lisa K; Merriman, Tony R

    2009-11-01

    To examine the role of genetic variation in the renal urate transporter SLC2A9 in gout in New Zealand sample sets of Māori, Pacific Island, and Caucasian ancestry and to determine if the Māori and Pacific Island samples could be useful for fine-mapping. Patients (n= 56 Māori, 69 Pacific Island, and 131 Caucasian) were recruited from rheumatology outpatient clinics and satisfied the American College of Rheumatology criteria for gout. The control samples comprised 125 Māori subjects, 41 Pacific Island subjects, and 568 Caucasian subjects without arthritis. SLC2A9 single-nucleotide polymorphisms rs16890979 (V253I), rs5028843, rs11942223, and rs12510549 were genotyped (possible etiologic variants in Caucasians). Association of the major allele of rs16890979, rs11942223, and rs5028843 with gout was observed in all sample sets (P = 3.7 x 10(-7), 1.6 x 10(-6), and 7.6 x 10(-5) for rs11942223 in the Māori, Pacific Island, and Caucasian samples, respectively). One 4-marker haplotype (1/1/2/1; more prevalent in the Māori and Pacific Island control samples) was not observed in a single gout case. Our data confirm a role of SLC2A9 in gout susceptibility in a New Zealand Caucasian sample set, with the effect on risk (odds ratio >2.0) greater than previous estimates. We also demonstrate association of SLC2A9 with gout in samples of Māori and Pacific Island ancestry and a consistent pattern of haplotype association. The presence of both alleles of rs16890979 on susceptibility and protective haplotypes in the Māori and Pacific Island sample is evidence against a role for this nonsynonymous variant as the sole etiologic agent. More extensive linkage disequilibrium in Māori and Pacific Island samples suggests that Caucasian samples may be more useful for fine-mapping.

  12. Roles and relationships between health professionals involved in insulin initiation for people with type 2 diabetes in the general practice setting: a qualitative study drawing on relational coordination theory.

    Science.gov (United States)

    Manski-Nankervis, Jo-Anne; Furler, John; Blackberry, Irene; Young, Doris; O'Neal, David; Patterson, Elizabeth

    2014-01-31

    The majority of care for people with type 2 diabetes occurs in general practice, however when insulin initiation is required it often does not occur in this setting or in a timely manner and this may have implications for the development of complications. Increased insulin initiation in general practice is an important goal given the increasing prevalence of type 2 diabetes and a relative shortage of specialists. Coordination between primary and secondary care, and between medical and nursing personnel, may be important in achieving this. Relational coordination theory identifies key concepts that underpin effective interprofessional work: communication which is problem solving, timely, accurate and frequent and relationships between professional roles which are characterized by shared goals, shared knowledge and mutual respect. This study explores roles and relationships between health professionals involved in insulin initiation in order to gain an understanding of factors which may impact on this task being carried out in the general practice setting. 21 general practitioners, practice nurses, diabetes nurse educators and physicians were purposively sampled to participate in a semi-structured interview. Transcripts of the interviews were analysed using framework analysis. There were four closely interlinked themes identified which impacted on how health professionals worked together to initiate people with type 2 diabetes on insulin: 1. Ambiguous roles; 2. Uncertain competency and capacity; 3. Varying relationships and communication; and 4. Developing trust and respect. This study has shown that insulin initiation is generally recognised as acceptable in general practice. The role of the DNE and practice nurse in this space and improved communication and relationships between health professionals across organisations and levels of care are factors which need to be addressed to support this clinical work. Relational coordination provides a useful framework for

  13. U.S. Food Safety and Inspection Service testing for Salmonella in selected raw meat and poultry products in the United States, 1998 through 2003: analysis of set results.

    Science.gov (United States)

    Naugle, Alecia Larew; Barlow, Kristina E; Eblen, Denise R; Teter, Vanessa; Umholtz, Robert

    2006-11-01

    The U.S. Food Safety and Inspection Service (FSIS) tests sets of samples of selected raw meat and poultry products for Salmonella to ensure that federally inspected establishments meet performance standards defined in the pathogen reduction-hazard analysis and critical control point system (PR-HACCP) final rule. In the present report, sample set results are described and associations between set failure and set and establishment characteristics are identified for 4,607 sample sets collected from 1998 through 2003. Sample sets were obtained from seven product classes: broiler chicken carcasses (n = 1,010), cow and bull carcasses (n = 240), market hog carcasses (n = 560), steer and heifer carcasses (n = 123), ground beef (n = 2,527), ground chicken (n = 31), and ground turkey (n = 116). Of these 4,607 sample sets, 92% (4,255) were collected as part of random testing efforts (A sets), and 93% (4,166) passed. However, the percentage of positive samples relative to the maximum number of positive results allowable in a set increased over time for broilers but decreased or stayed the same for the other product classes. Three factors associated with set failure were identified: establishment size, product class, and year. Set failures were more likely early in the testing program (relative to 2003). Small and very small establishments were more likely to fail than large ones. Set failure was less likely in ground beef than in other product classes. Despite an overall decline in set failures through 2003, these results highlight the need for continued vigilance to reduce Salmonella contamination in broiler chicken and continued implementation of programs designed to assist small and very small establishments with PR-HACCP compliance issues.

  14. "The Role of the Unit in Physics and Psychometrics" by Stephen Humphry--One Small Step for the Rasch Model, but Possibly One Giant Leap for Measurement in the Social Sciences

    Science.gov (United States)

    Salzberger, Thomas

    2011-01-01

    Compared to traditional test theory, where person measures are typically referenced to the distribution of a population, item response theory allows for a much more meaningful interpretation of measures as they can be directly compared to item locations. However, Stephen Humphry shows that the crucial role of the unit of measurement has been…

  15. Acetylated Histone H3K9 is associated with meiotic recombination hotspots, and plays a role in recombination redundantly with other factors including the H3K4 methylase Set1 in fission yeast

    Science.gov (United States)

    Yamada, Shintaro; Ohta, Kunihiro; Yamada, Takatomi

    2013-01-01

    Histone modifications are associated with meiotic recombination hotspots, discrete sites with augmented recombination frequency. For example, trimethylation of histone H3 lysine4 (H3K4me3) marks most hotspots in budding yeast and mouse. Modified histones are known to regulate meiotic recombination partly by promoting DNA double-strand break (DSB) formation at hotspots, but the role and precise landscape of involved modifications remain unclear. Here, we studied hotspot-associated modifications in fission yeast and found general features: acetylation of H3 lysine9 (H3K9ac) is elevated, and H3K4me3 is not significantly enriched. Mutating H3K9 to non-acetylatable alanine mildly reduced levels of the DSB-inducing protein Rec12 (the fission yeast homologue of Spo11) and DSB at hotspots, indicating that H3K9ac may be involved in DSB formation by enhancing the interaction between Rec12 and hotspots. In addition, we found that the lack of the H3K4 methyltransferase Set1 generally increased Rec12 binding to chromatin but partially reduced DSB formation at some loci, suggesting that Set1 is also involved in DSB formation. These results suggest that meiotic DSB formation is redundantly regulated by multiple chromatin-related factors including H3K9ac and Set1 in fission yeast. PMID:23382177

  16. The role of the state system of accounting for and control of nuclear material and its relationship with the international safeguards agreements for the set-up of peaceful nuclear programs and activities

    International Nuclear Information System (INIS)

    Mhadhbi, H.

    2010-01-01

    Nuclear energy plays an important role in the development of the economy and is considered as a key element with regard to the growth of the world energy demand due to the limitation of other natural energy resources, its contribution to the protection of the environment and the reduction of CO 2 emission. Several countries, including some Arab countries, are planning to consider the nuclear option in the near future. To provide an assurance to the international community of the peaceful uses of nuclear energy, the International Atomic Energy Agency established legal tools, called Safeguards Agreements, to be accepted by every state willing to run nuclear programmes for peaceful purposes. The most important basis required by these agreements is the State System of Accounting for and Control of Nuclear Material, which plays a primary role for effective and efficient fulfilment of the state commitment with regard to the international safeguards agreements. The requirements for the set-up of a State System of Accounting for and Control , its role, its objectives and its fundamental elements are deeply presented. (author)

  17. Dentists' self-perceived role in offering tobacco cessation services: results from a nationally representative survey, United States, 2010-2011.

    Science.gov (United States)

    Jannat-Khah, Deanna P; McNeely, Jennifer; Pereyra, Margaret R; Parish, Carrigan; Pollack, Harold A; Ostroff, Jamie; Metsch, Lisa; Shelley, Donna R

    2014-11-06

    Dental visits represent an opportunity to identify and help patients quit smoking, yet dental settings remain an untapped venue for treatment of tobacco dependence. The purpose of this analysis was to assess factors that may influence patterns of tobacco-use-related practice among a national sample of dental providers. We surveyed a representative sample of general dentists practicing in the United States (N = 1,802). Multivariable analysis was used to assess correlates of adherence to tobacco use treatment guidelines and to analyze factors that influence providers' willingness to offer tobacco cessation assistance if reimbursed for this service. More than 90% of dental providers reported that they routinely ask patients about tobacco use, 76% counsel patients, and 45% routinely offer cessation assistance, defined as referring patients for cessation counseling, providing a cessation prescription, or both. Results from multivariable analysis indicated that cessation assistance was associated with having a practice with 1 or more hygienists, having a chart system that includes a tobacco use question, having received training on treating tobacco dependence, and having positive attitudes toward treating tobacco use. Providers who did not offer assistance but who reported that they would change their practice patterns if sufficiently reimbursed were more likely to be in a group practice, treat patients insured through Medicaid, and have positive attitudes toward treating tobacco dependence. Findings indicate the potential benefit of increasing training opportunities and promoting system changes to increase involvement of dental providers in conducting tobacco use treatment. Reimbursement models should be tested to assess the effect on dental provider practice patterns.

  18. The role of government in the development and diffusion of renewable energy technologies: Wind power in the United States, California, Denmark and Germany, 1970--2000

    Science.gov (United States)

    Sawin, Janet Laughlin

    2001-07-01

    This dissertation seeks to determine the role of government policy in advancing the development and diffusion of renewable energy technologies, and to determine if specific policies or policy types are more effective than others in achieving these ends. This study analyzes legislation, regulations, research and development (R&D) programs and their impacts on wind energy in California, the rest of the United States, Denmark and Germany, from 1970 through 2000. These countries (and state) were chosen because each has followed a very different path and has adopted wind energy at different rates. Demand for energy, particularly electricity, is rising rapidly worldwide. Renewable energy technologies could meet much of the world's future demand for electricity without the national security, environmental and social costs of conventional technologies. But renewables now play only a minor role in the electric generation systems of most countries. According to conventional economic theory, renewable energy will achieve greater market penetration once it is cost-competitive with conventional generation. This dissertation concludes, however, that government policy is the most significant causal variable in determining the development and diffusion of wind energy technology. Policy is more important for bringing wind energy to maturity than a nation's wind resource potential, wealth, relative differences in electricity prices, or existing infrastructure. Further, policy is essential for enabling a technology to succeed in the marketplace once it is cost-competitive. Policies can affect a technology's perceived, or real, costs; they can reduce risks or increase the availability and affordability of capital; appropriate and consistent policies can eliminate barriers to wind technology. To be adopted on a large scale, renewables require effective, appropriate and, above all, consistent policies that are legislated with a long-term view toward advancing a technology and an

  19. Investigating the Predictive Validity of "TOEFL iBT"® Test Scores and Their Use in Informing Policy in a United Kingdom University Setting. "TOEFL iBT"® Research Report. TOEFL iBT-30. ETS Research Report. RR-17-41

    Science.gov (United States)

    Harsch, Claudia; Ushloda, Ema; Ladroue, Christophe

    2017-01-01

    The project examined the predictive validity of the "TOEFL iBT"® test with a focus on the relationship between TOEFL iBT scores and students' subsequent academic success in postgraduate studies in one leading university in the United Kingdom, paying specific attention to the role of linguistic preparedness as perceived by students and…

  20. Crisis Management's New Role in Educational Settings

    Science.gov (United States)

    Gainey, Barbara S.

    2009-01-01

    From natural disasters to the financial debacle, it is clear to the educational community that crises know no boundaries. Far from a passing fad, crisis planning must be an integrated part of effective school district leadership. Two studies explore the status of crisis management in selected public school systems and offer recommendations for…

  1. Reassessing the role of temperature in precipitation oxygen isotopes across the eastern and central United States through weekly precipitation-day data

    Science.gov (United States)

    Akers, Pete D.; Welker, Jeffrey M.; Brook, George A.

    2017-09-01

    Air temperature is correlated with precipitation oxygen isotope (δ18Oprcp) variability for much of the eastern and central United States, but the nature of this δ18Oprcp-temperature relationship is largely based on data coarsely aggregated at a monthly resolution. We constructed a database of 6177 weeks of isotope and precipitation-day air temperature data from 25 sites to determine how more precise data change our understanding of this classic relationship. Because the δ18Oprcp-temperature relationship is not perfectly linear, trends in the regression residuals suggest the influence of additional environmental factors such as moisture recycling and extratropical cyclone interactions. Additionally, the temporal relationships between δ18Oprcp and temperature observed in the weekly data at individual sites can explain broader spatial patterns observed across the study region. For 20 of 25 sites, the δ18Oprcp-temperature relationship slope is higher for colder precipitation than for warmer precipitation. Accordingly, northern and western sites with relatively more cold precipitation events have steeper overall relationships with higher slope values than southeastern sites that have more warm precipitation events. Although the magnitude of δ18Oprcp variability increases to the north and west, the fraction of δ18Oprcp variability explained by temperature increases due to wider annual temperature ranges, producing stronger relationships in these regions. When our δ18Oprcp-temperature data are grouped by month, we observe significant variations in the relationship from month to month. This argues against a principal causative role for temperature and suggests the existence of an alternative environmental control on δ18Oprcp values that simply covaries seasonally with temperature.

  2. The role of family planning in achieving safe pregnancy for serodiscordant couples: commentary from the United States government’s interagency task force on family planning and HIV service integration

    Science.gov (United States)

    Mason, Jennifer; Medley, Amy; Yeiser, Sarah; Nightingale, Vienna R.; Mani, Nithya; Sripipatana, Tabitha; Abutu, Andrew; Johnston, Beverly; Watts, D. Heather

    2017-01-01

    Abstract Introduction: People living with HIV (PLHIV) have the right to exercise voluntary choices about their health, including their reproductive health. This commentary discusses the integral role that family planning (FP) plays in helping PLHIV, including those in serodiscordant relationships, achieve conception safely. The United States (US) President’s Emergency Plan for AIDS Relief (PEPFAR) is committed to meeting the reproductive health needs of PLHIV by improving their access to voluntary FP counselling and services, including prevention of unintended pregnancy and counselling for safer conception. Discussion: Inclusion of preconception care and counselling (PCC) as part of routine HIV services is critical to preventing unintended pregnancies and perinatal infections among PLHIV. PLHIV not desiring a current pregnancy should be provided with information and counselling on all available FP methods and then either given the method onsite or through a facilitated referral process. PLHIV, who desire children should be offered risk reduction counselling, support for HIV status disclosure and partner testing, information on safer conception options to reduce the risk of HIV transmission to the partner and the importance of adhering to antiretroviral treatment during pregnancy and breastfeeding to reduce the risk of vertical transmission to the infant. Integration of PCC, HIV and FP services at the same location is recommended to improve access to these services for PLHIV. Other considerations to be addressed include the social and structural context, the health system capacity to offer these services, and stigma and discrimination of providers. Conclusion: Evaluation of innovative service delivery models for delivering PCC services is needed, including provision in community-based settings. The US Government will continue to partner with local organizations, Ministries of Health, the private sector, civil society, multilateral and bilateral donors, and other

  3. Intimate Partner Violence, Relationship Power Inequity and the Role of Sexual and Social Risk Factors in the Production of Violence among Young Women Who Have Multiple Sexual Partners in a Peri-Urban Setting in South Africa

    DEFF Research Database (Denmark)

    Zembe, Yanga Z.; Townsend, Loraine; Thorson, Anna

    2015-01-01

    INTRODUCTION: This paper aims to assess the extent and correlates of intimate partner violence (IPV), explore relationship power inequity and the role of sexual and social risk factors in the production of violence among young women aged 16-24 reporting more than one partner in the past three......-urban settings in South Africa, not much is known about how it manifests among women who engage in concomitantly high HIV risk behaviours such as multiple sexual partnering, transactional sex and age mixing. We know even less about how such women negotiate power and control if exposed to violence in such sexual...... networks. METHODS: Two hundred and fifty nine women with multiple sexual partners, residing in a predominantly Black peri-urban community in the Western Cape, South Africa, were recruited into a bio-behavioural survey using Respondent Driven Sampling (RDS). After the survey, focus group discussions...

  4. A comparison of stigma among patients with leprosy in rural Tanzania and urban United States: a role for public health in dermatology.

    Science.gov (United States)

    Roosta, Neda; Black, David S; Rea, Thomas H

    2013-04-01

      Leprosy is a chronic infection of the skin and peripheral nerves caused by the bacterium Mycobacterium leprae, which causes peripheral insensitivity and disfigurements of the skin, limbs, and digits. Social stigma is a common consequence of leprosy and may differ according to level of physical disfigurement and geographic location. The objective of this study was to assess social stigma encountered by patients with leprosy in clinical settings located in rural Tanzania and urban USA and to compare the social stigma reported in these regions.   A total of 56 respondents were recruited from one leprosy inpatient facility in Shirati, Tanzania (n = 28), and one outpatient clinic in Los Angeles, USA (n = 28). Cross-sectional data were obtained from face-to-face interviews, which were conducted with respondents at each clinic location. Measures of perceived stigma were assessed in family relationship, vocational, social interaction, and interpersonal contexts.   Patients in Tanzania, as compared with those in the USA, reported significantly higher levels of stigma in family relationship and vocational contexts. Tanzanian patients also reported higher levels of stigma in social interaction and self-esteem contexts, but these differences were marginally significant and may reflect the small sample size.   Leprosy-related social stigma is a major problem in regions of both developed and developing countries; however, patients with leprosy in developing countries reported higher levels of stigma in four social contexts. A public health role in dermatology is discussed as an agent of early diagnosis, control, and education in order to reduce social stigma and promote social rehabilitation. © 2013 The International Society of Dermatology.

  5. The Role of Preference on Outcomes of People Receiving Evidence-Informed Community Wound Care in Their Home or in a Nurse-Clinic Setting: A Cohort Study (n = 230

    Directory of Open Access Journals (Sweden)

    Margaret B. Harrison

    2014-09-01

    Full Text Available This study followed a cohort of community-dwelling individuals receiving wound-care in a large urban-rural region. During a randomized control trial (RCT evaluating outcomes of receiving care in a nurse-clinic or at home, many approached were willing to participate if they could choose their location of care. This provided a unique opportunity to enroll them as a “choice” cohort, following them in the same manner as the trial participants but allowing them to select their setting of care. The objective was to investigate the role of preference and location of care on care outcomes, including satisfaction with care, healing, health-related quality of life (HRQL, pain, and resource use. This is a secondary analysis of a prospective cohort of 126 individuals enrolled in an RCT to receive care at home or in a nurse-clinic (Allocated group, and an additional 104 who received care at home or in a nurse-clinic based on their preference (Choice group. Mobile individuals with a leg ulcer of venous or mixed venous etiology, referred for community leg ulcer care, were eligible. Specially-trained nurses provided care to both groups using an evidence-informed protocol. Baseline data included socio-demographic, circumstance-of-living and a detailed wound assessment. Mean age of the cohort was 68 years. Satisfaction, healing, recurrence, pain, HRQL, and resource utilization did not differ between groups. If available, individuals should have an option of care venue given almost half of those approached indicated a clear preference for clinic or home. With outcomes being similar, health care planners and decision-makers, as well as individuals and their families, can feel confident that the setting of care will not impact the outcomes. However, larger studies in other contexts are needed to explore the interaction between choice and setting.

  6. The Role of Preference on Outcomes of People Receiving Evidence-Informed Community Wound Care in Their Home or in a Nurse-Clinic Setting: A Cohort Study (n = 230).

    Science.gov (United States)

    Harrison, Margaret B; VanDenKerkhof, Elizabeth G; Hopman, Wilma M; Carley, Meg E

    2014-09-19

    This study followed a cohort of community-dwelling individuals receiving wound-care in a large urban-rural region. During a randomized control trial (RCT) evaluating outcomes of receiving care in a nurse-clinic or at home, many approached were willing to participate if they could choose their location of care. This provided a unique opportunity to enroll them as a "choice" cohort, following them in the same manner as the trial participants but allowing them to select their setting of care. The objective was to investigate the role of preference and location of care on care outcomes, including satisfaction with care, healing, health-related quality of life (HRQL), pain, and resource use. This is a secondary analysis of a prospective cohort of 126 individuals enrolled in an RCT to receive care at home or in a nurse-clinic (Allocated group), and an additional 104 who received care at home or in a nurse-clinic based on their preference (Choice group). Mobile individuals with a leg ulcer of venous or mixed venous etiology, referred for community leg ulcer care, were eligible. Specially-trained nurses provided care to both groups using an evidence-informed protocol. Baseline data included socio-demographic, circumstance-of-living and a detailed wound assessment. Mean age of the cohort was 68 years. Satisfaction, healing, recurrence, pain, HRQL, and resource utilization did not differ between groups. If available, individuals should have an option of care venue given almost half of those approached indicated a clear preference for clinic or home. With outcomes being similar, health care planners and decision-makers, as well as individuals and their families, can feel confident that the setting of care will not impact the outcomes. However, larger studies in other contexts are needed to explore the interaction between choice and setting.

  7. Toward the Application of Constructivism and Constructionism to Work-Related Training in Service of the Enhancement of Human Capital Development in Postsecondary Education Settings in the United States

    Science.gov (United States)

    Mays, Antje

    2015-01-01

    Education research and employer surveys reveal that the skill gap in the United States spans across the realms of academic foundations, industry qualifications and technical competencies, higher-order cognitive skills, and behavioral skills and values. The purpose of this investigation was to identify key components of the two theoretical models…

  8. Transition from island-arc to passive setting on the continental margin of Gondwana: U-Pb zircon dating of Neoproterozoic metaconglomerates from the SE margin of the Teplá-Barrandian Unit, Bohemian Massif

    Czech Academy of Sciences Publication Activity Database

    Sláma, Jiří; Dunkley, D. J.; Kachlík, V.; Kusiak, M. A.

    2008-01-01

    Roč. 461, 1-4 (2008), s. 44-59 ISSN 0040-1951 Institutional research plan: CEZ:AV0Z30130516 Keywords : Bohemian Massif * Teplá–Barrandian Unit * Neoproterozoic * Armorican Terrane Assemblage * Gondwana * zircon dating Subject RIV: DB - Geology ; Mineralogy Impact factor: 1.677, year: 2008

  9. The growing role of biologics and biosimilars in the United States: Perspectives from the APhA Biologics and Biosimilars Stakeholder Conference.

    Science.gov (United States)

    Crespi-Lofton, Judy; Skelton, Jann B

    The American Pharmacists Association (APhA) convened the Biologics and Biosimilars Stakeholder Conference on November 30, 2016, in Washington DC. The objectives of the Conference were to determine the key issues and challenges within the marketplace for biologics, follow-on biologics (FOBs), and biosimilars, identify potential roles and responsibilities of pharmacists regarding biologic and biosimilar medications, and identify actions or activities that pharmacists may take to optimize the safe and cost-effective use of biologics and biosimilars. National thought leaders and stakeholder representatives, including individuals from the Food and Drug Administration, Centers for Medicare and Medicaid Services, a private third-party payer, manufacturers, and several national organizations of health care professionals, participated in the conference. Information shared by this group was supplemented with relevant legal and regulatory information and published literature. Biologics play a valuable role in the treatment of numerous health conditions, but their associated costs, which tend to be greater than those of small-molecule drugs, place a burden on the health care system. Biosimilars (both noninterchangeable and interchangeable) are highly similar copies of the originator biologic and offer the potential to reduce costs and improve patient access to biological products by increasing treatment options and creating a more competitive market. Despite the potential benefits of biosimilars, certain factors may limit their uptake. The conference participants explored issues that different stakeholders think influence the use of biologics, including biosimilars, in the United States. Barriers included technology, prescriber-pharmacist communication, legislation and regulations, limited patient and health care practitioner knowledge of biological products, patient and health care practitioner perceptions of biosimilars, and evolving science or lack of long-term data. After

  10. Collimator setting optimization in intensity modulated radiotherapy

    International Nuclear Information System (INIS)

    Williams, M.; Hoban, P.

    2001-01-01

    Full text: The aim of this study was to investigate the role of collimator angle and bixel size settings in IMRT when using the step and shoot method of delivery. Of particular interest is minimisation of the total monitor units delivered. Beam intensity maps with bixel size 10 x 10 mm were segmented into MLC leaf sequences and the collimator angle optimised to minimise the total number of MU's. The monitor units were estimated from the maximum sum of positive-gradient intensity changes along the direction of leaf motion. To investigate the use of low resolution maps at optimum collimator angles, several high resolution maps with bixel size 5 x 5 mm were generated. These were resampled into bixel sizes, 5 x 10 mm and 10 x 10 mm and the collimator angle optimised to minimise the RMS error between the original and resampled map. Finally, a clinical IMRT case was investigated with the collimator angle optimised. Both the dose distribution and dose-volume histograms were compared between the standard IMRT plan and the optimised plan. For the 10 x 10 mm bixel maps there was a variation of 5% - 40% in monitor units at the different collimator angles. The maps with a high degree of radial symmetry showed little variation. For the resampled 5 x 5 mm maps, a small RMS error was achievable with a 5 x 10 mm bixel size at particular collimator positions. This was most noticeable for maps with an elongated intensity distribution. A comparison between the 5 x 5 mm bixel plan and the 5 x 10 mm showed no significant difference in dose distribution. The monitor units required to deliver an intensity modulated field can be reduced by rotating the collimator and aligning the direction of leaf motion with the axis of the fluence map that has the least intensity. Copyright (2001) Australasian College of Physical Scientists and Engineers in Medicine

  11. The Influence of Setting on Care Coordination for Childhood Asthma

    Science.gov (United States)

    Kelly, R. Patrick; Stoll, Shelley C.; Bryant-Stephens, Tyra; Janevic, Mary R.; Lara, Marielena; Ohadike, Yvonne U.; Persky, Victoria; Ramos-Valencia, Gilberto; Uyeda, Kimberly; Malveaux, Floyd J.

    2015-01-01

    Asthma affects 7.1 million children in the United States, disproportionately burdening African American and Latino children. Barriers to asthma control include insufficient patient education and fragmented care. Care coordination represents a compelling approach to improve quality of care and address disparities in asthma. The sites of The Merck Childhood Asthma Network Care Coordination Programs implemented different models of care coordination to suit specific settings—school district, clinic or health care system, and community—and organizational structures. A variety of qualitative data sources were analyzed to determine the role setting played in the manifestation of care coordination at each site. There were inherent strengths and challenges of implementing care coordination in each of the settings, and each site used unique strategies to deliver their programs. The relationship between the lead implementing unit and entities that provided (1) access to the priority population and (2) clinical services to program participants played a critical role in the structure of the programs. The level of support and infrastructure provided by these entities to the lead implementing unit influenced how participants were identified and how asthma care coordinators were integrated into the clinical care team. PMID:26232778

  12. Comparison of Hounsfield units by changing in size of physical area and setting size of region of interest by using the CT phantom made with a 3D printer

    International Nuclear Information System (INIS)

    Seung, Youl Hun

    2015-01-01

    In this study, we have observed the change of the Hounsfield (HU) in the alteration of by changing in size of physical area and setting size of region of interest (ROI) at focus on kVp and mAs. Four-channel multi-detector computed tomography was used to get transverse axial scanning images and HU. Three dimensional printer which is type of fused deposition modeling (FDM) was used to produce the Phantom. The structure of the phantom was designed to be a type of cylinder that contains 33 mm, 24 mm, 19 mm, 16 mm, 9 mm size of circle holes that are symmetrically located. It was charged with mixing iodine contrast agent and distilled water in the holes. The images were gained with changing by 90 kVp, 120 kVp, 140 kVp and 50 mAs, 100 mAs, 150 mAs, respectively. The ‘image J’ was used to get the HU measurement of gained images of ROI. As a result, it was confirmed that kVp affects to HU more than mAs. And it is suggested that the smaller size of physical area, the more decreasing HU even in material of a uniform density and the smaller setting size of ROI, the more increasing HU. Therefore, it is reason that to set maximum ROI within 5 HU is the best way to minimize in the alteration of by changing in size of physical area and setting size of region of interest

  13. Comparison of Hounsfield units by changing in size of physical area and setting size of region of interest by using the CT phantom made with a 3D printer

    Energy Technology Data Exchange (ETDEWEB)

    Seung, Youl Hun [Dept. of Radiological Science, Cheongju University, Cheongju (Korea, Republic of)

    2015-12-15

    In this study, we have observed the change of the Hounsfield (HU) in the alteration of by changing in size of physical area and setting size of region of interest (ROI) at focus on kVp and mAs. Four-channel multi-detector computed tomography was used to get transverse axial scanning images and HU. Three dimensional printer which is type of fused deposition modeling (FDM) was used to produce the Phantom. The structure of the phantom was designed to be a type of cylinder that contains 33 mm, 24 mm, 19 mm, 16 mm, 9 mm size of circle holes that are symmetrically located. It was charged with mixing iodine contrast agent and distilled water in the holes. The images were gained with changing by 90 kVp, 120 kVp, 140 kVp and 50 mAs, 100 mAs, 150 mAs, respectively. The ‘image J’ was used to get the HU measurement of gained images of ROI. As a result, it was confirmed that kVp affects to HU more than mAs. And it is suggested that the smaller size of physical area, the more decreasing HU even in material of a uniform density and the smaller setting size of ROI, the more increasing HU. Therefore, it is reason that to set maximum ROI within 5 HU is the best way to minimize in the alteration of by changing in size of physical area and setting size of region of interest.

  14. UpSet: Visualization of Intersecting Sets

    Science.gov (United States)

    Lex, Alexander; Gehlenborg, Nils; Strobelt, Hendrik; Vuillemot, Romain; Pfister, Hanspeter

    2016-01-01

    Understanding relationships between sets is an important analysis task that has received widespread attention in the visualization community. The major challenge in this context is the combinatorial explosion of the number of set intersections if the number of sets exceeds a trivial threshold. In this paper we introduce UpSet, a novel visualization technique for the quantitative analysis of sets, their intersections, and aggregates of intersections. UpSet is focused on creating task-driven aggregates, communicating the size and properties of aggregates and intersections, and a duality between the visualization of the elements in a dataset and their set membership. UpSet visualizes set intersections in a matrix layout and introduces aggregates based on groupings and queries. The matrix layout enables the effective representation of associated data, such as the number of elements in the aggregates and intersections, as well as additional summary statistics derived from subset or element attributes. Sorting according to various measures enables a task-driven analysis of relevant intersections and aggregates. The elements represented in the sets and their associated attributes are visualized in a separate view. Queries based on containment in specific intersections, aggregates or driven by attribute filters are propagated between both views. We also introduce several advanced visual encodings and interaction methods to overcome the problems of varying scales and to address scalability. UpSet is web-based and open source. We demonstrate its general utility in multiple use cases from various domains. PMID:26356912

  15. Palonosetron versus other 5-HT₃ receptor antagonists for prevention of chemotherapy-induced nausea and vomiting in patients with hematologic malignancies treated with emetogenic chemotherapy in a hospital outpatient setting in the United States.

    Science.gov (United States)

    Craver, Chris; Gayle, Julie; Balu, Sanjeev; Buchner, Deborah

    2011-01-01

    This study evaluated the rate of uncontrolled chemotherapy-induced nausea and vomiting (CINV) after initiating antiemetic prophylaxis with palonosetron versus other 5-HT₃ receptor antagonists (RAs) in patients diagnosed with hematologic malignancies (lymphoma and leukemia) and receiving highly emetogenic chemotherapy (HEC) or moderately emetogenic chemotherapy (MEC) in a hospital outpatient setting. Patients aged ≥ 18 years and diagnosed with hematologic malignancies initiating HEC or MEC and antiemetic prophylaxis with palonosetron (Group 1) and other 5-HT₃ RAs (Group 2) for the first time in a hospital outpatient setting between 4/1/2007 and 3/31/2009 were identified from the Premier Perspective Database. Within each cycle, CINV events were identified (in the hospital outpatient, inpatient, and emergency room settings) through ICD-9 codes for nausea, vomiting, and/or volume depletion (from each CT administration day 1 until the end of the CT cycle), or use of rescue medications (day 2 until the end of the CT cycle). Negative binomial distribution generalized linear multivariate regression model estimating the CINV event rate on CT, specific CT cycles, and cancer diagnosis (leukemia/lymphoma)-matched groups in the follow-up period (first of 8 cycles or 6 months) was developed. Of 971 identified patients, 211 initiated palonosetron (Group 1). Group 1 patients comprised of more females [50.2 vs. 41.4%; p = 0.0226], Whites [74.4 vs. 70.4%, and Hispanics [7.6 vs. 6.3%; all races p = 0.0105], received more HEC treatments [89.6 vs. 84.2%; all CT types p = 0.0129], and had more lymphoma diagnosed patients [89.6 vs. 76.3%; all cancer types p = 0.0033] at baseline. After controlling for differences in several demographic and clinical variables, the regression model predicted a 20.4% decrease in CINV event rate per CT cycle for Group 1 versus Group 2 patients. Study limitations include potential lack of generalizability, absence of data on certain

  16. Uniform Facility Data Set US (UFDS-1997)

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Uniform Facility Data Set (UFDS), formerly the National Drug and Alcohol Treatment Unit Survey or NDATUS, was designed to measure the scope and use of drug abuse...

  17. Uniform Facility Data Set US (UFDS-1998)

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Uniform Facility Data Set (UFDS) was designed to measure the scope and use of drug abuse treatment services in the United States. The survey collects information...

  18. The role of the medical physic on radiologic, hemodynamic and surgery unit at Hospital das Clinicas de Porto Alegre, Rio Grande do Sul State, Brazil

    International Nuclear Information System (INIS)

    Bacelar, A.; Furtado, A.P.A.; Krebs, E.M.; Oliveira, S.S.; Lima, A.A.; Jacques, L.C.; Silveira, C.S.

    1996-01-01

    The activities executed by the medical physic in the radiologic, hemodynamic and surgery unit are presented. Topics such as organization of a radiologic protection project and a quality assurance program, monthly information of the individual doses, sanitary inspection and training of the professionals involved are emphasized. The methodology and results are briefly presented

  19. Information Access in Rural Areas of the United States: The Public Library's Role in the Digital Divide and the Implications of Differing State Funding Models

    Science.gov (United States)

    Thiele, Jennifer

    2016-01-01

    In the United States, individual states have different means of determining and distributing funding. This influences library service and access to information particularly as it pertains to critical Internet access. Funding and service trends have changed, especially as it relates to public libraries, with some modifications working to their…

  20. The Leadership Role of the Teacher Librarian in Technology Integration: Early Results of a Survey of Highly Certified Teacher Librarians in the United States

    Science.gov (United States)

    Everhart, Nancy; Mardis, Marcia A.; Johnston, Melissa

    2010-01-01

    In 2008, the United States' Institute for Museum and Library Services funded Project Leadership-in-Action (LIA) that included surveys of the technology integration practices of teacher librarian leaders with National Board Certification. Preliminary 2009 survey results suggested that the 295 respondents worked in well-resourced libraries with…