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Hyundai Santa Fe Detroidi autonäituselt on esimene Hyundai märgi all valmistamisele tulev sport- ja tarbesõiduki eellane. Santa Fe töötasid välja korea insenerid Ulsanis ja ameerika disainerid firma Californias asuvas arenduskeskuses
Hyundai plans rubber unit despite overcapacity
Energy Technology Data Exchange (ETDEWEB)
Hyoungjin Kim
Despite the oversupply of synthetic rubber in South Korea, the government has granted approval to Hyundai Petrochemical (Seoul) to build the country's second synthetic rubber unit, to be located alongside its petrochemical complex at Daesan. The plant is due for startup during second-half 1995, when the local market is expected to be in better balance. Hyundai will use Goodyear Tire Rubber technology for the plant, which will have annual capacities for 40,000 m.t. of polybutadiene rubber (BR), 30,000 m.t. of styrene butadiene rubber (SBR) and 12,000 m.t. of nitrile rubber (NBR). Styrene and butadiene requirements will be met from Hyundai's own production at Daesan. The current local producer of synthetic rubber is Korea Kumho Petrochemicals (Seoul), which has annual capacities for 150,000 m.t. of SBR, 95,000 m.t. of BR, and 10,000 m.t. of NBR. Korean SBR demand is about 141,000 m.t./year but is expected to increase to 161,000 m.t./year by 1996 and reach 194,000 m.t./year by the end of the decade.
Thermal Load Reduction System Development in a Hyundai Sonata PHEV
Energy Technology Data Exchange (ETDEWEB)
Kreutzer, Cory J.; Rugh, John; Tomerlin, Jeff
Increased market penetration of electric drive vehicles (EDVs) requires overcoming a number of hurdles, including limited vehicle range and the elevated cost in comparison to conventional vehicles. Climate control loads have a significant impact on range, cutting it by over 50% in both cooling and heating conditions. To minimize the impact of climate control on EDV range, the National Renewable Energy Laboratory has partnered with Hyundai America and key industry partners to quantify the performance of thermal load reduction technologies on a Hyundai Sonata plug-in hybrid electric vehicle. Technologies that impact vehicle cabin heating in cold weather conditions and cabin cooling in warm weather conditions were evaluated. Tests included thermal transient and steady-state periods for all technologies, including the development of a new test methodology to evaluate the performance of occupant thermal conditioning. Heated surfaces demonstrated significant reductions in energy use from steady-state heating, including a 29%-59% reduction from heated surfaces. Solar control glass packages demonstrated significant reductions in energy use for both transient and steady-state cooling, with up to a 42% reduction in transient and 12.8% reduction in steady-state energy use for the packages evaluated. Technologies that demonstrated significant climate control load reduction were selected for incorporation into a complete thermal load reduction package. The complete package is set to be evaluated in the second phase of the ongoing project.
2011 Hyundai Sonata 3539 - Hybrid Electric Vehicle Battery Test Results
Energy Technology Data Exchange (ETDEWEB)
Matthew Shirk; Tyler Gray; Jeffrey Wishart
The U.S. Department of Energy's Advanced Vehicle Testing Activity Program consists of vehicle, battery, and infrastructure testing on advanced technology related to transportation. The activity includes tests on hybrid electric vehicles, including testing hybrid electric vehicle batteries when both the vehicles and batteries are new and at the conclusion of 160,000 miles of on-road fleet testing. This report documents battery testing performed for the 2011 Hyundai Sonata Hybrid (VIN KMHEC4A47BA003539). Battery testing was performed by Intertek Testing Services NA. The Idaho National Laboratory and Intertek collaborate on the Advanced Vehicle Testing Activity for the Vehicle Technologies Program of the U.S. Department of Energy.
Foreign direct investments in the Czech automotive industry : a case study of Hyundai Motor Company
Dolezalova, Eliska; Dailida, Yuliya
This thesis is a strategic analysis of the 2006 greenfield investment in the Czech Republic, by the global automotive manufacturer Hyundai Motor Group. We analyse the factors that made Czech Republic an advantageous location for automotive FDIs, and how this influenced Hyundai when they decided to open a production plant in Europe. Through applying relevant theories, our thesis aims to show that Czech Republic is an attractive location for automotive FDIs due to strong industri...
78 FR 38444 - Hyundai Motor Company, Grant of Petition for Decision of Inconsequential Noncompliance
... Hybrid passenger cars, do not fully comply with paragraph Sec. 220.127.116.11.2 of Federal Motor Vehicle Safety.... Vehicles Involved: Affected are approximately 14,728 MY 2011 and 2012 Hyundai Sonata Hybrid vehicles... states: Sec. 188.8.131.52 Passenger cars manufactured on or after September 1, 2007. Sec. 188.8.131.52.1 Except as...
FCV-VBS isolated from cats with typical symptoms caused VSD in experimental cats.
Ohe, Kyoko; Takahashi, Toshikazu; Hara, Daisuke; Hara, Motonobu
Commercially available vaccines have been used widely to prevent feline calicivirus infection (FCI). However, with their widespread use, field strains, which are weakly cross-reactive with the live-virus vaccine strain F9, have posed the problem of vaccine breakdown. Recently the existence of FCV--associated virulent systemic disease (VSD) has been published. But their molecular diversity, antigenic mutations and physicochemical property have not been sufficiently clarified. Thus, we experimentally gave the vaccine breakdown strain (VBS) H10 to cats that had been inoculated with an F9 live vaccine. After the administration of strain H10, vaccinated cats (1 through 4) had no respiratory symptoms, whereas the non-vaccinated cat 5 showed clinical symptoms such as a fever of over 40 degrees C, loss of vitality, decreased appetite, diarrhea, and nasal discharge after receiving strain H10, and died. Lethal FCV is rare, and may be a virulent systemic disease (VSD)--inducing strain. This is the initial report on VSD in Japan. It has been reported that symptoms of VSD were similar in vaccinated and nonvaccinated cats on experimental infection. However, no VSD-like symptoms developed, and the incidence of the disease varied depending on the presence or absence of vaccination, suggesting that there are two mechanisms of vaccine breakdown: one is associated with the vaccine immunity level, and the other is not. The characteristics of the VBS revealed were: (1) the duration of virus excretion was short when the originally carried antibody titer before virus challenge was high, (2) the excreted viral molecular species varied daily, not being limited to a specific species with time, and (3) the acquired physicochemical properties did not persist, and altered daily. FCV-VBS alters the molecular species and physicochemical properties daily due to the reduction of host immunity, which may lead to VSD.
The new Hyundai/Kia 1.1-l three-cylinder diesel engine; Der neue 1,1-l-Dreizylinder-Dieselmotor von Hyundai
Energy Technology Data Exchange (ETDEWEB)
Lee, Kyung Won; Jang, Kyoung Ik [Hyundai Motor Company, Seoul (Korea, Republic of). Engineering-Design-Team; Lee, Jeong Jun; Hur, Dong Han [Hyundai Motor Company, Seoul (Korea, Republic of). Motortest-Team
To achieve low CO{sub 2} emission with the recently launched B-segment vehicle Kia Rio, Hyundai has introduced the second-generation U2 1.1-l three-cylinder diesel engine. This engine and further vehicle features allow a class-leading CO{sub 2} emission of 85 g/km achieved by state-of-the-art technologies including an idle start/stop (ISS) system as well as weight and friction reductions. In addition, the combustion system was optimised to provide sufficient power output and to enable appropriate drivability for B-segment vehicles. (orig.)
Marketingová strategie společnosti Hyundai Centrum CB, s.r.o.
Chlebuch, Ondřej
The aim of the bachelor thesis is to analyze the marketing strategy of Hyundai CB Centrum Ltd. The result of this analysis will be proposals to amend and recommendations. The theoretical part is devoted to marketing strategies, market segmentation and individual marketing strategies. In the practical part will be using using suitable methods. In the practical part is an analysis of the marketing strategy. The result of the practical part will evaluate whether the analyzed marketing strategy i...
Performance Evaluation of a Thermal Load Reduction System in a Hyundai Sonata PHEV
Energy Technology Data Exchange (ETDEWEB)
Kreutzer, Cory J [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Rugh, John P [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Titov, Eugene V [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Gallagher, James [Gentherm, Inc.; Scott, Matthew [Hyundai America Technical Center, Inc.
Increased adoption of electric-drive vehicles (EDVs) requires overcoming hurdles including limited vehicle range. Vehicle cabin heating and cooling demand for occupant climate control requires energy from the main battery and has been shown to significantly degrade vehicle range. During peak cooling and heating conditions, climate control can require as much or more energy as propulsion. As part of an ongoing project, NREL and project partners Hyundai America Technical Center, Inc. (HATCI), Gentherm , Pittsburgh Glass Works (PGW), PPG Industries, Sekisui, 3M, and Hanon Systems developed a thermal load reduction system in order to reduce the range penalty associated with electric vehicle climate control. Solar reflective paint, solar control glass, heated and cooled/ventilated seats, heated surfaces, and heated windshield with door demisters were integrated into a Hyundai Sonata plug-in hybrid electric vehicle (PHEV). Cold weather field-testing was conducted in Fairbanks, Alaska while warm weather testing was conducted in Death Valley, California to assess the system performance in comparison to the baseline production vehicle. In addition, environmental chamber testing at peak heating and cooling conditions was performed to assess the performance of the system in standardized conditions compared to the baseline. Experimental results are presented in this paper providing quantitative data to automobile manufacturers on the impact of climate control thermal load reduction technologies to increase the advanced thermal technology adoption and market penetration of electric drive vehicles.
Design and Implementation of a Thermal Load Reduction System in a Hyundai PHEV
Energy Technology Data Exchange (ETDEWEB)
Kreutzer, Cory J [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Rugh, John P [National Renewable Energy Laboratory (NREL), Golden, CO (United States)
Increased market penetration of electric drive vehicles (EDVs) requires overcoming a number of hurdles including limited vehicle range and the elevated cost of EDVs as compared to conventional vehicles. Climate control loads have a significant impact on range, cutting it by over 50% in both cooling and heating conditions. In order to minimize the impact of climate control on EDV range, the National Renewable Energy Laboratory has partnered with Hyundai America and key industry partners to quantify the performance of thermal load reduction technologies on a Hyundai Sonata PHEV. Technologies that impact vehicle cabin heating in cold weather conditions and cabin cooling in warm weather conditions were evaluated. Tests included thermal transient and steady-state periods for all technologies, including the development of a new test methodology to evaluate the performance of occupant thermal conditioning. Heated surfaces and increased insulation demonstrated significant reductions in energy use from steady-state heating, including a 29% - 59% reduction from heated surfaces. Solar control glass packages demonstrated significant reductions in energy use for both transient and steady-state cooling, with up to a 42% reduction in transient and 12.8% reduction in steady-state energy use for the packages evaluated. Technologies that demonstrated significant climate control load reduction were selected for incorporation into a complete thermal load reduction package. The complete package is set to be evaluated in the second phase of the ongoing project.
Competitive strategies of late followers in auto industry: Case study Hyundai-Kia
Directory of Open Access Journals (Sweden)
Rakita Branko
Full Text Available This paper analyzes competitive strategy of late followers in auto industry in the case of Hyundai Kia Auto Group (HKAG. The global economic crisis has had a strong impact on the leaders in auto industry. HKAG took advantage of the crisis and increased sales and global market share at the expense of the leaders in the industry. We found that during the crisis the company achieved excellent results thanks to innovative marketing and sales strategies combined with top quality, product design and productivity. Growing competition and changes in business environment in the post-crisis period jeopardized the future growth of the company. The company reacted to the changes in business environment by shifting the focus to the luxury segment and green vehicles, by launching independent luxury brand Genesis and by scaling up investment in R&D.
Kulturně podmíněné aspekty marketigové komunikace firmy Hyundai v České republice
Hajzlerová, Jana
This thesis aspires to introduce the question of cultural influence on forms and character of marketing communication. It explains the main approaches to intercultural marketing and more closely looks at Hofstede's theory of cultural dimensions. With regards to the specifics of Korean society, marketing communication of Hyundai in the Czech Republic is introduced based on this theoretical background. Attention is paid especially to the communication style of Hyundai as recognized in PR and CS...
Sistema Hyundai de produção: uma proposição de modelo conceitual
Nunes, Fabiano de Lima
O Sistema Toyota de Produção (STP) ainda é o paradigma no tema de sistemas de produção. No entanto, nas últimas décadas, uma montadora de veículos coreana tem chamado a atenção na medida em que apresenta um significativo crescimento na participação do mercado mundial de autoconstrutores, a Hyundai Motor Company (HMC). Um dos alavancadores desse crescimento é o sistema de produção aplicado na construção e produção dos seus veículos, o Sistema Hyundai de Produção (SHP). Este estudo busca contri...
Nitrile/Buna N Material Failure Assessment for an O-Ring used on the Gaseous Hydrogen Flow Control Valve (FCV) of the Space Shuttle Main Engine
Wingard, Doug
After the rollout of Space Shuttle Discovery in April 2005 in preparation for return-to-flight, there was a failure of the Orbiter (OV-103) helium signature leak test in the gaseous hydrogen (GH2) system. Leakage was attributed to the Flow Control Valve (FCV) in Main Engine 3. The FCV determined to be the source of the leak for OV-103 is designated as LV-58. The nitrile/Buna N rubber O-ring seal was removed from LV-58, and failure analysis indicated radial cracks providing leak paths in one quadrant. Cracks were eventually found in 6 of 9 FCV O-rings among the three Shuttle Orbiters, though none were as severe as those for LV-58, OV-103. Testing by EM10 at MSFC on all 9 FCV O- rings included: laser dimensional, Shore A hardness and properties from a dynamic mechanical analyzer (DMA) and an Instron tensile machine. The following test data was obtained on the cracked quadrant of the LV-58, OV-103 O-ring: (1) the estimated compression set was only 9.5%, compared to none for the rest of the O-ring; (2) Shore A hardness for the O.D. was higher by almost 4 durometer points than for the rest of the O-ring; and (3) DMA data showed that the storage/elastic modulus E was almost 25% lower than for the rest of the O-ring. Of the 8 FCV O-rings tested on an Instron, 4 yielded tensile strengths that were below the MIL spec requirement of 1350 psi-a likely influence of rubber cracking. Comparisons were made between values of modulus determined by DNA (elastic) and Instron (Young s). Each nitrile/Buna N O-ring used in the FCV conforms to the MIL-P-25732C specification. A number of such O-rings taken from shelf storage at MSFC and Kennedy Space Center (KSC) were used to generate a reference curve of DMA glass transition temperature (Tg) vs. shelf storage time ranging from 8 to 26 years. A similar reference curve of TGA onset temperature (of rubber weight loss) vs. shelf storage time was also generated. The DMA and TGA data for the used FCV O-rings were compared to the reference
Space Shuttle Program (SSP) Orbiter Main Propulsion System (MPS) Gaseous Hydrogen (GH2) Flow Control Valve (FCV) Poppet Eddy Current (EC) Inspection Probability of Detection (POD) Study. Volume 1
Piascik, Robert S.; Prosser, William H.
The Director of the NASA Engineering and Safety Center (NESC), requested an independent assessment of the anomalous gaseous hydrogen (GH2) flow incident on the Space Shuttle Program (SSP) Orbiter Vehicle (OV)-105 during the Space Transportation System (STS)-126 mission. The main propulsion system (MPS) engine #2 GH2 flow control valve (FCV) LV-57 transition from low towards high flow position without being commanded. Post-flight examination revealed that the FCV LV-57 poppet had experienced a fatigue failure that liberated a section of the poppet flange. The NESC assessment provided a peer review of the computational fluid dynamics (CFD), stress analysis, and impact testing. A probability of detection (POD) study was requested by the SSP Orbiter Project for the eddy current (EC) nondestructive evaluation (NDE) techniques that were developed to inspect the flight FCV poppets. This report contains the findings and recommendations from the NESC assessment.
Space Shuttle Program (SSP) Orbiter Main Propulsion System (MPS) Gaseous Hydrogen (GH2) Flow Control Valve (FCV) Poppet Eddy Current (EC) Inspection Probability of Detection (POD) Study. Volume 2; Appendices
Piascik, Robert S.; Prosser, William H.
The Director of the NASA Engineering and Safety Center (NESC), requested an independent assessment of the anomalous gaseous hydrogen (GH2) flow incident on the Space Shuttle Program (SSP) Orbiter Vehicle (OV)-105 during the Space Transportation System (STS)-126 mission. The main propulsion system (MPS) engine #2 GH2 flow control valve (FCV) LV-57 transition from low towards high flow position without being commanded. Post-flight examination revealed that the FCV LV-57 poppet had experienced a fatigue failure that liberated a section of the poppet flange. The NESC assessment provided a peer review of the computational fluid dynamics (CFD), stress analysis, and impact testing. A probability of detection (POD) study was requested by the SSP Orbiter Project for the eddy current (EC) nondestructive evaluation (NDE) techniques that were developed to inspect the flight FCV poppets. This report contains the Appendices to the main report.
Particulate Emissions Control using Advanced Filter Systems: Final Report for Argonne National Laboratory, Corning Inc. and Hyundai Motor Company CRADA Project
Energy Technology Data Exchange (ETDEWEB)
Seong, Hee Je [Argonne National Lab. (ANL), Argonne, IL (United States); Choi, Seungmok [Argonne National Lab. (ANL), Argonne, IL (United States)
This is a 3-way CRADA project working together with Corning, Inc. and Hyundai Motor Co. (HMC). The project is to understand particulate emissions from gasoline direct-injection engines (GDI) and their physico-chemical properties. In addition, this project focuses on providing fundamental information about filtration and regeneration mechanisms occurring in gasoline particulate filter (GPF) systems. For the work, Corning provides most advanced filter substrates for GPF applications and HMC provides three-way catalyst (TWC) coating services of these filter by way of a catalyst coating company. Then, Argonne National Laboratory characterizes fundamental behaviors of filtration and regeneration processes as well as evaluated TWC functionality for the coated filters. To examine aging impacts on TWC and GPF performance, the research team evaluates gaseous and particulate emissions as well as back-pressure increase with ash loading by using an engine-oil injection system to accelerate ash loading in TWC-coated GPFs.
Význam jihokorejských investic v ČR a na Slovensku v letech 2004 - 2013 (příklad Hyundai Motor Company a KIA Motors)
Šebesta, Jan
The goal of this thesis is to map of the profit and cost of foreign direct investments (FDI) of car producers Hyundai Motor Company in the Czech Republic and KIA Motors Corporation in Slovakia in years 2004 -- 2013. The theoretical part of the work is directed to description and research of approach to foreign direct investment as a means of development, impact on home economy and possible negatives. Among the most significant positives this exercise are the know-how, increased work productiv...
Nelson, Jenny; Emmott, Christopher J M
Solar power represents a vast resource which could, in principle, meet the world's needs for clean power generation. Recent growth in the use of photovoltaic (PV) technology has demonstrated the potential of solar power to deliver on a large scale. Whilst the dominant PV technology is based on crystalline silicon, a wide variety of alternative PV materials and device concepts have been explored in an attempt to decrease the cost of the photovoltaic electricity. This article explores the potential for such emerging technologies to deliver cost reductions, scalability of manufacture, rapid carbon mitigation and new science in order to accelerate the uptake of solar power technologies.
On Monday 20 February members of the AT Department marked the delivery of the 1000th superconducting dipole magnet to CERN. Only 232 more of the dipole magnets are needed for the LHC. The 35 tonne-dipoles are 15 meters long and are being manufactured by three companies: Babcock Noell Nuclear in Germany (which finished its contract in November 2005), Ansaldo Superconduttori in Italy and Alstom-Jeumont in France. "The production is proceeding well and we expect to be complete in October as previously foreseen," said Lucio Rossi, Head of the Magnets and Superconductors Group (AT-MAS). In total, 1650 main magnets are needed for the LHC, of which 1300 have been delivered.
On Monday 20 February members of the AT Department marked the delivery of the 1000th superconducting dipole magnet to CERN. Only 232 more of the dipole magnets are needed for the LHC. The 35-tonne-dipoles are 15 meters long and are being manufactured by three companies: Babcock Noell Nuclear in Germany (which completed its contract in November 2005), Ansaldo Superconduttori in Italy and Alstom-Jeumont in France. 'The production is proceeding well and we expect to be complete in October as foreseen,' said Lucio Rossi, Head of the Magnets and Superconductors Group (AT-MAS). In total, 1650 main magnets are needed for the LHC, of which 1300 have already been delivered.
Delivering Science from Big Data
Quinn, Peter Joseph
The SKA will be capable of producing a stream of science data products that are Exa-scale in terms of their storage and processing requirements. This Google-scale enterprise is attracting considerable international interest and excitement from within the industrial and academic communities. In this paper we examine the data flow, storage and processing requirements of a number of key SKA survey science projects to be executed on the baseline SKA1 configuration. Based on a set of conservative assumptions about trends for HPC and storage costs, and the data flow process within the SKA Observatory, it is apparent that survey projects of the scale proposed will potentially drive construction and operations costs beyond the current anticipated SKA1 budget. This implies a sharing of the resources and costs to deliver SKA science between the community and what is contained within the SKA Observatory. A similar situation was apparent to the designers of the LHC more than 10 years ago. We propose that it is time for the SKA project and broader community to consider the effort and process needed to design and implement a distributed science data system that leans on the lessons of other projects and looks to recent developments in Cloud technologies to ensure an affordable, effective and global achievement of science goals.
Genetic diversity in Indian FCV and burley tobacco cultivars
Indian Academy of Sciences (India)
term tobacco improvement and reduction of vulnerability of the crop. Prior to the availability of DNA-based markers, most genetic diversity studies in various crops were carried out using morphological markers. Molecular markers have become useful tools to provide a relatively unbiased method of quantifying genetic ...
Delay Efficient Method for Delivering IPTV Services
National Research Council Canada - National Science Library
Sangamesh; Shilpa. K. Gowda
Internet Protocol Television (IPTV) is a system through which Internet television services are delivered using the architecture and networking methods of the Internet Protocol Suite over a packet-switched network infrastructure, e.g...
Is International Accounting Education Delivering Pedagogical Value?
Patel, Chris; Millanta, Brian; Tweedie, Dale
This paper examines whether universities are delivering pedagogical value to international accounting students commensurate with the costs of studying abroad. The paper uses survey and interview methods to explore the extent to which Chinese Learners (CLs) in an Australian postgraduate accounting subject have distinct learning needs. The paper…
Delivering best care in war and peace.
Moore, Alison
Col Alan Finnegan, the fi rst Ministry of Defence professor of nursing, is driving forward research into preparing nurses for deployment and ensuring they deliver the best care possible in war and peace. Research topics range from the role of autonomous practitioners to the effects on soldiers of injuries to their genitalia.
Delivering Online Examinations: A Case Study
Directory of Open Access Journals (Sweden)
John MESSING
Full Text Available Delivering Online Examinations: A Case Study Jason HOWARTH John MESSING Irfan ALTAS Charles Sturt University Wagga Wagga-AUSTRALIA ABSTRACT This paper represents a brief case study of delivering online examinations to a worldwide audience. These examinations are delivered in partnership with a commercial online testing company as part of the Industry Masters degree at Charles Sturt University (CSU. The Industry Masters degree is an academic program for students currently employed in the IT industry. Using Internet Based Testing (IBT, these students are examined in test centres throughout the world. This offers many benefits. For example, students have the freedom of sitting exams at any time during a designated interval. Computer-based testing also provides instructors with valuable feedback through test statistics and student comments. In this paper, we document CSUs use of the IBT system, including how tests are built and delivered, and how both human and statistical feedback is used to evaluate and enhance the testing process.
Delivering IT and eBusiness value
Willcocks, Leslie
Delivering Business Value from IT' is focused on the evaluation issue in IT and how IT evaluation can proceed across the life-cycle of any IT investment and be linked positively to improving business performance. .Chapters 1,2 and 3 detail an approach to IT evaluation whilst chapters 4 and 5 build on these by showing two distinctive approaches to linking IT to business performance. The remaining three chapters deal with a range of evaluation issues emerging as important - specifically Internet evaluation, Y2K and beyond, EMU, quality outsourcing, infrastructure, role of benchmarking, and cost
DESIGNS MATTER: Delivering Information Sources for Tourism
Directory of Open Access Journals (Sweden)
Margie A. Nolasco
Full Text Available Tourism has benefits not just for travelers, but also to the local economy. Since, Bicol Region has natural and cultural attractions; it is a potential travel destination in the country. Technology in delivering information sources played vital role for the success of the tourism industry in the Region. This allows travel enthusiasts to get more information about various tourist attractions. This paper analyzes the effectiveness of delivering information sources such as web advertisement and desktop publishing for tourist promotion in the Bicol Region. Specifically, it determined the status of tourism, and identified common forms of promotions for tourism development. The study adopted mixed method of research. This method was utilized to confirm and validate findings. Interviews and focus group discussions were used to gather data from the respondents of the selected Local Government Units, Department of Tourism, Travel Agencies and Hotel Agents in the Region. Based on the findings, of the total foreign visitors in the country, only 9.14% visited Bicol Region in 2014. That is why, domestic tourist showed high percentage against foreign visitors with 25.7%. Brochures with EZ maps as most commonly used desktop publishing materials and websites and social media for web advertisement. Thus, there is a need to reevaluate promotional activities by the DOT and other agencies. Adoption suggestive features for creative desktop publishing materials and web services should be considered to increase tourist visitors in the Region.
Combining Technologies to Deliver Distance Education
Directory of Open Access Journals (Sweden)
Vicki Freeman
Full Text Available In 1997 a Health Resources and Services Administration (HRSA grant was awarded to the Department of Clinical Laboratory Sciences (CLS at The University of Texas Medical Branch - Galveston (UTMB for support of the Laboratory Education and Advancement Project (LEAP. The project entailed three primary objectives, targeting laboratory practitioners in rural and medically underserved areas of Texas for delivering a bachelor's degree, laboratory-intensive course of study via distance education. Several delivery mechanisms were utilized and evaluated for their effectiveness and friendliness to both the faculty and students. The authors discuss and describe the mechanisms utilized for delivery of courses, the advantages and disadvantages encountered with each mechanism, and subjective evaluation of the effectiveness of the courses. Also discussed are the lessons learned and plans for future development.
Intranasal formulations: promising strategy to deliver vaccines.
Riese, Peggy; Sakthivel, Priya; Trittel, Stephanie; Guzmán, Carlos A
The emergence of new diseases and the lack of efficient vaccines against numerous non-treatable pathogens require the development of novel vaccination strategies. To date, only a few mucosal vaccines have been approved for humans. This was in part due to i) the use of live attenuated vaccines, which are not suitable for certain groups of individuals, ii) safety concerns derived from implementation in humans of some mucosal vaccines, iii) the poor stability, absorption and immunogenicity of antigens delivered by the mucosal route and iv) the limited number of available technologies to overcome the bottlenecks associated with mucosal antigen delivery. Recent advances make feasible the development of efficacious mucosal vaccines with adequate safety profile. Thus, currently intranasal vaccines represent an attractive and valid alternative to conventional vaccines. The present review is focused on the potentials and limitations of market-approved intranasal vaccines and promising candidates undergoing clinical investigations. Furthermore, emerging strategies to overcome main bottlenecks including efficient breaching of the mucosal barrier and safety concerns by implementation of new adjuvants and delivery systems are discussed. The rational design of intranasal vaccines requires an in-depth understanding of the anatomic, physicochemical and barrier properties of the nasal mucosa, as well as the molecular mechanisms governing the activation of the local innate and adaptive immune system. This would provide the critical knowledge to establish effective approaches to deliver vaccine antigens across the mucosal barrier, supporting the stimulation of a long-lasting protective response at both mucosal and systemic levels. Current developments in the area of adjuvants, nanotechnologies and mucosal immunology, together with the identification of surface receptors that can be exploited for cell targeting and manipulating their physiological properties, will become instrumental
Design Environment for Novel Vertical Lift Vehicles: DELIVER
Theodore, Colin
This is a 20 minute presentation discussing the DELIVER vision. DELIVER is part of the ARMD Transformative Aeronautics Concepts Program, particularly the Convergent Aeronautics Solutions Project. The presentation covers the DELIVER vision, transforming markets, conceptual design process, challenges addressed, technical content, and FY2016 key activities.
Delivering flavonoids into solid tumors using nanotechnologies.
Wang, Shengpeng; Zhang, Jinming; Chen, Meiwan; Wang, Yitao
Long-term epidemiological studies have demonstrated that regular ingestion of flavonoids contained in dietary sources is associated with a reduced risk for many chronic diseases including cancer. However, although flavonoids are largely consumed in the diet and high concentrations may exist in the intestine after oral administration, the plasma/tissue concentrations of flavonoids are lower than their effective therapeutic doses due to poor bioavailability, resulting in the limited efficacy of flavonoids in various clinical studies. Therefore, the application of nanotechnology to deliver flavonoids to tumor sites has received considerable attention in recent years. In this review, after a general review of the potential benefits of flavonoids in cancer therapy and several key factors affecting their bioavailability, the current efforts in improving the delivery efficacy of promising candidates that are particularly important in the human diet, namely quercetin, epigallocatechin-3-gallate (EGCG) and genistein were focused on. Finally, the challenges of developing flavonoid delivery systems that improve flavonoid bioavailability and their anticancer therapy potentials were summarized. The design of suitable molecular carriers for flavonoids is an area of research that is in rapid progress. A large number of unheeded promising favonoids are suffering from poor in vivo parameters, their potential benefits deserves further research. Furthermore, more effort should be placed on developing active targeting systems, evaluating the efficacy and toxicity of novel flavonoid delivery systems through small and large scale clinical trials.
Delivering new physics at impressive speed
The speed with which the heavy ion run at the LHC is delivering new physics is impressive not only for the insights it is bringing to the early Universe, but also for the clear demonstration it gives of the value of competition and complementarity between the experiments. ALICE was the first off the mark to publish papers from the ion run, as you'd expect from the LHC's dedicated ion experiment, but results emerging from ATLAS and CMS are bringing new understanding in their own right. Each collaboration's result plays to the strengths of its detector, and it is by taking all the results together that our knowledge advances. The creation, observation and understanding of the hot dense matter that would have existed in the early Universe, normally known as Quark Gluon Plasma (QGP), is complex science and one of the ion programme's key goals. Many signals for QGP exist, and like pieces of a puzzle, we must assemble all of them to get the full picture. At th...
Polymers for delivering peptides and proteins.
Burnham, N L
The use of polymers for delivering peptide and protein drugs is described. Soluble-polymer technology attempts to bind a polymer to all sites on therapeutic protein molecules that cause the body to recognize the molecules as foreign. Goals include a stable linkage, water solubility, low immunogenicity, prolonged half-life, and intact biological activity. Polyethylene glycol (PEG)-adenosine deaminase (ADA), or pegademase bovine, has FDA-approved labeling as replacement therapy for ADA deficiency in patients with severe combined immunodeficiency disease who are not suitable candidates for bone marrow transplantation. Pegademase bovine reverses the toxic accumulation of adenosine and deoxyadenosine in adenosine deaminase-deficient cells, restoring the immune system. PEG-asparaginase (pegaspargase) has shown promise in patients with acute lymphocytic leukemia; allergic reactions have been minimal. Animal studies suggest that superoxide dismutase has potential use in conditions in which the body's ability to remove oxygen free radicals is reduced, such as burns and myocardial infarction; coupling with PEG may greatly increase the protein's half-life. Other PEG-conjugated proteins under investigation include PEG-catalase, PEG-uricase, PEG-honeybee venom, PEG-hemoglobin, and PEG-modified ragweed pollen extract. Dextran, albumin, DL-amino acids, and polyvinyl pyrrolidone have also been studied as protein carriers; most of the products created thus far have not shown much promise. The coupling of polymers to proteins has yielded protein drugs with intact biological activity and reduced immunogenicity, but much remains to be learned about this technology.
Where should noninvasive ventilation be delivered?
Hill, Nicholas S
Noninvasive ventilation (NIV) has assumed an important role in the management of certain types of respiratory failure in acute-care hospitals. However, the optimal location for NIV has been a matter of debate. Some have argued that all patients begun on NIV in the acute-care setting should go to an intensive care unit (ICU), but this is impractical because ICU beds are often unavailable, and it may not be a sensible use of resources. Also, relatively few studies have examined the question of location for NIV. One problem is that various units' capabilities to deliver NIV differ substantially, even in the same hospital. Choosing the appropriate environment for NIV requires consideration of the patient's need for monitoring, the monitoring capabilities of the unit, including both technical and personnel resources (nursing and respiratory therapy), and the staff's skill and experience. In some hospitals NIV is begun most often in the emergency department, but is most often managed in an ICU. Step-down units are often good locations for NIV, but many institutions do not have step-down units. With ICU beds at a premium, many hospitals are forced to manage some NIV patients on general wards, which can be safely done with more stable patients if the ward is suitably monitored and experienced. When deciding where to locate the patient, clinicians must be familiar with the capabilities of the units in their facility and try to match the patient's need for monitoring and the unit's capabilities.
Oral microflora in infants delivered vaginally and by caesarean section
DEFF Research Database (Denmark)
Nelun Barfod, Mette; Magnusson, Kerstin; Lexner, Michala Oron
International Journal of Paediatric Dentistry 2011 Background. Early in life, vaginally delivered infants exhibit a different composition of the gut flora compared with infants delivered by caesarean section (C-section); however, it is unclear whether this also applies to the oral cavity. Aim...
The Use of Freshmen Seminar Programs to Deliver Personalized Feedback
Henslee, Amber M.; Correia, Christopher J.
The current study tested the effectiveness of delivering personalized feedback to first-semester college freshmen in a group lecture format. Participants enrolled in semester-long courses were randomly assigned to receive either personalized feedback or general information about alcohol. Both lecture conditions were delivered during a standard…
A Randomized Trial of Contingency Management Delivered by Community Therapists
Petry, Nancy M.; Alessi, Sheila M.; Ledgerwood, David M.
Objective: Contingency management (CM) is an evidence-based treatment, but few clinicians deliver this intervention in community-based settings. Method: Twenty-three clinicians from 3 methadone maintenance clinics received training in CM. Following a didactics seminar and a training and supervision period in which clinicians delivered CM to pilot…
Contractor firm strategies in delivering green project: A review
Powmya, Ayisha; Abidin, Nazirah Zainul; Azizi, Nurul Sakina Mokhtar
Building green requires effort from various parties, from those who plan, design, manage and construct the building. Contractors are responsible for converting the design on paper into a real building and their role at the construction site support environmental sustainability by implementing responsible construction practices. Inefficient or inexperienced contractor in green construction project may find that delivering this type of project is not an easy task due to added requirement in design, stringent practices at site and the use of green technology and materials. Adopting suitable strategies at firm level will assist in preparatory process and readiness of delivering the green project. This paper reviews the strategies at firm level to deliver green construction project. From extensive literature review, it was discovered that there are six strategies to be adopted by the contractor. Understanding these strategies is expected to promote more contractors to be proactive in delivering green projects.
Expert assessment concludes negative emissions scenarios may not deliver
Vaughan, Naomi E; Gough, Clair
Many integrated assessment models (IAMs) rely on the availability and extensive use of biomass energy with carbon capture and storage (BECCS) to deliver emissions scenarios consistent with limiting climate change to below 2 °C average temperature rise. BECCS has the potential to remove carbon dioxide (CO2) from the atmosphere, delivering 'negative emissions'. The deployment ofBECCS at the scale assumed in IAM scenarios is highly uncertain: biomass energy is commonly used but not at such a sca...
Delivering Faster Congestion Feedback with the Mark-Front Strategy
Liu, Chunlei; Jain, Raj
Computer networks use congestion feedback from the routers and destinations to control the transmission load. Delivering timely congestion feedback is essential to the performance of networks. Reaction to the congestion can be more effective if faster feedback is provided. Current TCP/IP networks use timeout, duplicate Acknowledgement Packets (ACKs) and explicit congestion notification (ECN) to deliver the congestion feedback, each provides a faster feedback than the previous method. In this paper, we propose a markfront strategy that delivers an even faster congestion feedback. With analytical and simulation results, we show that mark-front strategy reduces buffer size requirement, improves link efficiency and provides better fairness among users. Keywords: Explicit Congestion Notification, mark-front, congestion control, buffer size requirement, fairness.
Meeting the challenges: delivering interactive stoma care education.
Lee, Janice; Moore, Hazel; Asbury, Nicky
This article illustrates how the authors used the following frameworks: audit cycle, clinical governance, essence of care and evaluations to create a fun, interactive and transferable method of delivering an education programme in the workplace environment. The article demonstrates the benefits of using action planning, benchmarking and overcoming difficulties in delivering education across two organizational boundaries (primary and secondary care). 'Today's 6 x 30 minute Stoma Challenges are...' a full and fun afternoon of interactive stoma education for primary and secondary care staff delivered in an innovative and creative way. The main objective is to enhance qualified and unqualified nurses existing knowledge and skills in relation to stoma care. Also encouraging staff development therefore enhancing the patients' experiences regardless of whether they are in a primary or secondary care setting.
Delivering supplemental oxygen during sedation via a saliva ejector.
Milnes, Alan R
Intraoperative oxygen supplementation to sedated children has been shown to prevent hemoglobin desaturations even in the presence of apnea during pediatric conscious sedation. Although many practitioners deliver supplemental oxygen via a nasal hood, this method is impractical and often unsuccessful if the child is a mouth breather, has moderate adenotonsillar hypertrophy or occasionally cries during treatment (at which time there will be mouth breathing). This paper describes a method in which the saliva ejector is used to deliver supplemental oxygen to sedated children while they are receiving dental treatment. The advantages of this method and suggestions for its successful application are also included.
The Role of Universities in Supporting and Delivering Enterprise Education
Edwards, Louise-Jayne; Muir, Elizabeth J.
While the academic debate has moved beyond the question of whether or not entrepreneurship can be taught and whether or not there is a need or demand for it, there is still considerable debate as to the most appropriate methods of delivering entrepreneurship education. This paper provides an overview of teaching strategies, pedagogies and methods…
Essential medical laboratory services: their role in delivering ...
African Journals Online (AJOL)
This paper examines the establishment of Essential Medical Laboratory Services (EMLS) and their crucial role for delivering equitable health care to the poor population of Malawi as part of the Essential Health Package. We examine each of the major areas identified for intervention (maternal health, malaria, tuberculosis ...
The Role of the Postgraduate Student in Delivering Bioscience Teaching
Scott, Jon; Maw, Stephen J.
There has been much recent interest in the extent to which the teaching in higher education delivered by non-academic staff has increased in the recent past. Within the Biosciences there has always been a tradition of engaging postgraduate students to support the delivery of some forms of teaching. In this paper we report on the findings of a…
Hepatitis B virus infection among pregnant women delivering at ...
African Journals Online (AJOL)
Objective: To determine the prevalence of hepatitis B virus (HBV) carrier and infectivity status among women delivering at Harare Maternity Hospital. Design: A serological survey study of pregnant women admitted for labour and delivery. Setting: Harare Maternity Hospital, Harare, Zimbabwe between June 1996 and June ...
School Nurse-Delivered Adolescent Relationship Abuse Prevention
Raible, Claire A.; Dick, Rebecca; Gilkerson, Fern; Mattern, Cheryl S.; James, Lisa; Miller, Elizabeth
Background: Project Connect is a national program to build partnerships among public health agencies and domestic violence services to improve the health care sector response to partner and sexual violence. Pennsylvania piloted the first school nurse-delivered adolescent relationship abuse intervention in the certified school nurses' office…
Term tubal ectopic pregnancy delivered by laparotomy with a viable ...
African Journals Online (AJOL)
We describe an extremely rare medical phenomenon in a 28 year old who presented with undiagnosed tubal ectopic pregnancy at 41 weeks gestation and was delivered by laparotomy with linear salpingostomy at the Kenyatta National Hospital, Nairobi, Kenya. Key words: Term ectopic pregnancy, Ultrasound ...
Health facility and health worker readiness to deliver new national ...
African Journals Online (AJOL)
Health facility and health worker readiness to deliver new national treatment policy for malaria in Kenya. ... Design: Cross-sectional survey. ... on the survey day, stock-outs in past six months, presence of AL wall charts, health worker\\'s exposure to in-service training on AL and access to new national malaria guidelines.
Capacity to deliver pharmaceutical care by community pharmacies ...
African Journals Online (AJOL)
Pharmacy practice has transcended from largely a dispensary practice to pharmaceutical care practice. The capacity of community pharmacies to deliver pharmaceutical care was studied using pretested self survey methods. Ninety five percent (95%) of the respondents always educated customers on drug related needs, ...
Pregnancy outcome among women who delivered in a secondary ...
African Journals Online (AJOL)
Pregnancy outcome among women who delivered in a secondary care hospital in ... 11(0.4%) maternal deaths with a maternal mortality ratio of 427 per 100,000 live births. ... There should be an improvement in the quality of care for obstetric ...
Using technology to deliver quality education in Asia | IDRC ...
International Development Research Centre (IDRC) Digital Library (Canada)
Jun 8, 2016 ... An IDRC-funded project in Asia found that distance education can be as effective as traditional face-to-face education in delivering quality teaching and a good learning experience. This finding is particularly significant for remote and resource-poor regions in countries such as Mongolia and Cambodia.
Foresight begins with FMEA. Delivering accurate risk assessments.
Passey, R D
If sufficient factors are taken into account and two- or three-stage analysis is employed, failure mode and effect analysis represents an excellent technique for delivering accurate risk assessments for products and processes, and for relating them to legal liability. This article describes a format that facilitates easy interpretation.
Unexplained massive subdural haematoma in a newborn delivered ...
African Journals Online (AJOL)
Emergency Caesarean Section (EmC/S) carried out after failed attempts at vaginal delivery may also be complicated by symptomatic SDH but spontaneous symptomatic SDH complicating Elective Caesarean Section (ElC/S) is a rarity. We describe a case of massive SDH in a term baby delivered by Elective C/S in the ...
Hepatitis C virus seroprevalence among mothers delivering at the ...
African Journals Online (AJOL)
Hepatitis C virus seroprevalence among mothers delivering at the Korle-Bu Teaching Hospital, Ghana. ... AT Lassey, NK Damale, V Bekoe, CA Klufio ... To determine the Hepatitis C virus (HCV) carrier rate among mothers, and to determine if selected sociodemographic characteristics are associated with HCV seropositivity.
Delivering Physical Education in selected schools in Soweto, South ...
African Journals Online (AJOL)
The programme utilizes Physical Education (PE) during schooltime, while building the capacity of PE teachers to teach PE and Extra School Support Programme (ESSP) coaches (a programme of the National Department of Education) to deliver school sport. The aim of the study was to evaluate the Soweto Active Schools ...
VET Providers Planning to Deliver Degrees: Good Practice Guide
National Centre for Vocational Education Research (NCVER), 2015
This good practice guide is intended to assist public and private registered training organisations (RTOs) planning to commence higher education (HE) delivery. The guide is based on research undertaken by Victor Callan and Kaye Bowman, who completed case studies with six providers currently delivering higher education qualifications in addition to…
A Review of Physical Activity Interventions Delivered via Facebook.
Ferrer, David A; Ellis, Rebecca
The use of social networking sites to deliver behavioral interventions is becoming more prevalent. The purpose of this review was to systematically evaluate the published research to determine the effectiveness of Facebook-delivered interventions for promoting physical activity behavior change. A search of interventions delivered via Facebook (as the primary delivery method or part of a multifaceted intervention) in which physical activity was the primary or secondary outcome resulted in 8 studies for review. Overall, 87.5% of the Facebook interventions reported some type of significant physical activity behavior change (ie, interactions, main effects for time, differences between conditions); however, only 2 of these interventions found this change to be significantly better for the treatment group than the control group. Future researchers are encouraged to test the effectiveness of Facebook-delivered physical activity interventions with additional control groups that receive no aspects of the intervention within experimental study designs, more diverse samples, theory-based content with assessment of mediators of behavior change, direct observations of physical activity, and long-term follow-ups. Although based on a small sample of studies, Facebook appears to be a promising delivery method for physical activity interventions.
Portable devices for delivering imagery and modelling interventions ...
African Journals Online (AJOL)
The main objective of this study was to investigate the effectiveness of portable devices (MP4) and a stationary device (DVD and fixed point stationary computer) in delivering imagery and modelling training among female netball players, examining the effect on imagery adherence, performance, self-efficacy, and the relative ...
Inefficient charging for delivered gas by local gas distributors
Directory of Open Access Journals (Sweden)
Siniša Bikić
Full Text Available In this region, especially in Serbia, common belief is that local distributors of gas used by households don't charge for gas properly. It is suspected that there are two sources for improper ways of gas charging. Local distributors charge for delivered gas only, according to flow rat but not according to gas quality. It is usual that local distributors deliver gas of different quality than one signed in contract. In this work will be considered only one of aspects inefficient charging for delivered gas by local gas distributors, which is connected to variable atmospheric pressure. There is doubt, that local distributors make mistakes during accounting for delivered gas to costumers in regard atmospheric pressure. At the beginning of every investigation, problem has to be located and recognized. Authors are going to collect as much as possible available data, to elaborate and analyze data by scientific methods and to represent conclusions. So, the aim of this work is to diagnose current state and to approve or disapprove above mentioned suspicions. In our region this theme is very interesting, both because of energy efficiency and air pollution control. In this way both consumer and distributor will know, how mush energy they have really spent.
Glucose 6 phosphate dehydrogenase levels in babies delivered at ...
African Journals Online (AJOL)
Background: Glucose-6-phosphate dehydrogenase deficiency, an X-linked recessive disorder, is the most common enzymopathy producing disease in humans.It is known to cause severe neonatal hyperbilirubinaemia. Aims and Objectives: To determine G6PD levels in babies delivered at the University of Ilorin Teaching ...
Delivering Advanced Technical Education Using Online, Immersive Classroom Technology
Smith, Delmer; Louwagie, Nancy
Vacuum and thin film technologies are critical to advanced manufacturing industries. With a grant from the National Science Foundation (DUE #14004080), Normandale Community College has developed courses that are delivered online and via telepresence to provide a formal education to vacuum technician students around the country. Telepresence…
The Challenges of Globalisation: Delivering an MBA Programme in Eritrea.
Dence, Roger; O'Toole, John
Describes the experiences of delivering an MBA (Master in Business Administration) program in Eritrea (North East Africa) through the United Kingdom's Open University. Discusses tutoring teams that travel to Eritrea, localizing case examples and assignments, sensitivity to local cultural contexts, writing assignments, student assessment, and…
Dealing with Learner Resistance to Technology-Delivered Training.
McCormick, Patricia
Discussion of student resistance to technology-delivered training focuses on strategies at the IRS (Internal Revenue Service) that overcame learner resistance by maintaining a personal relationship with each student and flexibly addressing each student's personal style and concerns. Considers reasons for student resistance and the continued need…
The knowledge and skills gap of medical practitioners delivering ...
African Journals Online (AJOL)
The knowledge and skills gap of medical practitioners delivering district hospital services in the Western Cape, South Africa. ... Rural family practice requires that doctors have the knowledge and skills to practise in settings where high technology and specialist resources are not available, while at the same time requiring ...
Heterologous mitochondrial targeting sequences can deliver functional proteins into mitochondria.
Marcus, Dana; Lichtenstein, Michal; Cohen, Natali; Hadad, Rita; Erlich-Hadad, Tal; Greif, Hagar; Lorberboum-Galski, Haya
Mitochondrial Targeting Sequences (MTSs) are responsible for trafficking nuclear-encoded proteins into mitochondria. Once entering the mitochondria, the MTS is recognized and cleaved off. Some MTSs are long and undergo two-step processing, as in the case of the human frataxin (FXN) protein (80aa), implicated in Friedreich's ataxia (FA). Therefore, we chose the FXN protein to examine whether nuclear-encoded mitochondrial proteins can efficiently be targeted via a heterologous MTS (hMTS) and deliver a functional protein into mitochondria. We examined three hMTSs; that of citrate synthase (cs), lipoamide deydrogenase (LAD) and C6ORF66 (ORF), as classically MTS sequences, known to be removed by one-step processing, to deliver FXN into mitochondria, in the form of fusion proteins. We demonstrate that using hMTSs for delivering FXN results in the production of 4-5-fold larger amounts of the fusion proteins, and at 4-5-fold higher concentrations. Moreover, hMTSs delivered a functional FXN protein into the mitochondria even more efficiently than the native MTSfxn, as evidenced by the rescue of FA patients' cells from oxidative stress; demonstrating a 18%-54% increase in cell survival; and a 13%-33% increase in ATP levels, as compared to the fusion protein carrying the native MTS. One fusion protein with MTScs increased aconitase activity within patients' cells, by 400-fold. The implications form our studies are of vast importance for both basic and translational research of mitochondrial proteins as any mitochondrial protein can be delivered efficiently by an hMTS. Moreover, effective targeting of functional proteins is important for restoration of mitochondrial function and treatment of related disorders. Copyright © 2016 Elsevier Ltd. All rights reserved.
Axial compressive bearing capacity of piles in oil-contaminated sandy soil using FCV
Mohammadi, Amirhossein; Ebadi, Taghi; Eslami, Abolfazl; Zee, van der S.E.A.T.M.
Oil and its derivatives contaminate many soils and not only affect their chemical and biological properties but also their geotechnical properties. As oil contamination may deteriorate the functioning of piles, this paper addresses the effects of oil contamination on soil–pile interactions. Axial
Power Delivered to Mechanical Systems by Random Vibrations
Directory of Open Access Journals (Sweden)
Timothy S. Edwards
Full Text Available This paper develops deformational response power descriptions of multiple degree-of-freedom systems due to stationary random vibration excitation. Two new concepts are developed. The deformational response power density (DRPD can be computed when a structure's natural frequencies and modal masses are available. The DRPD shows the spectral content of the deformational power delivered to a specific structure by the stationary, random excitation. This function can be found through a weighted windowing of the power spectrum of the input acceleration excitation. Deformational response input power spectra (DRIPS, similar to the input energy spectrum and shock response spectrum, give the power delivered to single-degree-of-freedom systems as a function of natural frequency. It is shown that the DRIPS is simply a smoothed version of the power spectrum of the input acceleration excitation. The DRIPS gives rise to a useful power-based data smoothing operation.
Delivering phage therapy per os: benefits and barriers.
Zelasko, Susan; Gorski, Andrzej; Dabrowska, Krystyna
Multidrug-resistant bacterial infections of the gastrointestinal tract pose a serious public health concern. High levels of antibiotic drug resistance, along with the potential for antibiotics to precipitate disease or alter the gut microbiome has prompted research into alternative treatment methods. Evidence suggests that bacteriophage therapy delivered per os may be well-suited to target such infections. Areas covered: Herein, we discuss the specific advantages and challenges of using orally administered phage therapy. Our literature review encompasses recent works using phages to target various clinically-relevant bacteria in vivo. We also provide insights into methods that aim to overcome the barriers to effective phage transit through the harsh gastrointestinal environment. Expert commentary: Evidence from a number of in vivo animal studies suggests that targeting bacterial infections using phages delivered orally holds potential. Efficacious oral phage therapy depends on the delivery of sufficient phage titers to the infection site, which may be hindered by the host's gastrointestinal tract and immune response.
Teaching Trainees to Deliver Adolescent Reproductive Health Services.
Shah, Brandi; Chan, Serena H; Perriera, Lisa; Gold, Melanie A; Akers, Aletha Y
Delivery of reproductive services to adolescents varies according to specialty and has been linked to differences in clinical training. Few studies have explored how different specialties' graduate medical education (GME) programs prepare providers to deliver adolescent reproductive services. We explored the perceptions of resident physicians regarding their training in delivering adolescent reproductive health services. Between November 2008 and February 2009, 9 focus groups were conducted with graduate medical trainees in 3 specialties that routinely care for adolescents. The semistructured discussions were audio-recorded, transcribed, and analyzed using an inductive approach to content analysis. Large, urban academic medical center in Pittsburgh, Pennsylvania. Fifty-four resident trainees in pediatrics, family medicine, and obstetrics/gynecology. None. Trainees' perspectives regarding the didactic teaching and clinical training in providing adolescent reproductive services. Five themes emerged, reflecting trainees' beliefs regarding the best practices in which GME programs can engage to ensure that trainees graduate with the belief that they are competent and will be comfortable delivering adolescent reproductive services. Trainees believed programs need to: (1) provide didactic lectures and diverse inpatient and outpatient clinical experiences; (2) have faculty preceptors skilled in providing and supervising adolescent reproductive services; (3) teach skills for engaging adolescents in clinical assessments and decision-making; (4) train providers to navigate confidentiality issues with adolescents and caregivers; and (5) provide infrastructure and resources for delivering adolescent reproductive services. The 3 specialties differed in how well each of the 5 best practices were reportedly addressed during GME training. Policy recommendations are provided. Copyright © 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc
Examining the cost of delivering routine immunization in Honduras.
Janusz, Cara Bess; Castañeda-Orjuela, Carlos; Molina Aguilera, Ida Berenice; Felix Garcia, Ana Gabriela; Mendoza, Lourdes; Díaz, Iris Yolanda; Resch, Stephen C
Many countries have introduced new vaccines and expanded their immunization programs to protect additional risk groups, thus raising the cost of routine immunization delivery. Honduras recently adopted two new vaccines, and the country continues to broaden the reach of its program to adolescents and adults. In this article, we estimate and examine the economic cost of the Honduran routine immunization program for the year 2011. The data were gathered from a probability sample of 71 health facilities delivering routine immunization, as well as 8 regional and 1 central office of the national immunization program. Data were collected on vaccinations delivered, staff time dedicated to the program, cold chain equipment and upkeep, vehicle use, infrastructure, and other recurrent and capital costs at each health facility and administrative office. Annualized economic costs were estimated from a modified societal perspective and reported in 2011 US dollars. With the addition of rotavirus and pneumococcal conjugate vaccines, the total cost for routine immunization delivery in Honduras for 2011 was US$ 32.5 million. Vaccines and related supplies accounted for 23% of the costs. Labor, cold chain, and vehicles represented 54%, 4%, and 1%, respectively. At the facility level, the non-vaccine system costs per dose ranged widely, from US$ 25.55 in facilities delivering fewer than 500 doses per year to US$ 2.84 in facilities with volume exceeding 10,000 doses per year. Cost per dose was higher in rural facilities despite somewhat lower wage rates for health workers in these settings; this appears to be driven by lower demand for services per health worker in sparsely populated areas, rather than increased cost of outreach. These more-precise estimates of the operational costs to deliver routine immunizations provide program managers with important information for mobilizing resources to help sustain the program and for improving annual planning and budgeting as well as longer
Dan VELICU
This article aims to analyze the seller's obligations under the Convention on International Sale of Goods (CISG) and in particular the obligation to deliver the goods showing the main issues that arise in an international sale. We also wish to point the major innovations or improvements brought by the CISG in comparison to the European civil codes regulation and to conclude if the CSIG managed to revolutionize the tradition view on this issue.
Viability and Functionality of Cells Delivered from Peptide Conjugated Scaffolds
Vacharathit, Voranaddha; Silva, Eduardo A.; Mooney, David J.
Many cell-based therapies aim to transplant functional cells to revascularize damaged tissues and ischemic areas. However, conventional cell therapy is not optimally efficient: massive cell death, damage, and non-localization of cells both spatially and temporally all likely contribute to poor tissue functionality. An alginate cell depot system has been proposed as an alternative means to deliver outgrowth endothelial cells (OECs) in a spatiotemporally controllable manner while protecting the...
Directory of Open Access Journals (Sweden)
Dan VELICU
Full Text Available This article aims to analyze the seller's obligations under the Convention on International Sale of Goods (CISG and in particular the obligation to deliver the goods showing the main issues that arise in an international sale. We also wish to point the major innovations or improvements brought by the CISG in comparison to the European civil codes regulation and to conclude if the CSIG managed to revolutionize the tradition view on this issue.
Delivering Sustainability Through Supply Chain Distribution Network Redesign
Denise Ravet
Purpose - Companies could gain (cost, service, green/sustainable) competitive advantage through the supply chain network. The goal of this article is to study how to deliver sustainability through the supply chain distribution network redesign.Design/methodology/approach - A literature review is conducted to examine research relating to sustainable supply chain strategies and supply chain distribution network redesign.Findings - A study of the supply chain literature reveals the importance to...
Delivering business analytics practical guidelines for best practice
Stubbs, Evan
AVOID THE MISTAKES THAT OTHERS MAKE - LEARN WHAT LEADS TO BEST PRACTICE AND KICKSTART SUCCESS This groundbreaking resource provides comprehensive coverage across all aspects of business analytics, presenting proven management guidelines to drive sustainable differentiation. Through a rich set of case studies, author Evan Stubbs reviews solutions and examples to over twenty common problems spanning managing analytics assets and information, leveraging technology, nurturing skills, and defining processes. Delivering Business Analytics also outlines the Data Scientist's Code, fifteen principle
Variability in delivered dose and respirable delivered dose from nebulizers: are current regulatory testing guidelines sufficient to produce meaningful information?
Directory of Open Access Journals (Sweden)
Hatley RHM
Full Text Available Ross HM Hatley, Sarah M Byrne Respironics Respiratory Drug Delivery (UK Ltd, a business of Philips Electronics UK Limited, Chichester, UK Background: To improve convenience to patients, there have been advances in the operation of nebulizers, resulting in fast treatment times and less drug lost to the environment. However, limited attention has been paid to the effects of these developments on the delivered dose (DD and respirable delivered dose (RDD. Published pharmacopoeia and ISO testing guidelines for adult-use testing utilize a single breathing pattern, which may not be sufficient to enable effective comparisons between the devices.Materials and methods: The DD of 5 mg of salbutamol sulfate into adult breathing patterns with inhalation:exhalation (I:E ratios between 1:1 and 1:4 was determined. Droplet size was determined by laser diffraction and RDD calculated. Nine different nebulizer brands with different modes of operation (conventional, venturi, breath-enhanced, mesh, and breath-activated were tested.Results: Between the non-breath-activated nebulizers, a 2.5-fold difference in DD (~750–1,900 µg salbutamol was found; with RDD, there was a more than fourfold difference (~210–980 µg. With increasing time spent on exhalation, there were progressive reductions in DD and RDD, with the RDD at an I:E ratio of 1:4 being as little as 40% of the dose with the 1:1 I:E ratio. The DD and RDD from the breath-activated mesh nebulizer were independent of the I:E ratio, and for the breath-activated jet nebulizer, there was less than 20% change in RDD between the I:E ratios of 1:1 and 1:4.Conclusion: Comparing nebulizers using the I:E ratio recommended in the guidelines does not predict relative performance between the devices at other ratios. There was significant variance in DD or RDD between different brands of non-breath-activated nebulizer. In future, consideration should be given to revision of the test protocols included in the guidelines
Solute clearance in CRRT: prescribed dose versus actual delivered dose.
Lyndon, William D; Wille, Keith M; Tolwani, Ashita J
Substantial efforts have been made toward defining the dose threshold of continuous renal replacement therapy (CRRT) associated with improved survival in critically ill patients with acute kidney injury. Published studies have used prescribed effluent rates, expressed as total effluent volume (TEV) per weight and unit time (mL/kg/h), as a surrogate for dose. The purpose of this study was to compare differences in CRRT dose based on prescribed effluent rate, measured TEV and direct measurement of urea and creatinine clearance. We analyzed data that had been prospectively collected on 200 patients enrolled in a randomized trial comparing survival with a prescribed effluent rate of 20 mL/kg/h (standard dose) to 35 mL/kg/h (high dose) using pre-dilution continuous venovenous hemodiafiltration (CVVHDF). Filters were changed every 72 h. Blood urea nitrogen (BUN), serum creatinine (SCr), effluent urea nitrogen (EUN) and effluent creatinine (ECr) were collected daily. Actual delivered dose was calculated as: (EUN/BUN)*TEV for urea and (ECr/SCr)*TEV for creatinine. Data were available for 165 patients. In both groups, prescribed dose differed significantly from the measured TEV dose (P < 0.001). In the standard dose group, there was no difference between the measured TEV dose and actual delivered urea and creatinine clearances. However, in the high-dose group, measured TEV dose differed significantly from delivered urea clearance by 7.1% (P < 0.001) and creatinine clearance by 13.9% (P < 0.001). Dose based on prescribed effluent rate or measured TEV is a poor substitute for actual CVVHDF creatinine and urea clearance.
Optimizing a Drone Network to Deliver Automated External Defibrillators.
Boutilier, Justin J; Brooks, Steven C; Janmohamed, Alyf; Byers, Adam; Buick, Jason E; Zhan, Cathy; Schoellig, Angela P; Cheskes, Sheldon; Morrison, Laurie J; Chan, Timothy C Y
Public access defibrillation programs can improve survival after out-of-hospital cardiac arrest, but automated external defibrillators (AEDs) are rarely available for bystander use at the scene. Drones are an emerging technology that can deliver an AED to the scene of an out-of-hospital cardiac arrest for bystander use. We hypothesize that a drone network designed with the aid of a mathematical model combining both optimization and queuing can reduce the time to AED arrival. We applied our model to 53 702 out-of-hospital cardiac arrests that occurred in the 8 regions of the Toronto Regional RescuNET between January 1, 2006, and December 31, 2014. Our primary analysis quantified the drone network size required to deliver an AED 1, 2, or 3 minutes faster than historical median 911 response times for each region independently. A secondary analysis quantified the reduction in drone resources required if RescuNET was treated as a large coordinated region. The region-specific analysis determined that 81 bases and 100 drones would be required to deliver an AED ahead of median 911 response times by 3 minutes. In the most urban region, the 90th percentile of the AED arrival time was reduced by 6 minutes and 43 seconds relative to historical 911 response times in the region. In the most rural region, the 90th percentile was reduced by 10 minutes and 34 seconds. A single coordinated drone network across all regions required 39.5% fewer bases and 30.0% fewer drones to achieve similar AED delivery times. An optimized drone network designed with the aid of a novel mathematical model can substantially reduce the AED delivery time to an out-of-hospital cardiac arrest event. © 2017 American Heart Association, Inc.
Capturing, Harmonizing and Delivering Data and Quality Provenance
Leptoukh, Gregory; Lynnes, Christopher
Satellite remote sensing data have proven to be vital for various scientific and applications needs. However, the usability of these data depends not only on the data values but also on the ability of data users to assess and understand the quality of these data for various applications and for comparison or inter-usage of data from different sensors and models. In this paper, we describe some aspects of capturing, harmonizing and delivering this information to users in the framework of distributed web-based data tools.
Delivering Sustainability Through Supply Chain Distribution Network Redesign
Directory of Open Access Journals (Sweden)
Denise Ravet
Full Text Available Purpose - Companies could gain (cost, service, green/sustainable competitive advantage through the supply chain network. The goal of this article is to study how to deliver sustainability through the supply chain distribution network redesign.Design/methodology/approach - A literature review is conducted to examine research relating to sustainable supply chain strategies and supply chain distribution network redesign.Findings - A study of the supply chain literature reveals the importance to rethink the supply chain distribution network design and to treat sustainability as integral to operations.
Expert assessment concludes negative emissions scenarios may not deliver
Vaughan, Naomi E.; Gough, Clair
Many integrated assessment models (IAMs) rely on the availability and extensive use of biomass energy with carbon capture and storage (BECCS) to deliver emissions scenarios consistent with limiting climate change to below 2 °C average temperature rise. BECCS has the potential to remove carbon dioxide (CO2) from the atmosphere, delivering 'negative emissions'. The deployment of BECCS at the scale assumed in IAM scenarios is highly uncertain: biomass energy is commonly used but not at such a scale, and CCS technologies have been demonstrated but not commercially established. Here we present the results of an expert elicitation process that explores the explicit and implicit assumptions underpinning the feasibility of BECCS in IAM scenarios. Our results show that the assumptions are considered realistic regarding technical aspects of CCS but unrealistic regarding the extent of bioenergy deployment, and development of adequate societal support and governance structures for BECCS. The results highlight concerns about the assumed magnitude of carbon dioxide removal achieved across a full BECCS supply chain, with the greatest uncertainty in bioenergy production. Unrealistically optimistic assumptions regarding the future availability of BECCS in IAM scenarios could lead to the overshoot of critical warming limits and have significant impacts on near-term mitigation options.
Type VI secretion delivers bacteriolytic effectors to target cells.
Russell, Alistair B; Hood, Rachel D; Bui, Nhat Khai; LeRoux, Michele; Vollmer, Waldemar; Mougous, Joseph D
Peptidoglycan is the major structural constituent of the bacterial cell wall, forming a meshwork outside the cytoplasmic membrane that maintains cell shape and prevents lysis. In Gram-negative bacteria, peptidoglycan is located in the periplasm, where it is protected from exogenous lytic enzymes by the outer membrane. Here we show that the type VI secretion system of Pseudomonas aeruginosa breaches this barrier to deliver two effector proteins, Tse1 and Tse3, to the periplasm of recipient cells. In this compartment, the effectors hydrolyse peptidoglycan, thereby providing a fitness advantage for P. aeruginosa cells in competition with other bacteria. To protect itself from lysis by Tse1 and Tse3, P. aeruginosa uses specific periplasmically localized immunity proteins. The requirement for these immunity proteins depends on intercellular self-intoxication through an active type VI secretion system, indicating a mechanism for export whereby effectors do not access donor cell periplasm in transit.
Adaptation finance: How can Durban deliver on past promises?
Energy Technology Data Exchange (ETDEWEB)
Ciplet, David; Roperts, J. Timmons; He, Linlang; Fields, Spencer [Brown University (United States); Khan, Mizan [North South University (Bangladesh)
There is an ever-widening chasm between the support developing countries need to adapt to climate change, and the funding promised and delivered by wealthy nations. While UN climate meetings endlessly debate terms such as 'new and additional' or 'balanced allocation', even some basic commitments to adaptation funding are going unfulfilled. And as we approach the final year of the 'fast-start' phase for climate finance, there is no plan for the crucial 'scale-up' period of 2013–2019, when contributions must swell tenfold. At the Durban negotiations, countries should take three steps to ensure the developed world can meet its agreed responsibilities: establish funding sources based on international trade; define annual targets for the scale-up; and adopt a transparent, centralised accounting system.
A Fetus with Iniencephaly Delivered at the Third Trimester
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Esra Cinar Tanriverdi
Full Text Available Iniencephaly is an uncommon neural tube defect, having retroflexion of the head without a neck and severe distortion of the spine. Iniencephaly is classified into two groups, iniencephaly apertus (with encephalocele and iniencephaly clausus (without encephalocele. Incidence ranges from 0.1 to 10 in 10.000 pregnancies and it is seen more frequently in girls. Most of the fetuses with this defect die before birth or soon after birth, while those with the milder forms may live through childhood. Recurrence risk is around 1–5%. Family should be offered termination to reduce maternal risks and counseled for folic acid supplementation before the next planned pregnancy. Here we present a rare case of iniencephaly clausus which was diagnosed at 18th week of gestation by ultrasonography and delivered in the third trimester of pregnancy due to rejection of termination.
Competitive advantage of diferric transferrin in delivering iron to reticulocytes.
Huebers, H A; Csiba, E; Huebers, E; Finch, C A
Radioiron- and radioiodine-labeled forms of human diferric and monoferric transferrin and apotransferrin, isolated by preparative isoelectric focusing, were used to define transferrin-iron uptake by human reticulocytes. In mixtures of human diferric and monoferric transferrin, the diferric molecule had a constant 7-fold advantage in delivering iron to reticulocytes, as compared with the 2-fold advantage when single solutions of mono- and diferric transferrins were compared. This was shown to be due to competitive interaction in iron delivery, probably at a common membrane-receptor binding site for transferrin. Apotransferrin did not interfere with the iron-donating process and its limited cellular uptake was inhibited in noncompetitive fashion by diferric transferrin. PMID:6572005
Increasing capacity to deliver diabetes self-management education
DEFF Research Database (Denmark)
Carey, M. E.; Mandalia, P. K.; Daly, H.
were referred for self-management education as part of routine care and attended either a control or intervention format DESMOND course. The primary outcome measure was change in illness coherence score (derived from the Diabetes Illness Perception Questionnaire-Revised) between baseline and 4 months......Aim: To develop and test a format of delivery of diabetes self-management education by paired professional and lay educators. Methods: We conducted an equivalence trial with non-randomized participant allocation to a Diabetes Education and Self Management for Ongoing and Newly Diagnosed Type 2...... diabetes (DESMOND) course, delivered in the standard format by two trained healthcare professional educators (to the control group) or by one trained lay educator and one professional educator (to the intervention group). A total of 260 people with Type 2 diabetes diagnosed within the previous 12 months...
Prediction of bone density around orthopedic implants delivering bisphosphonate.
Stadelmann, Vincent A; Terrier, Alexandre; Gauthier, O; Bouler, J-M; Pioletti, Dominique P
The fixation of an orthopedic implant depends strongly upon its initial stability. Peri-implant bone may resorb shortly after the surgery. This resorption is directly followed by new bone formation and implants fixation strengthening, the so-called secondary fixation. If the initial stability is not reached, the resorption continues and the implant fixation weakens, which leads to implant loosening. Studies with rats and dogs have shown that a solution to prevent peri-implant resorption is to deliver bisphosphonate from the implant surface. The aims of the study were, first, to develop a model of bone remodeling around an implant delivering bisphosphonate, second, to predict the bisphosphonate dose that would induce the maximal peri-implant bone density, and third to verify in vivo that peri-implant bone density is maximal with the calculated dose. The model consists of a bone remodeling equation and a drug diffusion equation. The change in bone density is driven by a mechanical stimulus and a drug stimulus. The drug stimulus function and the other numerical parameters were identified from experimental data. The model predicted that a dose of 0.3 microg of zoledronate on the implant would induce a maximal bone density. Implants with 0.3 microg of zoledronate were then implanted in rat femurs for 3, 6 and 9 weeks. We measured that peri-implant bone density was 4% greater with the calculated dose compared to the dose empirically described as best. The approach presented in this paper could be used in the design and analysis processes of experiments in local delivery of drug such as bisphosphonate.
Engineering a plant community to deliver multiple ecosystem services.
Storkey, Jonathan; Döring, Thomas; Baddeley, John; Collins, Rosemary; Roderick, Stephen; Jones, Hannah; Watson, Christine
The sustainable delivery of multiple ecosystem services requires the management of functionally diverse biological communities. In an agricultural context, an emphasis on food production has often led to a loss of biodiversity to the detriment of other ecosystem services such as the maintenance of soil health and pest regulation. In scenarios where multiple species can be grown together, it may be possible to better balance environmental and agronomic services through the targeted selection of companion species. We used the case study of legume-based cover crops to engineer a plant community that delivered the optimal balance of six ecosystem services: early productivity, regrowth following mowing, weed suppression, support of invertebrates, soil fertility building (measured as yield of following crop), and conservation of nutrients in the soil. An experimental species pool of 12 cultivated legume species was screened for a range of functional traits and ecosystem services at five sites across a geographical gradient in the United Kingdom. All possible species combinations were then analyzed, using a process-based model of plant competition, to identify the community that delivered the best balance of services at each site. In our system, low to intermediate levels of species richness (one to four species) that exploited functional contrasts in growth habit and phenology were identified as being optimal. The optimal solution was determined largely by the number of species and functional diversity represented by the starting species pool, emphasizing the importance of the initial selection of species for the screening experiments. The approach of using relationships between functional traits and ecosystem services to design multifunctional biological communities has the potential to inform the design of agricultural systems that better balance agronomic and environmental services and meet the current objective of European agricultural policy to maintain viable food
Forest conservation delivers highly variable coral reef conservation outcomes.
Klein, Carissa J; Jupiter, Stacy D; Selig, Elizabeth R; Watts, Matthew E; Halpern, Benjamin S; Kamal, Muhammad; Roelfsema, Chris; Possingham, Hugh P
Coral reefs are threatened by human activities on both the land (e.g., deforestation) and the sea (e.g., overfishing). Most conservation planning for coral reefs focuses on removing threats in the sea, neglecting management actions on the land. A more integrated approach to coral reef conservation, inclusive of land-sea connections, requires an understanding of how and where terrestrial conservation actions influence reefs. We address this by developing a land-sea planning approach to inform fine-scale spatial management decisions and test it in Fiji. Our aim is to determine where the protection of forest can deliver the greatest return on investment for coral reef ecosystems. To assess the benefits of conservation to coral reefs, we estimate their relative condition as influenced by watershed-based pollution and fishing. We calculate the cost-effectiveness of protecting forest and find that investments deliver rapidly diminishing returns for improvements to relative reef condition. For example, protecting 2% of forest in one area is almost 500 times more beneficial than protecting 2% in another area, making prioritization essential. For the scenarios evaluated, relative coral reef condition could be improved by 8-58% if all remnant forest in Fiji were protected rather than deforested. Finally, we determine the priority of each coral reef for implementing a marine protected area when all remnant forest is protected for conservation. The general results will support decisions made by the Fiji Protected Area Committee as they establish a national protected area network that aims to protect 20% of the land and 30% of the inshore waters by 2020. Although challenges remain, we can inform conservation decisions around the globe by tackling the complex issues relevant to integrated land-sea planning.
Rebamipide delivered by brushite cement enhances osteoblast and macrophage proliferation.
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Michael Pujari-Palmer
Full Text Available Many of the bioactive agents capable of stimulating osseous regeneration, such as bone morphogenetic protein-2 (BMP-2 or prostaglandin E2 (PGE2, are limited by rapid degradation, a short bioactive half-life at the target site in vivo, or are prohibitively expensive to obtain in large quantities. Rebamipide, an amino acid modified hydroxylquinoline, can alter the expression of key mediators of bone anabolism, cyclo-oxygenase 2 (COX-2, BMP-2 and vascular endothelial growth factor (VEGF, in diverse cell types such as mucosal and endothelial cells or chondrocytes. The present study investigates whether Rebamipide enhances proliferation and differentiation of osteoblasts when delivered from brushite cement. The reactive oxygen species (ROS quenching ability of Rebampide was tested in macrophages as a measure of bioactivity following drug release incubation times, up to 14 days. Rebamipide release from brushite occurs via non-fickian diffusion, with a rapid linear release of 9.70% ± 0.37% of drug per day for the first 5 days, and an average of 0.5%-1% per day thereafter for 30 days. Rebamipide slows the initial and final cement setting time by up to 3 and 1 minute, respectively, but does not significantly reduce the mechanical strength below 4% (weight percentage. Pre-osteoblast proliferation increases by 24% upon exposure to 0.4 uM Rebamipide, and by up to 73% when Rebamipide is delivered via brushite cement. Low doses of Rebamipide do not adversely affect peak alkaline phosphatase activity in differentiating pre-osteoblasts. Rebamipide weakly stimulates proliferation in macrophages at low concentrations (118 ± 7.4% at 1 uM, and quenches ROS by 40-60%. This is the first investigation of Rebamipide in osteoblasts.
Concentrated ERP Delivered in a Group Setting: A Replication Study.
Havnen, Audun; Hansen, Bjarne; Öst, Lars-Göran; Kvale, Gerd
In a previous effectiveness study (Havnen et al., 2014), 35 obsessive compulsive disorder (OCD) patients underwent Concentrated Exposure Treatment (cET), which is a newly developed group treatment format delivered over four consecutive days. The primary aims of the present study were to evaluate the treatment results for a new sample of OCD patients receiving the cET treatment approach and to replicate the effectiveness study described in Havnen et al. (2014). Forty-two OCD patients underwent cET treatment. Treatment was delivered by different therapists than in Havnen et al. (2014), except for two groups led by the developers of the treatment. Assessments of OCD symptom severity, treatment satisfaction, and occupational impairment were included. The results showed a significant reduction in Yale-Brown Obsessive Compulsive Scale scores from pre-treatment to post-treatment, which was maintained at 6-month follow-up. At post-treatment, 74% of the sample was remitted; at 6-month follow-up, 60% were recovered. The sample showed a very high degree of overall treatment satisfaction. The results from the present study were statistically compared with those obtained in the previous study. The analyses showed that the study samples had comparable demographic data and equal application of treatment. The outcome of the present and original study did not differ significantly on primary and secondary outcome measures. This study shows that cET was successfully replicated in a new patient sample treated by different therapists than the original study. The results indicate that cET is well accepted by the patients, and the potential for dissemination is discussed.
Capacity of mesoporous bioactive glass nanoparticles to deliver therapeutic molecules
El-Fiqi, Ahmed; Kim, Tae-Hyun; Kim, Meeju; Eltohamy, Mohamed; Won, Jong-Eun; Lee, Eun-Jung; Kim, Hae-Won
Inorganic bioactive nanomaterials are attractive for hard tissue regeneration, including nanocomponents for bone replacement composites and nanovehicles for delivering therapeutics. Bioactive glass nanoparticles (BGn) have recently gained potential usefulness as bone and tooth regeneratives. Here we demonstrate the capacity of the BGn with mesopores to load and deliver therapeutic molecules (drugs and particularly genes). Spherical BGn with sizes of 80-90 nm were produced to obtain 3-5 nm sized mesopores through a sono-reacted sol-gel process. A simulated body fluid test of the mesoporous BGn confirmed their excellent apatite forming ability and the cellular toxicity study demonstrated their good cell viability up to 100 μg ml-1. Small molecules like chemical drug (Na-ampicillin) and gene (small interfering RNA; siRNA) were introduced as model drugs considering the mesopore size of the nanoparticles. Moreover, amine-functionalization allowed switchable surface charge property of the BGn (from -20-30 mV to +20-30 mV). Loading of ampicillin or siRNA saturated within a few hours (~2 h) and reflected the mesopore structure. While the ampicillin released relatively rapidly (~12 h), the siRNA continued to release up to 3 days with almost zero-order kinetics. The siRNA-nanoparticles were easily taken up by the cells, with a transfection efficiency as high as ~80%. The silencing effect of siRNA delivered from the BGn, as examined by using bcl-2 model gene, showed dramatic down-regulation (~15% of control), suggesting the potential use of BGn as a new class of nanovehicles for genes. This, in conjunction with other attractive properties, including size- and mesopore-related high surface area and pore volume, tunable surface chemistry, apatite-forming ability, good cell viability and the possible ion-related stimulatory effects, will potentiate the usefulness of the BGn in hard tissue regeneration.Inorganic bioactive nanomaterials are attractive for hard tissue regeneration
The new Hyundai-Kia 1.0 l three-cylinder gasoline engine; Der neue 1,0-L-Dreizylinder-Ottomotor von Hyundai/KIA
Energy Technology Data Exchange (ETDEWEB)
Lee, Sunghoon; Gu, Youngsam; Kim, Taechung [Hyundai Motor Company (HMC), Seoul (Korea, Republic of); Hahn, Joachim [Hyundai Motor Europe (HMETC), Ruesselsheim (Germany)
In order to reach lowest CO{sub 2} emissions, Bosch modified a three-cylinder diesel engine regarding its turbo-charging and fuel injection system and integrated it into a mid-size luxury car. So it is possible to determine both, the potentials concerning fuel consumption and emissions of this downsizing approach as well as its limits. (orig.)
77 FR 46632 - Closed Captioning of Internet Protocol-Delivered Video Programming: Implementation of the Twenty...
... COMMISSION 47 CFR Part 79 Closed Captioning of Internet Protocol-Delivered Video Programming: Implementation... captioning of Internet protocol-delivered video programming and apparatus closed captioning requirements... Captioning of Video Programming Delivered Using Internet Protocol, and Apparatus Closed Caption Requirements...
Mouse embryonic retina delivers information controlling cortical neurogenesis.
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Ciro Bonetti
Full Text Available The relative contribution of extrinsic and intrinsic mechanisms to cortical development is an intensely debated issue and an outstanding question in neurobiology. Currently, the emerging view is that interplay between intrinsic genetic mechanisms and extrinsic information shape different stages of cortical development. Yet, whereas the intrinsic program of early neocortical developmental events has been at least in part decoded, the exact nature and impact of extrinsic signaling are still elusive and controversial. We found that in the mouse developing visual system, acute pharmacological inhibition of spontaneous retinal activity (retinal waves-RWs during embryonic stages increase the rate of corticogenesis (cell cycle withdrawal. Furthermore, early perturbation of retinal spontaneous activity leads to changes of cortical layer structure at a later time point. These data suggest that mouse embryonic retina delivers long-distance information capable of modulating cell genesis in the developing visual cortex and that spontaneous activity is the candidate long-distance acting extrinsic cue mediating this process. In addition, these data may support spontaneous activity to be a general signal coordinating neurogenesis in other developing sensory pathways or areas of the central nervous system.
Delivering effective science communication: advice from a professional science communicator.
Illingworth, Sam
Science communication is becoming ever more prevalent, with more and more scientists expected to not only communicate their research to a wider public, but to do so in an innovative and engaging manner. Given the other commitments that researchers and academics are required to fulfil as part of their workload models, it is unfair to be expect them to also instantly produce effective science communication events and activities. However, by thinking carefully about what it is that needs to be communicated, and why this is being done, it is possible to develop high-quality activities that are of benefit to both the audience and the communicator(s). In this paper, I present some practical advice for developing, delivering and evaluating effective science communication initiatives, based on over a decade of experience as being a professional science communicator. I provide advice regarding event logistics, suggestions on how to successfully market and advertise your science communication initiatives, and recommendations for establishing effective branding and legacy. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.
Habitable Worlds: Delivering on the Promises of Online Education
Horodyskyj, Lev B.; Mead, Chris; Belinson, Zack; Buxner, Sanlyn; Semken, Steven; Anbar, Ariel D.
Critical thinking and scientific reasoning are central to higher education in the United States, but many courses (in-person and online) teach students information about science much more than they teach the actual process of science and its associated knowledge and skills. In the online arena specifically, the tools available for course construction exacerbate this problem by making it difficult to build the types of active learning activities that research shows to be the most effective. Here, we present a report on Habitable Worlds, offered by Arizona State University for 12 semesters over the past 6 years. This is a unique online course that uses an array of novel technologies to deliver an active, inquiry-driven learning experience. Learning outcomes and quantitative data from more than 3000 students demonstrate the success of our approach but also identify several remaining challenges. The design and development of this course offers valuable lessons for instructional designers and educators who are interested in fully capitalizing on the capabilities of 21st-century technology to achieve educational goals.
Can the capitalist economic system deliver environmental justice?
Bell, Karen
Can a healthy environment for all social groups be delivered through capitalism via market mechanisms? Or is it the capitalist system, itself, that has been at the root of the environmental and social crises we now face? This letter engages with this ongoing debate by drawing on material from a wider study, 'Achieving Environmental Justice', which examined the extent, form and causes of environmental justice and injustice in a range of countries with varying depths of marketization—United States, South Korea, United Kingdom, Sweden, China, Bolivia and Cuba. The analysis described here focuses on the interview material from this mixed methods study, drawing on over 140 interviews with officials, policy makers, and civil society leaders. The letter argues that there is an apparent propensity for capitalist processes to exacerbate, rather than reduce, environmental problems and inequities though the pursuit of relentless economic growth and profit accumulation. Therefore, we should perhaps let go of efforts to resolve environmental injustice within the constraints of capitalism and, instead, build an alternative economic system that can meet human needs in the context of a harmonious and respectful relationship with nature.
Delivering neurocritical care in resource-challenged environments.
Shrestha, Gentle S; Goffi, Alberto; Aryal, Diptesh
Resource-challenged environments of low and middle-income countries face a significant burden of neurocritical illness. This review attempts to elaborate on the multiple barriers to delivering neurocritical care in these settings and the possible solutions to overcome such barriers. Epidemiology of neurocritical illness appears to have changed over time in low and middle-income countries. In addition to neuro-infection, noncommunicable neurological illnesses like stroke, traumatic brain injury, and traumatic spinal cord injury pose a significant neurocritical burden in resource-limited settings. Many barriers that exist hinder effective delivery of neurocritical care in resource-challenged environments. Very little information exists about the neurocritical care capacity. Research and publications are few. Intensive care unit beds and trained personnel are significantly lacking. Awareness about the risk factors of preventable conditions, including stroke, is lacking. Prehospital care and trauma systems are poorly developed. There should be attempts to leverage neurocritical care in these settings with focus on promoting research, local training, capacity building, preventive measures like vaccination, raising awareness, and developing prehospital care. Considering the disease burden and potentials to improve outcome, attempts should be made to develop neurocritical care in resource-challenged environments. http://links.lww.com/COCC/A11.
Regulatory adaptations for delivering information: The case of confession.
Sznycer, Daniel; Schniter, Eric; Tooby, John; Cosmides, Leda
Prior to, or concurrent with, the encoding of concepts into speech, the individual faces decisions about whether, what, when, how, and with whom to communicate. Compared to the existing wealth of linguistic knowledge however, we know little of the mechanisms that govern the delivery and accrual of information. Here we focus on a fundamental issue of communication: The decision whether to deliver information. Specifically, we study spontaneous confession to a victim. Given the costs of social devaluation, offenders are hypothesized to refrain from confessing unless the expected benefits of confession (e.g. enabling the victim to remedially modify their course of action) outweigh its marginal costs-the victim's reaction, discounted by the likelihood that information about the offense has not leaked. The logic of welfare tradeoffs indicates that the victim's reaction will be less severe and, therefore, less costly to the offender, with decreases in the cost of the offense to the victim and, counter-intuitively, with increases in the benefit of the offense to the offender. Data from naturalistic offenses and experimental studies supported these predictions. Offenders are more willing to confess when the benefit of the offense to them is high, the cost to the victim is low, and the probability of information leakage is high. This suggests a conflict of interests between senders and receivers: Often, offenders are more willing to confess when confessions are less beneficial to the victims. An evolutionary-computational framework is a fruitful approach to understanding the factors that regulate communication.
Delivering a Multi-Functional and Resilient Urban Forest
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James D. Hale
Full Text Available Tree planting is widely advocated and applied in urban areas, with large-scale projects underway in cities globally. Numerous potential benefits are used to justify these planting campaigns. However, reports of poor tree survival raise questions about the ability of such projects to deliver on their promises over the long-term. Each potential benefit requires different supporting conditions—relating not only to the type and placement of the tree, but also to the broader urban system within which it is embedded. This set of supporting conditions may not always be mutually compatible and may not persist for the lifetime of the tree. Here, we demonstrate a systems-based approach that makes these dependencies, synergies, and tensions more explicit, allowing them to be used to test the decadal-scale resilience of urban street trees. Our analysis highlights social, environmental, and economic assumptions that are implicit within planting projects; notably that high levels of maintenance and public support for urban street trees will persist throughout their natural lifespan, and that the surrounding built form will remain largely unchanged. Whilst the vulnerability of each benefit may be highly context specific, we identify approaches that address some typical weaknesses, making a functional, resilient, urban forest more attainable.
Novel drug delivering conduit for peripheral nerve regeneration
Labroo, Pratima; Shea, Jill; Edwards, Kyle; Ho, Scott; Davis, Brett; Sant, Himanshu; Goodwin, Isak; Gale, Bruce; Agarwal, Jay
Objective. This paper describes the design of a novel drug delivery apparatus integrated with a poly lactic-co-glycolic acid (PLGA) based nerve guide conduit for controlled local delivery of nerve growth factor (NGF) and application in peripheral nerve gap injury. Approach. An NGF dosage curve was acquired to determine the minimum in vitro concentration for optimal neurite outgrowth of dorsal root ganglion (DRG) cells; PLGA based drug delivery devices were then designed and tested in vitro and in vivo across 15 mm rat sciatic nerve gap injury model. Main results. The drug delivery nerve guide was able to release NGF for 28 d at concentrations (0.1–10 ng ml‑1) that were shown to enhance DRG neurite growth. Furthermore, the released NGF was bioactive and able to enhance DRG neurite growth. Following these tests, optimized NGF-releasing nerve conduits were implanted across 15 mm sciatic nerve gaps in a rat model, where they demonstrated significant myelination and muscle innervation in vivo as compared to empty nerve conduits (p injury. Significance. This integrated drug delivering nerve guide simplifies the design process and provides increased versatility for releasing a variety of different growth factors. This innovative device has the potential for broad applicability and allows for easier customization to change the type of drugs and dosage of individual drugs without devising a completely new biomaterial–drug conjugate each time.
Development of oral microencapsulated forms for delivering viral vaccines.
Nechaeva, Elena
Rapid development in biotechnology during the last decade has allowed novel ideas in the development of antiviral vaccines to be considered and provides interesting technological approaches to their realization. Designing of microencapsulated forms for delivering bacterial and viral antigens or antigenic complexes using biodegradable biopolymers is an important novel direction. This approach involves the production of polymeric spherical particles with a diameter of 1 microm to 3 mm, containing isolated viral antigens or whole viral particles. Microencapsulated antigens administered orally are protected from low pH values of the gastric juice, bile acids, their salts and proteolytic enzymes of the gastrointestinal tract. The ability to drastically potentiate the immune response to encapsulated antigens, together with the ability to penetrate into the intestinal and respiratory mucosae upon oral and tracheal administrations, respectively, with induction of local and systemic immune reactions are the special merits of such polymers. However, the majority of data on microencapsulated viral vaccines has so far been obtained in animal models, as well as a limited number of studies on the protective effect they elicit. Certain success in the development of vaccines against a number of human viral infections, such as hepatitis B, cytomegalovirus and rotavirus, gives hope to successful completion of this research. Presumably, such vaccines will be safe and innocuous, simple in administration and capable of inducing both the systemic and local immune responses at the primary portal of viral infection.
Can natural polymers assist in delivering insulin orally?
Nur, Mokhamad; Vasiljevic, Todor
Diabetes mellitus is one of the most grave and lethal non communicable diseases. Insulin is normally used to medicate diabetes. Due to bioavailability issues, the most regular route of administration is through injection, which may pose compliance problems to treatment. The oral administration thus appears as a suitable alternative, but with several important problems. Low stability of insulin in the gastrointestinal tract and low intestinal permeation are some of the issues. Encapsulation of insulin into polymer-based particles emerges as a plausible strategy. Different encapsulation approaches and polymers have been used in this regard. Polymers with different characteristics from natural or synthetic origin have been assessed to attain this goal, with natural polymers being preferable. Natural polymers studied so far include chitosan, alginate, carrageenan, starch, pectin, casein, tragacanth, dextran, carrageenan, gelatine and cyclodextrin. While some promising knowledge and results have been gained, a polymeric-based particle system to deliver insulin orally has not been introduced onto the market yet. In this review, effectiveness of different natural polymer materials developed so far along with fabrication techniques are evaluated. Copyright © 2017 Elsevier B.V. All rights reserved.
Evaluation of a community pharmacy delivered oral contraception service.
Parsons, Judith; Adams, Christine; Aziz, Najia; Holmes, Jo; Jawad, Ruhi; Whittlesea, Cate
In the UK half of all pregnancies are unplanned and half of teenage pregnancies terminated. Southwark and Lambeth have the highest teenage conception rates in London. In 2009, many teenage pregnancies in Southwark led to terminations. A contraception service was established where qualified pharmacists supplied oral contraception (OC) using a patient group direction (PGD). This service evaluation aimed to assess this service delivered in five community pharmacies. Monthly data were submitted by each pharmacy to the Primary Care Trust on consultations, pills supplied, initial or subsequent supply and client referral. For specified periods consultation time was collected and a clinical notes audit undertaken. Client satisfaction was determined using a structured questionnaire returned to the pharmacy. Mystery shoppers were employed to assess the service. A total of 741 consultations were undertaken by seven pharmacists at five community pharmacies (October 2009-June 2011) with many (45.5%) occurring following emergency contraception supply. The mean consultation time was 19 minutes . Combined OC was most commonly supplied with nearly half (46.1%) of initial supplies to first-time pill users. Most consultations (92.2%) were with women aged under 30 years, with 22.5% aged under 20. Most consultations were with black or black British clients. Of the 99 women who completed the satisfaction questionnaires, most clients were very satisfied or satisfied with the service and felt comfortable talking to the pharmacist about contraception. Trained pharmacists were clinically competent and provided OC in community pharmacy according to a PGD. This service was accessed by the target population; young women using emergency hormonal contraception who had not previously used OC. Clients were largely very satisfied with the service.
Data driven customer experience and the roadmap to deliver happiness
Directory of Open Access Journals (Sweden)
Ahmed Aly Shaban Abdelmoteleb
Full Text Available Happiness is a choice, in which individuals have the ability to create lasting and genuine happiness for themselves. They make choices and take actions to be happy, choosing what to wear, what to eat, whom to love, and where to work. It is very subjective to delimit whether our choices are good while others are not but all based on individual profound desire to be happy. In some related work, researchers have found a strong correlation between customer satisfaction, happiness, and organization performance. Many organizations have spent money and effort in innovating and implementing initiatives, which were focusing on increasing customers' satisfaction; however, customers are not happier today compared to what they were before. Therefore, the need for studying on mechanism of achieving customer happiness is crucial to ensure effectiveness and efficiency of customer service initiatives. In fact, it is important to identify factors that can elevate customer happiness and shift customers from comfort to happiness zone. This will motivate organizations to design products and services that can meet customer needs and exceed customer expectation in every touch point. In UAE, customers come from 202 countries with diverse cultures, religions, habits and ethnicity, which force government, semi-government and private sector to deliver services that not only meet but also exceed customer expectations. Accordingly, the paper will take you through the journey of UAE government for exceeding customer expectations starting from understanding drivers of happiness using a research framework that segment customers in different zones (Trust vs. Control & Stand out vs. Fit in until quantifying drivers to measure service happiness score.
Locally-Delivered T-Cell-Derived Cellular Vehicles Efficiently Track and Deliver Adenovirus Delta24-RGD to Infiltrating Glioma
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Rutger K. Balvers
Full Text Available Oncolytic adenoviral vectors are a promising alternative for the treatment of glioblastoma. Recent publications have demonstrated the advantages of shielding viral particles within cellular vehicles (CVs, which can be targeted towards the tumor microenvironment. Here, we studied T-cells, often having a natural capacity to target tumors, for their feasibility as a CV to deliver the oncolytic adenovirus, Delta24-RGD, to glioblastoma. The Jurkat T-cell line was assessed in co-culture with the glioblastoma stem cell (GSC line, MGG8, for the optimal transfer conditions of Delta24-RGD in vitro. The effect of intraparenchymal and tail vein injections on intratumoral virus distribution and overall survival was addressed in an orthotopic glioma stem cell (GSC-based xenograft model. Jurkat T-cells were demonstrated to facilitate the amplification and transfer of Delta24-RGD onto GSCs. Delta24-RGD dosing and incubation time were found to influence the migratory ability of T-cells towards GSCs. Injection of Delta24-RGD-loaded T-cells into the brains of GSC-bearing mice led to migration towards the tumor and dispersion of the virus within the tumor core and infiltrative zones. This occurred after injection into the ipsilateral hemisphere, as well as into the non-tumor-bearing hemisphere. We found that T-cell-mediated delivery of Delta24-RGD led to the inhibition of tumor growth compared to non-treated controls, resulting in prolonged survival (p = 0.007. Systemic administration of virus-loaded T-cells resulted in intratumoral viral delivery, albeit at low levels. Based on these findings, we conclude that T-cell-based CVs are a feasible approach to local Delta24-RGD delivery in glioblastoma, although efficient systemic targeting requires further improvement.
Cathodes Delivered for Space Station Plasma Contactor System
Patterson, Michael J.
technical and schedule considerations, the NASA Lewis Research Center was asked to manufacture and deliver the engineering model, the qualification model, and the flight HCA units for the plasma contactor system as government furnished equipment. To date, multiple units have been built. One cathode has demonstrated approximately 28 000-hr lifetime, two development HCA units have demonstrated over 15 000-hr lifetime, and one HCA unit has demonstrated more than 38 000 ignitions. All eight flight HCA's have been manufactured, acceptance tested, and are ready for delivery to the flight contractor.
Delivering stepped care: an analysis of implementation in routine practice
Directory of Open Access Journals (Sweden)
Richards David A
Full Text Available Abstract Background In the United Kingdom, clinical guidelines recommend that services for depression and anxiety should be structured around a stepped care model, where patients receive treatment at different 'steps,' with the intensity of treatment (i.e., the amount and type increasing at each step if they fail to benefit at previous steps. There are very limited data available on the implementation of this model, particularly on the intensity of psychological treatment at each step. Our objective was to describe patient pathways through stepped care services and the impact of this on patient flow and management. Methods We recorded service design features of four National Health Service sites implementing stepped care (e.g., the types of treatments available and their links with other treatments, together with the actual treatments received by individual patients and their transitions between different treatment steps. We computed the proportions of patients accessing, receiving, and transiting between the various steps and mapped these proportions visually to illustrate patient movement. Results We collected throughput data on 7,698 patients referred. Patient pathways were highly complex and very variable within and between sites. The ratio of low (e.g., self-help to high-intensity (e.g., cognitive behaviour therapy treatments delivered varied between sites from 22:1, through 2.1:1, 1.4:1 to 0.5:1. The numbers of patients allocated directly to high-intensity treatment varied from 3% to 45%. Rates of stepping up from low-intensity treatment to high-intensity treatment were less than 10%. Conclusions When services attempt to implement the recommendation for stepped care in the National Institute for Health and Clinical Excellence guidelines, there were significant differences in implementation and consequent high levels of variation in patient pathways. Evaluations driven by the principles of implementation science (such as targeted planning
Using technology to deliver healthcare education to rural patients.
McIlhenny, Carol V; Guzic, Brenda L; Knee, Dawna R; Wendekier, Camille M; Demuth, Barbara R; Roberts, Jay B
The prevalence of chronic disease in the US population is increasing. Projections indicate that half the US population will live with at least one chronic disease by the year 2030. Statistics indicate that chronic illnesses account for 70% of all deaths. Developing healthy self-management behaviors can lower the risk of developing chronic disease and also minimize the magnitude of subsequent morbidity and disability. Individuals need access to reliable information in order to learn successful self-management skills. Delivering healthcare information in rural areas is difficult. Geography, distance, inclement weather and/or the lack of financial resources are barriers that can prevent individuals from accessing health care and health education. Likewise, rural health clinics often lack the financial resources to provide the most current patient education materials. However, the internet allows remote and immediate access to this type of information if individuals know how and where to search for it. An internet portal, My Health Education & Resources Online (MyHERO) was created to facilitate locating current, non-commercial, reliable, evidence-based health information. The authors sought to assess the impact of a publically accessible internet information portal on diabetes knowledge, quality of life (QOL) measures, and self-management behaviors in a US rural area. Participants (n=48) with type 2 diabetes in one clinic received regularly scheduled, one-on-one individualized diabetes-related health education and hands-on instructions on how to use an internet portal from a nurse educator. Each health clinic was supplied with a laptop computer for participants to use if they lacked internet access. Control participants (n=50) in a second clinic received a pamphlet describing how to access the portal. All participants completed baseline and end-of-study surveys. Disease knowledge was measured with the BASICS test developed by the International Diabetes Center. Problem
Hipparcos to deliver its final results catalogue soon
them, almost 30 years ago, to propose carrying out these observations from the relatively benign environment of space. Hipparcos is, by present standards, a medium-sized satellite, with a 30 cm telescope sensing simply ordinary light. But it has been described as the most imaginative in the short history of space astronomy. This foresight has been amply repaid. In the long history of stargazing it ranks with the surveys by Hipparchus the Greek in the 2nd Century BC and by Tichy Brahe the Dane in the 16th Century AD, both of which transformed human perceptions of the Universe. Positions derived from the Hipparcos satellite are better than a millionth of a degree, and newly a thousand times more accurate than star positions routinely determined from he ground. This accuracy makes it possible to measure directly the distances to the stars. While it took 250 years between astronomers first setting out on the exacting task of measuring the distance to a star, and a stellar distance being measured for the first time, ESA's Hipparcos mission has revolutionised this long, painstaking, and fundamental task by measuring accurate distances and movements of more than one hundred thousand. The measurement concept involved he satellite triangulating its way between he stars all wound the sky, building up a celestial map in much the same way as land surveyors use triangulation between hill-tops to measure distances accurately. Only the angles involved are much smaller : the accuracy that has been achieved with the Hipparcos Catalogue is such that he two edges of a coin, viewed from he other side of the Atlantic Ocean, could be distinguished. The results from Hipparcos will deliver scientists with long-awaited details of our place in he Milky Way Galaxy. Most of he stars visible to the naked eye are, to a large extent, companions of the Sun, in a great orbital march around the centre of the Galaxy, a journey so long that it takes individual stars 250 million years to complete, in
Effects of acoustical stimuli delivered through hearing aids on tinnitus.
Sweetow, Robert W; Sabes, Jennifer Henderson
range of preferences observed for fractal settings, with most participants preferring fractals with a slow or medium tempo and restricted dynamic range. The majority (86%) indicated that it was easier to relax while listening to fractal signals. Participants had preferences for certain programs and fractal characteristics. Although seven participants rated the noise-only condition as providing the least tinnitus annoyance, only two opted to have noise only as a program during the field trial, and none selected the noise-only condition as the preferred setting. Furthermore, while all four of the experienced hearing aid users selected noise as producing the least annoying tinnitus in the laboratory, only one selected it for field wear. Tinnitus Handicap Inventory and Tinnitus Reaction Questionnaire scores were improved over the course of the 6 mo trial, with clinically significant improvements occurring for over half of the participants on at least one of the measures. The results suggest that use of acoustic stimuli, particularly fractal tones, delivered though hearing aids can provide amplification while allowing for relief for some tinnitus sufferers. It is important to recognize, however, that tinnitus management procedures need to be supplemented with appropriate counseling. American Academy of Audiology.
Telephone-Delivered Cognitive Behavioral Therapy for Chronic Pain Following Traumatic Brain Injury
AWARD NUMBER: W81XWH-12-2-0109 TITLE: Telephone-Delivered Cognitive Behavioral Therapy for Chronic Pain Following Traumatic Brain Injury...2014-29 Sept 2015 4. TITLE AND SUBTITLE Telephone-Delivered Cognitive Behavioral Therapy for Chronic Pain 5a. CONTRACT NUMBER W81XWH-12-2-0109...included a Quad Chart for this particular study as requested by the CDMRP. Planned Recruitment Telephone-Delivered Cognitive Behavioral Therapy for
Telephone Delivered Cognitive Behavioral Therapy for Chronic Pain Following Traumatic Brain Injury
AWARD NUMBER: W81XWH-12-2-0109 TITLE: Telephone -Delivered Cognitive Behavioral Therapy for Chronic Pain Following Traumatic Brain Injury...2015 - 29 Sep 2016 4. TITLE AND SUBTITLE Telephone -Delivered Cognitive Behavioral Therapy for Chronic Pain 5a. CONTRACT NUMBER Following Traumatic...evaluate the efficacy of a telephone -delivered cognitive behavioral treatment (T-CBT) in Veterans with a history of traumatic brain injury (TBI) for the
A conceptual framework for understanding and improving adolescents' exposure to Internet-delivered interventions
National Research Council Canada - National Science Library
Crutzen, R.M.M; de Nooijer, J; Brouwer, W; Oenema, A; Brug, J; de Vries, N.K
.... Therefore, a conceptual framework, which incorporates elements of user experience of websites, is applied to Internet-delivered health behaviour change interventions aimed at adolescents and results...
Therapist effects in guided internet-delivered CBT for anxiety disorders
Almlov, J.; Carlbring, P.; Kallqvist, K.; Paxling, B.; Cuijpers, P.; Andersson, G.
Background: Guided internet-delivered CBT for anxiety disorders has received increasing empirical support, but little is known regarding the role of the therapist. Aims: This study addressed therapist factors in guided internet-delivered cognitive behavioural therapy for anxiety disorders. Method:
Some like to join, others to deliver: an econometric analysis of farmers' relationships with agricultural cooperatives
Pascucci, S.; Gardebroek, C.; Dries, L.K.E.
In many European countries, farmers are a member of a processing or marketing co-operative, and most of these farmers deliver their products to that co-operative. However, an extensive data set of Italian farmers shows that not all members deliver to their co-op, and that there are also non-members
The effect of support on internet-delivered treatment for Insomnia : Does baseline depression severity matter?
Lancee, Jaap; Sorbi, Marjolijn J.; Eisma, Maarten C.; van Straten, Annemieke; van den Bout, Jan
Internet-delivered cognitive-behavioral treatment is effective for insomnia. However, little is known about the beneficial effects of support. Recently we demonstrated that motivational support moderately improved the effects of Internet-delivered treatment for insomnia. In the present study, we
The effect of support on Internet-delivered treatment for insomnia: Does baseline depression severity matter?
Lancee, J.; Sorbi, M.J.; Eisma, M.C.; van Straten, A.; van den Bout, J.
Internet-delivered cognitive-behavioral treatment is effective for insomnia. However, little is known about the beneficial effects of support. Recently we demonstrated that motivational support moderately improved the effects of Internet-delivered treatment for insomnia. In the present study, we
Using a NLSI to deliver the Effective Learning Programme: problems and practicalities
Directory of Open Access Journals (Sweden)
Bob Hunter
Full Text Available In 1996 the University of Lincolnshire and Humberside implemented its Effective Learning programme (ELP. This is delivered by a Networked Learning Support Intranet (NLSI. This paper discusses some of the issues raised in linking NLSI to centralised databases and the changing staff roles within Learning Support required to develop, deliver and support ELP and the NLSI.
29 CFR 570.106 - "Ship or deliver for shipment in commerce".
... Section 12(a) § 570.106 "Ship or deliver for shipment in commerce". (a) Section 12(a) forbids producers, manufacturers, and dealers to "ship or deliver for shipment in commerce" the goods referred to therein. A producer, manufacturer, or dealer may "ship" goods in commerce either by moving them himself in interstate...
31 CFR 375.15 - Who is responsible for delivering securities?
... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Who is responsible for delivering securities? 375.15 Section 375.15 Money and Finance: Treasury Regulations Relating to Money and Finance....23.) All securities you deliver must be free and clear of all liens, charges, claims, and any other...
A Comparison of Self- and Peer-Delivered Immediate Corrective Feedback on Multiplication Performance.
Skinner, Christopher H.; And Others
Compared effects of peer-delivered (PDF) and self-delivered (SDF) immediate corrective feedback intervention on multiplication performance of six second grade students. SDF resulted in greater multiplication performance for four of six students, suggesting that SDF interventions may be more efficient and less obtrusive than PDF interventions and…
The effect of support on internet-delivered treatment for insomnia: does baseline depression severity matter?
Lancee, J.; Sorbi, M.J.; Eisma, M.C.; van Straten, A.; van den Bout, J.
Internet-delivered cognitive-behavioral treatment is effective for insomnia. However, little is known about the beneficial effects of support. Recently we demonstrated that motivational support moderately improved the effects of Internet-delivered treatment for insomnia. In the present study, we
A gray wolf (Canis lupus) delivers live prey to a pup
Mech, L. David
A two-year-old sibling Gray Wolf (Canis lupus) carefully captured an Arctic Hare (Lepus arcticus) leveret alive on Ellesmere Island, Nunavut, Canada, and delivered it alive to a pup 28–33 days old. This appears to be the first observation of a Gray Wolf delivering live prey to a pup.
Characteristics of factory-grade hardwood logs delivered to Appalachian sawmills
Curtis D. Goho; Paul S. Wysor; Paul S. Wysor
Until now, information about the characteristics of sawlogs delivered to Appalachian sawmills has been generally unavailable. We know what the standing timber is like, from forest-survey data. But this paper covers a different spectrum: the frequency distributions-by size, grade, volume, and species group-of factory-grade logs actually harvested and delivered to the...
Effects of gas composition on the delivered tidal volume of the Avance Carestation.
Miyaji, Tetsuya; Fukakura, Yoshimasa; Usuda, Yutaka; Maruyama, Koichi; Hirabayashi, Go; Yamada, Rieko; Akihisa, Yuki; Nishioka, Hiroko; Andoh, Tomio
Measurements with various flowmeters are affected by changes in gas mixture density. The Avance Carestation incorporates ventilator feedback controlled by a built-in flowmeter with a variable orifice sensor. We hypothesised that changes in the composition of delivered gas may cause changes in the delivered tidal volume by affecting the flow measurement unless appropriate corrections are made. We used 100 % O2, 40 % O2 in N2 and 40 % O2 in N2O as carrier gases with/without sevoflurane and desflurane. We measured delivered tidal volume using the FlowAnalyzer™ PF 300 calibrated with the corresponding gas mixtures during volume control ventilation with 500-ml tidal volume using the Avance Carestation connected to a test lung. Change of carrier gas and addition of sevoflurane and desflurane significantly altered delivered tidal volume. Desflurane 6 % reduced delivered tidal volume by 7.6, 3.6 and 16 % of the pre-set volume at 100 % O2, 40 % O2 in N2 and 40 % O2 in N2O, respectively. Importantly, the Carestation panel indicator did not register these changes in measured expired tidal volume. Ratios of delivered tidal volume to 500 ml correlated inversely with the square root of the delivered gas density. These results support our hypothesis and suggest that changing gas composition may alter delivered tidal volume of anesthesia machines with built-in ventilators that are feedback-controlled by uncorrected flowmeters due to changes in gas mixture density.
20 CFR 669.330 - How are services delivered to the customer?
... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false How are services delivered to the customer... Farmworker Jobs Program Customers and Available Program Services § 669.330 How are services delivered to the customer? To ensure that all services are focused on the customer's needs, services are provided through a...
77 FR 22386 - Hyundai Motor Company, Receipt of Petition for Decision of Inconsequential Noncompliance
... with a fixed rear seat back, there is no advantage or reason for the owner to detach the center rear... be written in the English language, and be no greater than 15 pages in length, although there is no...
77 FR 33807 - Hyundai Motor Company, Receipt of Petition for Decision of Inconsequential Noncompliance
... x 18 wheel rims at the assembly plant. NHTSA notes that the statutory provisions (49 U.S.C. 30118(d... required by Sec. 567.4 or Sec. 567.5 of this chapter. This information shall be in the English language... in the English language, and be no greater than 15 pages in length, although there is no limit to the...
Comparison of use and appreciation of a print-delivered versus CD-ROM-delivered, computer-tailored intervention targeting saturated fat intake: Randomized controlled trial
W. Kroeze (Willemieke); A. Oenema (Anke); M.K. Campbell (Marci); J. Brug (Hans)
textabstractBackground: Computer-tailored health education, a promising health education technique, is increasingly being delivered interactively, for example, over the Internet. It has been suggested that there may be differences in use and appreciation between print and interactive delivery of
Are breastfeeding rates higher among mothers delivering in Baby Friendly accredited maternity units in the UK?
National Research Council Canada - National Science Library
Bartington, Suzanne; Griffiths, Lucy J; Tate, A Rosemary; Dezateux, Carol
.... We examined whether mothers were more likely to start and continue to breastfeed if they delivered in a UNICEF UK Baby Friendly accredited maternity unit, in a cohort with a high representation...
How natural capital delivers ecosystem services: A typology derived from a systematic review
CSIR Research Space (South Africa)
Smith, AC
Full Text Available There is no unified evidence base to help decision-makers understand how the multiple components of natural capital interact to deliver ecosystem services. We systematically reviewed 780 papers, recording how natural capital attributes (29 biotic...
Risk of respiratory morbidity in term infants delivered by elective caesarean section: cohort study
DEFF Research Database (Denmark)
Hansen, Anne Kirkeby; Wisborg, Kirsten; Uldbjerg, Niels
of the newborn, respiratory distress syndrome, persistent pulmonary hypertension of the newborn) and serious respiratory morbidity (oxygen therapy for more than two days, nasal continuous positive airway pressure, or need for mechanical ventilation). RESULTS: 2687 infants were delivered by elective caesarean...... section. Compared with newborns intended for vaginal delivery, an increased risk of respiratory morbidity was found for infants delivered by elective caesarean section at 37 weeks' gestation (odds ratio 3.9, 95% confidence interval 2.4 to 6.5), 38 weeks' gestation (3.0, 2.1 to 4.3), and 39 weeks......-eclampsia, and intrauterine growth retardation, or by breech presentation. CONCLUSION: Compared with newborns delivered vaginally or by emergency caesarean sections, those delivered by elective caesarean section around term have an increased risk of overall and serious respiratory morbidity. The relative risk increased...
A Sentiment Delivering Estimate Scheme Based on Trust Chain in Mobile Social Network
Directory of Open Access Journals (Sweden)
Meizi Li
Full Text Available User sentiment analysis has become a flourishing frontier in data mining mobile social network platform since the mobile social network plays a significant role in users' daily communication and sentiment interaction. This study studies the scheme of sentiment estimate by using the users' trustworthy relationships for evaluating sentiment delivering. First, we address an overview of sentiment delivering estimate scheme and propose its related definitions, that is, trust chain among users, sentiment semantics, and sentiment ontology. Second, this study proposes the trust chain model and its evaluation method, which is composed of evaluation of atomic, serial, parallel, and combined trust chains. Then, we propose sentiment modeling method by presenting its modeling rules. Further, we propose the sentiment delivering estimate scheme from two aspects: explicit and implicit sentiment delivering estimate schemes, based on trust chain and sentiment modeling method. Finally, examinations and results are given to further explain effectiveness and feasibility of our scheme.
The Need to Deliver Higher-Order Skills in the Context of Marketing in SMEs
Copley, Paul
It is argued that the delivery of learning and the development of skills and competences are central to SME success; and there appears to be a requirement for higher-order education and training that can deliver a
Organization-and-technological model of medical care delivered to patients with coronary heart disease
Directory of Open Access Journals (Sweden)
Popova Y.V.
Full Text Available Organization-and-technological model of medical care delivered to patients with coronary heart disease based on IDEF0 methodology and corresponded with clinical guidelines is presented.
Improved low-cost, MR-compatible olfactometer to deliver tobacco smoke odor.
Lowen, Steven B; Farmer, Stacey L; Lukas, Scott E
We describe a low-cost, MRI-compatible olfactometer that delivers fresh cigarette smoke odor, a challenging odorant to present, as well as other odorants. This new olfactometer retains all of the advantages of an earlier design that was capable of only delivering volatile odors (Lowen & Lukas, Behavior Research Methods, 38, 307-313, 2006). The new system incorporates a novel switching mechanism that allows it to deliver fresh smoke generated from a burning cigarette during a stimulus presentation paradigm that might be employed in a cue-reactivity experiment. An evaluation study established that the olfactometer reliably delivered smoke to the participants and that tobacco smoke was discriminated from other odorants; there were no adverse reactions to the device.
Development of a Health System-Based Nurse-Delivered Aromatherapy Program.
Joswiak, Denise; Kinney, Mary Ellen; Johnson, Jill R; Kolste, Alison K; Griffin, Kristen H; Rivard, Rachael L; Dusek, Jeffery A
Healthcare systems are increasingly looking to integrate aromatherapy (essential oils) as a safe, low-cost, and nonpharmacologic option for patient care to reduce pain, nausea, and anxiety and to improve sleep. This article describes the development and implementation of a healthcare system-wide program of nurse-delivered essential oil therapeutic interventions to inpatients throughout an acute care setting. In addition, we provide lessons learned for nursing administrators interested in developing similar nurse-delivered aromatherapy programs.
Preparing Air Force Nurses to Deliver Health Care in a Unique Operational Environment: Detainee Operations
Dr. Josephna Campinha-Bacote's, President and Founder of Transcultural C.A.R.E. Associates, model of cultural competence in health care delivery...AU/ACSC/DOLIHITE/AY10 AIR COMMAND AND STAFF COLLEGE AIR UNIVERSITY PREPARING AIR FORCE NURSES TO DELIVER HEALTH CARE IN A...provided in areas of battlefield nursing and the combat health care system. Specifically, nursing care is taught to be delivered at the Air Force
Feasibility and preliminary efficacy of remotely delivering cognitive training to people with schizophrenia using tablets
Directory of Open Access Journals (Sweden)
Bruno Biagianti
Conclusion: Although underpowered and not randomized, this study demonstrates that delivering CT remotely to people with SZ using tablets is feasible and results in retention rates, adherence, and cognitive and functional outcome improvements that are comparable to those observed when CT is delivered in the laboratory. This has important implications in terms of scalability and dissemination of CT. These results require confirmation in larger samples.
Reproductive health counseling delivered to women living with HIV in the United States.
Gokhale, Runa H; Bradley, Heather; Weiser, John
Advances in antiretroviral therapy (ART) and reproductive technologies have made transmission of HIV to partners and infants almost completely preventable. Comprehensive reproductive health counseling (CRHC) is an important component of care for women living with HIV, but few women report discussing reproductive health with an HIV care provider. We surveyed a probability sample of U.S. HIV care providers during 2013-2014. Of 2023 eligible providers, 1234 responded (64% adjusted provider response rate). We estimated the percentage delivering CRHC to their female patients. CRHC was defined as delivering each of five components of reproductive health care to most or all female patients. We assessed associations between provider characteristics and delivering CRHC using chi-squared tests and multivariable logistic regression. Of all providers, 49% (95% confidence interval [CI], 42-55) reported delivering all components of CRHC: 71% assessed reproductive intentions of reproductive-aged women, 78% explained perinatal transmission risk, 87% discussed ART for preventing perinatal transmission, 76% provided contraception as appropriate, and 64% provided referrals for preconception care. Among providers who offered primary care (83% of sample), 52% (CI: 44-60) delivered CRHC compared to 33% (CI: 22-44) of providers who did not offer primary care (P = .01). More female providers (46% of sample) compared to male providers delivered CRHC (57% [CI: 48-65] vs. 40% [CI: 31-50], P reproductive health with all reproductive-aged women who are living with HIV, even among providers offering primary care to their HIV patients.
Technical Quality of Delivered Care for Patients with Inflammatory Bowel Disease in Tabriz Care Centers
Directory of Open Access Journals (Sweden)
Mohammad Hosein Somi
Full Text Available Background and objectives : Inflammatory Bowel Disease (IBD is a chronic disease and requires complex treatment. Due to the various treatment options and gradual understanding of specialists about the risks and benefits of different treatments of IBD, delivering care according to the treatment protocols and guidelines is essential. This study was conducted to assess delivered care from the perspective of patients with inflammatory bowel disease. Material and Methods : This cross-sectional study was conducted with 94 participants with IBD selected randomly in Emam Reza hospital and Golgasht clinic in Tabriz. Data were collected by an approved researcher-made questionnaire via interviewing patients. Chi-Squared Test was used to evaluate the relationship between demographic variables and accordance of delivered care with standards. SPSS17 was used for data analysis. Results : The results indicated that "visit by specialist" and "providing dietary recommendation by nutritionist" aspects had highest and lowest degree of accordance with standards, respectively. Furthermore, the aspects of "delivered care in exacerbation status of disease" and "delivered care by other specialists" had only 20 percent compliance with standards. Also, there was a significant relationship between age, job, education status, smoking and compliance with related standards in some care aspects (p Conclusion : The study results indicated that there is a deep gap between delivered cares for patients with inflammatory bowel disease and related standards. These deficiencies showed the parts that need improvement and require healthcare managers and policy makers' attention.
Hospital nurses' comfort in and frequency of delivering heart failure self-care education.
Albert, Nancy M; Cohen, Bonni; Liu, Xiaobo; Best, Carolyn H; Aspinwall, Laura; Pratt, Lisa
Nurses are expected to deliver pre-discharge heart failure education in 8 content areas: what heart failure means, medications, diet, activity, weight monitoring, fluid restriction, signs/symptoms of worsening condition and signs/symptoms of fluid overload. To examine nurses' comfort in and frequency of delivering heart failure education to hospitalized patients. A multicenter, descriptive, correlational design and questionnaire methods were used. General linear models were performed to assess associations of comfort in and frequency of delivering patient education after controlling for significant nurse characteristics. Of 118 nurses, mean age was 39 ± 11.6 years, 61.9% worked on cardiac units and 58.3% spent heart failure education. Comfort in delivering education was highest for weight monitoring and lowest for activity, and was associated with nurse age (p=0.019), years in profession (p=0.004) and minutes providing pre-discharge education (p=0.003). Frequency delivering education was highest for signs/symptoms of worsening condition (mean frequency, 71.5% ± 29%) and lowest for activity (42.7% ± 29.4%) and was associated with comfort in educating patients (all pheart failure education delivery. Nurses' comfort in and frequency of delivering education varied by heart failure self-care content area. Self-care education areas most important to survival and hospitalization had the lowest rates of nurse comfort and frequency. Systems and processes are needed to facilitate education delivery prior to hospital discharge. © The European Society of Cardiology 2014.
Delivering Bad News: Attitudes, Feelings, and Practice Characteristics Among Speech-Language Pathologists.
Gold, Rinat; Gold, Azgad
The purpose of this study was to examine the attitudes, feelings, and practice characteristics of speech-language pathologists (SLPs) in Israel regarding the subject of delivering bad news. One hundred and seventy-three Israeli SLPs answered an online survey. Respondents represented SLPs in Israel in all stages of vocational experience, with varying academic degrees, from a variety of employment settings. The survey addressed emotions involved in the process of delivering bad news, training on this subject, and background information of the respondents. Frequency distributions of the responses of the participants were determined, and Pearson correlations were computed to determine the relation between years of occupational experience and the following variables: frequency of delivering bad news, opinions regarding training, and emotions experienced during the process of bad news delivery. Our survey showed that bad news delivery is a task that most participants are confronted with from the very beginning of their careers. Participants regarded training in the subject of delivering bad news as important but, at the same time, reported receiving relatively little training on this subject. In addition, our survey showed that negative emotions are involved in the process of delivering bad news. Training SLPs on specific techniques is required for successfully delivering bad news. The emotional burden associated with breaking bad news in the field of speech-language pathology should be noticed and addressed.
Localization and quantification of the delivered dose to the spinal cord. Predicting actual delivered dose during daily MVCT image-guided tomotherapy
Energy Technology Data Exchange (ETDEWEB)
Duma, M.N.; Molls, M.; Kampfer, S. [Technische Univ. Muenchen, Klinikum rechts der Isar, Muenchen (Germany). Dept. of Radiation Oncology; Schuster, T. [Technische Univ. Muenchen, Klinikum rechts der Isar, Muenchen (Germany). Inst. of Medical Statistics and Epidemiology; Aswathanarayana, N.; Fromm, L.S. [Technische Univ. Muenchen, Muenchen (Germany). Medical School; Geinitz, H. [Krankenhaus der Barmherzigen Schwestern, Linz (Austria). Abt. fuer Radio-Onkologie
Purpose: The goal of the present work was to localize and quantify the actual delivered dose to the cervical spinal cord (SC) during head and neck cancer (H and N) treatment. Materials and methods: A total of 20 H and N patients treated with bilateral nodal irradiation with helical tomotherapy (HT) were analyzed. Daily MVCTs were performed for image guidance. On every second MVCT, the SC was recontoured and the delivered dose for the given treatment fraction (12 fractions per patient) was recalculated. The magnitude and localization (CT slice, spinal cord quadrant) of the Dmax to the SC on the planning CT (PLAN-Dmax) and of the actual delivered Dmax (a-Dmax) were analyzed. Results: A systematic deviation from the PLAN-Dmax was observed in 15 out of 20 patients. Large interpatient variability of the a-Dmax in the spinal cord was noted (4.5 {+-} 4 %). Intrapatient variability in a-Dmax was, generally, minimal (1.8 {+-} 2.7 %). Throughout the treatment course, the higher dose was located in the same CT slices and in the same quadrants (anterior right and anterior left) for the same patient. Conclusion: Exact localization and quantification of the change of the a-Dmax can be made for most patients by recalculating the dose on the daily IGRT-MVCTs. This could be helpful in assessing whether replanning is necessary in patients with doses close to the known tolerance doses of the spinal cord. (orig.)
Meta-analysis of internet-delivered interventions to increase physical activity levels
Directory of Open Access Journals (Sweden)
Davies Cally A
Full Text Available Abstract Many internet-delivered physical activity behaviour change programs have been developed and evaluated. However, further evidence is required to ascertain the overall effectiveness of such interventions. The objective of the present review was to evaluate the effectiveness of internet-delivered interventions to increase physical activity, whilst also examining the effect of intervention moderators. A systematic search strategy identified relevant studies published in the English-language from Pubmed, Proquest, Scopus, PsychINFO, CINHAL, and Sport Discuss (January 1990 – June 2011. Eligible studies were required to include an internet-delivered intervention, target an adult population, measure and target physical activity as an outcome variable, and include a comparison group that did not receive internet-delivered materials. Studies were coded independently by two investigators. Overall effect sizes were combined based on the fixed effect model. Homogeneity and subsequent exploratory moderator analysis was undertaken. A total of 34 articles were identified for inclusion. The overall mean effect of internet-delivered interventions on physical activity was d = 0.14 (p = 0.00. Fixed-effect analysis revealed significant heterogeneity across studies (Q = 73.75; p = 0.00. Moderating variables such as larger sample size, screening for baseline physical activity levels and the inclusion of educational components significantly increased intervention effectiveness. Results of the meta-analysis support the delivery of internet-delivered interventions in producing positive changes in physical activity, however effect sizes were small. The ability of internet-delivered interventions to produce meaningful change in long-term physical activity remains unclear.
Mucosally delivered peptides prime strong immunity in HLA-A2.1 transgenic rabbits
Hu, Jiafen; Cladel, Nancy; Balogh, Karla; Christensen, Neil
DNA vaccines delivered subcutaneously by gene-gun have generated strong protective and therapeutic immunity in rabbits. Recent studies have shown that peptides delivered by the mucosal routes also stimulate local and systemic immune responses. Since mucosal delivery is easier to administer and more cost-effective when compared to gene-gun delivery, we were interested to learn whether mucosally-delivered peptides would prime protective immunity comparable to that of gene-gun delivered DNA in rabbits. Our newly developed HLA-A2.1 transgenic rabbit model was used to test the hypothesis. We chose an HLA-A2.1 restricted cottontail rabbit papillomavirus (CRPV) E1 epitope (E1/303–311, MLQEKPFQL) for the peptide immunization studies because it provided complete protection when used as a DNA vaccine. Adjuvant has been widely used to boost immunity for vaccines. In this study, three adjuvants reported to be effective for rabbits (TT helper motif, PADRE and CpG2007) were tested with the peptide vaccine. Peptide alone or fused to TT helper or PADRE to create chimeric peptides was delivered by two mucosal routes (ocular and intranasal) together. Partial protection was found in HLA-A2.1 transgenic rabbits when peptide was delivered mucosally in the presence of adjuvant. When a subsequent booster of a half dose of the corresponding DNA vaccine was delivered, complete protections were achieved. We conclude that mucosal peptide immunization can be combined with a single DNA vaccination to provide strong protective immunity in rabbits. PMID:20332046
The effect of support on internet-delivered treatment for insomnia: does baseline depression severity matter?
Lancee, Jaap; Sorbi, Marjolijn J; Eisma, Maarten C; van Straten, Annemieke; van den Bout, Jan
Internet-delivered cognitive-behavioral treatment is effective for insomnia. However, little is known about the beneficial effects of support. Recently we demonstrated that motivational support moderately improved the effects of Internet-delivered treatment for insomnia. In the present study, we tested whether depressive symptoms at baseline moderate the effect of support on Internet-delivered treatment for insomnia. We performed a multilevel intention-to-treat analysis on 262 participants in a randomized controlled trial. We found that baseline depressive symptoms moderated the effect of support on sleep efficiency, total sleep time, and sleep onset latency (but not on wake after sleep onset, number of nightly awakenings, or the Insomnia Severity Index). This means that for these variables, people with high levels of depressive symptoms benefit from support, whereas people with low levels of depressive symptoms improve regardless of support. The data show that baseline depression severity plays an important role in the way Internet treatments need to be delivered. These findings open up opportunities to personalize the support offered in Internet-delivered treatments. Copyright © 2014. Published by Elsevier Ltd.
Clinician proficiency in delivering manual treatment for neck pain within specified force ranges.
Gudavalli, Maruti Ram; Vining, Robert D; Salsbury, Stacie A; Corber, Lance G; Long, Cynthia R; Patwardhan, Avinash G; Goertz, Christine M
Neck pain is a common musculoskeletal complaint responsive to manual therapies. Doctors of chiropractic commonly use manual cervical distraction, a mobilization procedure, to treat neck pain patients. However, it is unknown if clinicians can consistently apply standardized cervical traction forces, a critical step toward identifying an optimal therapeutic dose. To assess clinicians' proficiency in delivering manually applied traction forces within specified ranges to neck pain patients. An observational study nested within a randomized clinical trial. Two research clinicians provided study interventions to 48 participants with neck pain. Clinician proficiency in delivering cervical traction forces within three specified ranges (low force, less than 20 N; medium force, 21-50 N; and high force 51-100 N). Participants were randomly allocated to three force-based treatment groups. Participants received five manual cervical distraction treatments over 2 weeks while lying prone on a treatment table instrumented with force sensors. Two clinicians delivered manual traction forces according to treatment groups. Clinicians treated participants first without real-time visual feedback displaying traction force and then with visual feedback. Peak traction force data were extracted and descriptively analyzed. Clinicians delivered manual cervical distraction treatments within the prescribed traction force ranges 75% of the time without visual feedback and 97% of the time with visual feedback. This study demonstrates that doctors of chiropractic can successfully deliver prescribed traction forces while treating neck pain patients, enabling the capability to conduct force-based dose response clinical studies. Copyright © 2015 Elsevier Inc. All rights reserved.
Helping clinicians deliver consistent HIV prevention counseling to their HIV-infected patients.
Myers, Janet J; Kang Dufour, Mi-Suk; Koester, Kimberly A; Rose, Carol Dawson; Shade, Starley B; Maiorana, Andres; Morin, Stephen F
The delivery of HIV risk assessment and behavioral counseling by clinicians in HIV clinical settings is one component in a comprehensive "positive prevention" strategy to help patients reduce their transmission risk behavior. Clinicians engage in behavioral prevention inconsistently, however, depending on whether patients are new to a practice or are established in regular care and on their attitudes and characteristics of their practices. We analyzed clinician reports of behavioral prevention delivered before and after participation in a large federal demonstration project of positive prevention interventions. The interventions that were part of this project were successful in increasing behavioral prevention among both new and returning patients. Prior to study interventions, clinicians reported counseling 69% of new patients and 52% of returning patients. In follow-up interviews 12 months after receiving training, clinicians reported delivering prevention messages to 5% more new patients and 9% of returning patients (both phelp clinicians more consistently deliver behavioral prevention messages to their HIV-infected patients.
Comparison of radiation delivered by current diagnostic procedures for herniated disc
Energy Technology Data Exchange (ETDEWEB)
Gasquet, C.; Drouineau, J.; Goubault, F.; Hurmic, A.; Lavigne, B.; Vandermarcq, P. (Hopital Jean-Bernard, 86 - Poitiers (France))
Three methods are currently employed for the diagnosis of sciatica due to disc lesions: radiculography, spinal phlebography, and computed tomography. Though their indications vary according to the author, it seemed worthwhile to compare radiation delivered by each of them, because of the often young age of the patients. Dosimetric studies using a Rando Phantom enabled calculation of doses to the skin, spinal cord, and gonads. Results indicated that low doses were delivered by the scanner, relatively high doses by spinal phlebography, and intermediate doses by radiculography. These findings suggest that the initial examination preoperatively in cases of simple sciatica due to herniated disc should be a CT scan whenever possible. Phlebography, on the contrary, and particularly in young women, should be used only exceptionally, as a result of the high doses delivered to the ovaries even during technically simple explorations.
SU-E-J-21: Advantages of Ultra Fast Radiation Dose Delivering
Energy Technology Data Exchange (ETDEWEB)
Feng, Y [DCH Reg. Medical Center, Tuscaloosa, AL (United States)
Purpose: For delivering conformed dose to a moving tumor and sparing normal tissue, we presented an innovation that was combined a linear accelerator and a storage ring to generate ultra high dose rate. This innovation allows delivering prescribed dose to a moving target in such a short time period, for an example 0.1 second, during which the displacement of the target could be ignored. Methods: The advantages of this approach were evaluated based on normal tissue sparing, feasibility, accuracy, and time saving in clinical treatment. The target volume reduction with this innovation approach was demonstrated by analyzing the values of GTVs, ITVs, and PTVs obtained from 15 patients who had been diagnosed with malignant neoplasm of lung and treated with SBRT. The processes of SBRT treatment were investigated and advantages of this innovation in improving SBRT lung treatment were evaluated. Results: With the ultra-high dose rate, the target volumes could be reduced by ∼30% to 50%. The innovation combining with IGRT technique could deliver prescribed dose to moving target accurately with simpler procedures than that of adaptive approach. This new approach could reduce the time of guiding treatment by many times. The new technique make a new strategy became feasible that was to deliver the dose to a target when it moved to a desirable location, such as away from critical organs. Conclusion: Combining with IGRT technique, this innovation could significantly improve the accuracy to deliver dose to moving targets with a shorter time than conventional techniques. The innovation opens a door for new strategies to deliver dose to moving targets.
Clients' safe food-handling knowledge and risk behavior in a home-delivered meal program.
Almanza, Barbara A; Namkung, Young; Ismail, Joseph A; Nelson, Douglas C
To determine typical handling practices of home-delivered meals, and provide appropriate handling instructions to reduce the risk of foodborne illness by improving consumer handling of home-delivered meals. Once permission was given by the home-delivered meal site directors, clients were provided a voluntary survey and requested by the delivery drivers to complete the self-administered questionnaire. The completed questionnaire was collected by the driver the following day. Because of the special needs of the home-delivered meal populations, the questionnaire was made as easy and convenient to answer as possible. Two hundred fifty-eight male clients (31%) and 575 female clients (69%) whose mean age was 79 years participated in the study. The respondents' safe food-handling practices, food safety knowledge, and demographic information were assessed. Average time for delivery and consumption of meals were also measured. Descriptive statistics (frequency and chi(2) test) of the participants' handling of home-delivered meals, their general food safety knowledge, and demographic information were reported. Delivery time and consumption time were calculated for each subject. Five hundred thirty-six of 869 clients (63%) reported that they ate their meals as soon as they were delivered. Of those clients who did not eat their meals immediately, 234 (82%) stored the cold food in the refrigerator and 142 (58%) stored the hot food in the freezer. More than one-third of the clients (n=277, 35%) reported that they had leftovers and only 34 (15%) ate the leftovers within 2 hours. Significant differences among groups on the basis of a derived food safety knowledge score were observed in terms of whether or not they ate their meal immediately (Pconsumed their meals an average of 1.22 hours after delivery. Time in conjunction with temperature can be used as a hazard control measure to reduce foodborne illness caused by improper food-handling procedures. Careful attention should be
Internet-Delivered Cognitive Behavioral Therapy to Treat Insomnia: A Systematic Review and Meta-Analysis.
Directory of Open Access Journals (Sweden)
Michael Seyffert
Full Text Available Insomnia is of major public health importance. While cognitive behavioral therapy is beneficial, in-person treatment is often unavailable. We assessed the effectiveness of internet-delivered cognitive behavioral therapy for insomnia.The primary objectives were to determine whether online cognitive behavioral therapy for insomnia could improve sleep efficiency and reduce the severity of insomnia in adults. Secondary outcomes included sleep quality, total sleep time, time in bed, sleep onset latency, wake time after sleep onset, and number of nocturnal awakenings.We searched PubMed/MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, PsycInfo, Cochrane Library, Embase, and the Web of Science for randomized trials.Studies were eligible if they were randomized controlled trials in adults that reported application of cognitive behavioral therapy for insomnia via internet delivery. Mean differences in improvement in sleep measures were calculated using the Hartung-Knapp-Sidik-Jonkman method for random effects meta-analysis.We found 15 trials, all utilizing a pretest-posttest randomized control group design. Sleep efficiency was 72% at baseline and improved by 7.2% (95% CI: 5.1%, 9.3%; p<0.001 with internet-delivered cognitive behavioral therapy versus control. Internet-delivered cognitive behavioral therapy resulted in a decrease in the insomnia severity index by 4.3 points (95% CI: -7.1, -1.5; p = 0.017 compared to control. Total sleep time averaged 5.7 hours at baseline and increased by 20 minutes with internet-delivered therapy versus control (95% CI: 9, 31; p = 0.004. The severity of depression decreased by 2.3 points (95% CI: -2.9, -1.7; p = 0.013 in individuals who received internet-delivered cognitive behavioral therapy compared to control. Improvements in sleep efficiency, the insomnia severity index and depression scores with internet-delivered cognitive behavioral therapy were maintained from 4 to 48 weeks after post
Internet-Delivered Cognitive Behavioral Therapy to Treat Insomnia: A Systematic Review and Meta-Analysis
Seyffert, Michael; Lagisetty, Pooja; Landgraf, Jessica; Chopra, Vineet; Pfeiffer, Paul N.; Conte, Marisa L.; Rogers, Mary A. M.
Background Insomnia is of major public health importance. While cognitive behavioral therapy is beneficial, in-person treatment is often unavailable. We assessed the effectiveness of internet-delivered cognitive behavioral therapy for insomnia. Objectives The primary objectives were to determine whether online cognitive behavioral therapy for insomnia could improve sleep efficiency and reduce the severity of insomnia in adults. Secondary outcomes included sleep quality, total sleep time, time in bed, sleep onset latency, wake time after sleep onset, and number of nocturnal awakenings. Data Sources We searched PubMed/MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, PsycInfo, Cochrane Library, Embase, and the Web of Science for randomized trials. Methods Studies were eligible if they were randomized controlled trials in adults that reported application of cognitive behavioral therapy for insomnia via internet delivery. Mean differences in improvement in sleep measures were calculated using the Hartung-Knapp-Sidik-Jonkman method for random effects meta-analysis. Results We found 15 trials, all utilizing a pretest-posttest randomized control group design. Sleep efficiency was 72% at baseline and improved by 7.2% (95% CI: 5.1%, 9.3%; pinternet-delivered cognitive behavioral therapy versus control. Internet-delivered cognitive behavioral therapy resulted in a decrease in the insomnia severity index by 4.3 points (95% CI: -7.1, -1.5; p = 0.017) compared to control. Total sleep time averaged 5.7 hours at baseline and increased by 20 minutes with internet-delivered therapy versus control (95% CI: 9, 31; p = 0.004). The severity of depression decreased by 2.3 points (95% CI: -2.9, -1.7; p = 0.013) in individuals who received internet-delivered cognitive behavioral therapy compared to control. Improvements in sleep efficiency, the insomnia severity index and depression scores with internet-delivered cognitive behavioral therapy were maintained from 4 to
Web-PE: Internet-Delivered Prolonged Exposure Therapy for PTSD
Award Number: W81XWH-14-1-0008 TITLE: "Web-PE: Internet -Delivered Prolonged Exposure Therapy for PTSD PRINCIPAL INVESTIGATOR: Carmen P. McLean...2014 – 29 Sept 2015 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER W81XWH-14-1-0008 "Web-PE: Internet -Delivered Prolonged Exposure Therapy for PTSD 5b...Web-PE. Method: Feedback on the Web-PE prototype was sought from members of an expert advisory board and 10 military personnel. Beta-testing
The Multi-Agent Tactical Sentry: Designing and Delivering Robots to the CF
Technical Report DRDC Suffield TR 2008-148 August 2008 Designing and Delivering Robots to the CF J. Giesbrecht, S. Penzes, and B. Fairbrother...The Multi-Agent Tactical Sentry Designing and Delivering Robots to the CF J. Giesbrecht, S. Penzes, and B. Fairbrother Defence R&D...the Minister of National Defence, 2008 c© Sa Majesté la Reine (en droit du Canada), telle que représentée par le ministre de la Défense nationale
Internet-Delivered Interpersonal Psychotherapy Versus Internet-Delivered Cognitive Behavioral Therapy for Adults With Depressive Symptoms: Randomized Controlled Noninferiority Trial
Bennett, Kylie; Bennett, Anthony; Mackinnon, Andrew; van Straten, Annemieke; Cuijpers, Pim; Christensen, Helen; Griffiths, Kathleen M
Background Face-to-face cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) are both effective treatments for depressive disorders, but access is limited. Online CBT interventions have demonstrated efficacy in decreasing depressive symptoms and can facilitate the dissemination of therapies among the public. However, the efficacy of Internet-delivered IPT is as yet unknown. Objective This study examines whether IPT is effective, noninferior to, and as feasible as CBT when delivered online to spontaneous visitors of an online therapy website. Methods An automated, 3-arm, fully self-guided, online noninferiority trial compared 2 new treatments (IPT: n=620; CBT: n=610) to an active control treatment (MoodGYM: n=613) over a 4-week period in the general population. Outcomes were assessed using online self-report questionnaires, the Center for Epidemiological Studies Depression scale (CES-D) and the Client Satisfaction Questionnaire (CSQ-8) completed immediately following treatment (posttest) and at 6-month follow-up. Results Completers analyses showed a significant reduction in depressive symptoms at posttest and follow-up for both CBT and IPT, and were noninferior to MoodGYM. Within-group effect sizes were medium to large for all groups. There were no differences in clinical significant change between the programs. Reliable change was shown at posttest and follow-up for all programs, with consistently higher rates for CBT. Participants allocated to IPT showed significantly lower treatment satisfaction compared to CBT and MoodGYM. There was a dropout rate of 1294/1843 (70%) at posttest, highest for MoodGYM. Intention-to-treat analyses confirmed these findings. Conclusions Despite a high dropout rate and lower satisfaction scores, this study suggests that Internet-delivered self-guided IPT is effective in reducing depressive symptoms, and may be noninferior to MoodGYM. The completion rates of IPT and CBT were higher than MoodGYM, indicating some
Internet-delivered interpersonal psychotherapy versus internet-delivered cognitive behavioral therapy for adults with depressive symptoms: randomized controlled noninferiority trial.
Donker, Tara; Bennett, Kylie; Bennett, Anthony; Mackinnon, Andrew; van Straten, Annemieke; Cuijpers, Pim; Christensen, Helen; Griffiths, Kathleen M
Face-to-face cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) are both effective treatments for depressive disorders, but access is limited. Online CBT interventions have demonstrated efficacy in decreasing depressive symptoms and can facilitate the dissemination of therapies among the public. However, the efficacy of Internet-delivered IPT is as yet unknown. This study examines whether IPT is effective, noninferior to, and as feasible as CBT when delivered online to spontaneous visitors of an online therapy website. An automated, 3-arm, fully self-guided, online noninferiority trial compared 2 new treatments (IPT: n=620; CBT: n=610) to an active control treatment (MoodGYM: n=613) over a 4-week period in the general population. Outcomes were assessed using online self-report questionnaires, the Center for Epidemiological Studies Depression scale (CES-D) and the Client Satisfaction Questionnaire (CSQ-8) completed immediately following treatment (posttest) and at 6-month follow-up. Completers analyses showed a significant reduction in depressive symptoms at posttest and follow-up for both CBT and IPT, and were noninferior to MoodGYM. Within-group effect sizes were medium to large for all groups. There were no differences in clinical significant change between the programs. Reliable change was shown at posttest and follow-up for all programs, with consistently higher rates for CBT. Participants allocated to IPT showed significantly lower treatment satisfaction compared to CBT and MoodGYM. There was a dropout rate of 1294/1843 (70%) at posttest, highest for MoodGYM. Intention-to-treat analyses confirmed these findings. Despite a high dropout rate and lower satisfaction scores, this study suggests that Internet-delivered self-guided IPT is effective in reducing depressive symptoms, and may be noninferior to MoodGYM. The completion rates of IPT and CBT were higher than MoodGYM, indicating some progress in refining Internet-based self
Building Coping Skills on a Firm Foundation: Using a Metaphorical Interface To Deliver Stress Management Instruction.
Berkley, Jeannette; Cates, Ward Mitchell
This paper examines the benefits of a metaphorical graphical user interface (GUI) and discusses how metaphorical interfaces can be used to deliver instruction on stress management. A computer-based instructional (CBI) program for college students was developed on the fundamentals of stress and the role of time management as a coping strategy. The…
Delivering on Equity: Implications for Decision-Makers. Issue Brief #1
Stonemeier, Jennifer; Trader, Barb; Richards, Curtis; Blank, Rolf; East, Bill; Toson, Amy
The SWIFT Center will demonstrate how schools can be transformed to provide inclusive educational opportunities for all students. The SWIFT Center will address the key American goal of equal educational opportunity by assisting schools to reorganize in ways that enable them to fully deliver on inclusive, general education for all…
Comparison of Hair Cortisol Levels and Perceived Stress in Mothers Who Deliver at Preterm and Term.
Duffy, Allyson R; Schminkey, Donna L; Groer, Maureen W; Shelton, Melissa; Dutra, Samia
To evaluate relationships between hair cortisol levels and perceived stress in mothers who deliver preterm and term. We hypothesized that the rate of change in cortisol levels would be greater in the preterm delivery group. This preliminary study compared hair cortisol levels and Perceived Stress Scale (PSS) scores in predominately Caucasian mothers who delivered preterm ( n = 22) and term ( n = 30). We collected PSS and hair samples of ≥10 cm in length from mothers after delivery. Hair was segmented into three sections, and cortisol was measured using enzyme-linked immunosorbent assay. The mean gestational age was 31.45 ( SD = 4.2) weeks for preterm deliveries and 39.45 ( SD = 1.1) for term. Cortisol differed significantly in the third trimester between mothers delivering term and preterm ( t = 2.16, df = 48, p = .04) and trended toward significance in the second trimester ( t = 1.88, df = 48, p = .06). PSS differed significantly between the two groups ( t = -2.96, df = 50, p = .05). Our data did not provide support for our hypothesis. There appeared to be a blunted, flattened pattern of change in cortisol levels across gestation in the women who delivered preterm, suggesting diminished hypothalamic-pituitary-adrenal axis responsiveness in mechanisms that promote preterm labor. Future studies are needed to further evaluate best strategies for measuring the mechanisms of allostatic load during pregnancy along with the psychoneuroendocrine and immune triggers and placental responses that lead to premature birth.
Exploratory Research to Design a School Nurse-Delivered Intervention to Treat Adolescent Overweight and Obesity
Gellar, Lauren; Druker, Sue; Osganian, Stavroula K.; Gapinski, Mary Ann; LaPelle, Nancy; Pbert, Lori
Objective: In preparation for a pilot study to evaluate the efficacy of a school nurse-delivered intervention, focus groups were conducted to gain insight into the perceptions of stakeholders regarding the design and implementation of the intervention. Setting and Participants: Fifteen focus groups at participating schools. One hundred subjects,…
Internet-delivered cognitive behavior therapy for anxiety disorders is here to stay
Andrews, Gavin; Newby, Jill M; Williams, Alishia D
Anxiety disorders are common and disabling. Cognitive behavior therapy is the treatment of choice but is often difficult to obtain. Automated, internet-delivered, cognitive behavior therapy (iCBT) courses may be an answer. There are three recent systematic reviews of randomized controlled trials
Rural Redesign: Delivering Online Professional Development for Rural Teachers of ESL
Manner, Jane Carol; Rodriguez, Diane
This study reports the progress of a project in a teacher education program designed to deliver professional development to rural teachers through an online format addressing ESOL (English for speakers of other languages). Funded by a Professional Development Grant from the OELA (Office of English Language Acquisition) of the United States…
Non-physician delivered intravitreal injection service is feasible and safe
DEFF Research Database (Denmark)
Rasul, Asrin; Subhi, Yousif; Sørensen, Torben Lykke
outcome based on non-physician delivered intravitreal therapy regardless of the study design. Being non-physician was defined as the injecting personnel not being a physician, but no further restrictions were made. RESULTS: Five studies were included with a total of 31,303 injections having been performed...
78 FR 54612 - Closed Captioning of Internet Protocol-Delivered Video Programming: Implementation of the Twenty...
... From the Federal Register Online via the Government Publishing Office FEDERAL COMMUNICATIONS COMMISSION 47 CFR Part 79 Closed Captioning of Internet Protocol-Delivered Video Programming: Implementation of the Twenty-First Century Communications and Video Accessibility Act of 2010 AGENCY: Federal...
Fractured long bones in a term infant delivered by cesarian section
Energy Technology Data Exchange (ETDEWEB)
Kaplan, M.; Dollberg, M.; Wajntraub, G.; Itzchaki, M.
A term infant was delivered uneventfully by repeat cesarian section. At the age of 1 week there was clinical and radiographic evidence of fractures of the left tibia and right radius. The fractures most likely occurred during the cesarian section. Birth trauma should not be excluded on the basis of cesarian section delivery.
Innovative model of delivering quality improvement education for trainees – a pilot project
Directory of Open Access Journals (Sweden)
Kannan Ramar
Full Text Available Background: After incorporating quality improvement (QI education as a required curriculum for our trainees in 2010, a need arose to readdress our didactic sessions as they were too long, difficult to schedule, and resulting in a drop in attendance. A 'flipped classroom' (FC model to deliver QI education was touted to be an effective delivery method as it allows the trainees to view didactic materials on videos, on their own time, and uses the classroom to clarify concepts and employ learned tools on case-based scenarios including workshops. Methods: The Mayo Quality Academy prepared 29 videos that incorporated the previously delivered 17 weekly didactic sessions, for a total duration of 135 min. The half-day session clarified questions related to the videos, followed by case examples and a hands-on workshop on how to perform and utilize a few commonly used QI tools and methods. Results: Seven trainees participated. There was a significant improvement in knowledge as measured by pre- and post-FC model test results [improvement by 40.34% (SD 16.34, p<0.001]. The survey results were overall positive about the FC model with all trainees strongly agreeing that we should continue with this model to deliver QI education. Conclusions: The pilot project of using the FC model to deliver QI education was successful in a small sample of trainees.
Therapist Factors in Internet-Delivered Cognitive Behavioural Therapy for Major Depressive Disorder
Almlov, J.; Carlbring, P.; Berger, T.; Cuijpers, P.; Andersson, G.
Internet-delivered cognitive behavioural therapy (CBT) can be an effective method for treating major depression, but it often works best when therapist support is provided in the form of e-mail support or telephone calls. The authors investigated whether there were any intraclass correlations within
Mobile Phone-Delivered Cognitive Behavioral Therapy for Insomnia : A Randomized Waitlist Controlled Trial
Horsch, C.H.G.; Lancee, J; Griffioen-Both, Fiemke; Spruit, Sandor; Fitrianie, S.; Neerincx, M.A.; Beun, RJ; Brinkman, W.P.
Background: This study is one of the first randomized controlled trials investigating cognitive behavioral therapy for insomnia (CBT-I) delivered by a fully automated mobile phone app. Such an app can potentially increase the accessibility of insomnia treatment for the 10% of people who have
Mobile Phone-Delivered Cognitive Behavioral Therapy for Insomnia : A Randomized Waitlist Controlled Trial
Horsch, C.H.G.; Lancee, J.; Griffioen-Both, F.; Spruit, S.; Fitrianie, S.; Neerincx, M.A.; Beun, R.J.; Brinkman, W.-P.
Background: This study is one of the first randomized controlled trials investigating cognitive behavioral therapy for insomnia (CBT-I) delivered by a fully automated mobile phone app. Such an app can potentially increase the accessibility of insomnia treatment for the 10% of people who have
Delivering Software Process-Specific Project Courses in Tertiary Education Environment: Challenges and Solution
Rong, Guoping; Shao, Dong
The importance of delivering software process courses to software engineering students has been more and more recognized in China in recent years. However, students usually cannot fully appreciate the value of software process courses by only learning methodology and principle in the classroom. Therefore, a process-specific project course was…
Academic Performance, Age, Gender, and Ethnicity in Online Courses Delivered by Two-Year Colleges
Jost, Bruce; Rude-Parkins, Carolyn; Githens, Rod P.
This study investigated the effects the demographic variables age, gender, and ethnicity and their interactions had on academic performance in online courses delivered by public two-year colleges in Kentucky. The study controlled for previous academic performance measured by cumulative grade point average (GPA). The study used a random sample (N =…
Determining transthoracic impedance, delivered energy, and peak current during defibrillation episodes.
Jones, V C; Charbonnier, F M; Long, P
A simplified method has been developed to determine peak current, transthoracic impedance, and delivered energy during a damped sinusoidal defibrillation pulse. The discharge waveform information is generated from sampling the peak discharge current through a current transformer and measuring the voltage stored on the energy storage capacitor. For a given defibrillator circuit a unique relationship exists between the peak discharge current IM and the unknown external impedance Rext presented to the defibrillator by the patient; hence, measurement of IM allows calculation of Rext. A microprocessor-controlled algorithm provides delivered energy information using known internal resistance, capacitance, and inductance parameters. The benefit of this method of delivered energy calculation is that the current and voltage waveforms need not be digitized and then integrated to provide the desired information. This method also keeps defibrillation circuitry ground isolated and simplifies operation through the high electromagnetic fields generated during the discharge. The delivered energy information, along with time, date, and other patient parameters, is documented automatically with an annotation strip-chart recorder.
Distributed mode filtering rod fiber amplifier delivering 292W with improved mode stability
DEFF Research Database (Denmark)
Laurila, Marko; Jørgensen, Mette Marie; Hansen, Kristian Rymann
We demonstrate a high power fiber (85μm core) amplifier delivering up to 292Watts of average output power using a mode-locked 30ps source at 1032nm. Utilizing a single mode distributed mode filter bandgap rod fiber, we demonstrate 44% power improvement before the threshold-like onset of mode...
Using Adobe Connect to Deliver Online Library Instruction to the RN to BSN Program
Carlson, Kathleen
This paper takes a look at how one academic health sciences librarian brought mediated literature searching to the distance RN to BSN nursing students. It takes a look at why Adobe Connect was the webinar software that was selected to deliver online instruction to the students. The article explains how students participated in a pre-class survey…
Behavioral Activation Treatment for Depression in Older Adults Delivered via Videoconferencing: A Pilot Study
Lazzari, Claudia; Egan, Sarah J.; Rees, Clare S.
Depression affects up to 25% of older adults. Underdetection and subsequent undertreatment of depression in older adults has been attributed in part to difficulties in older adults being able to access treatment. This uncontrolled pilot study, N = 3, explored the acceptability and efficacy of a brief behavioral activation treatment delivered via…
The Use of E-Mail to Deliver Performance-Based Feedback to Early Childhood Practitioners
Barton, Erin E.; Pribble, Lois; Chen, Ching-I
Three studies are described that examined the relation between performance-based (PB) feedback delivered via e-mail and preschool teachers' use of recommended practices. The authors conducted the first two studies in the same classroom with different classroom staff. The third study was conducted with three different teachers employed in…
7 CFR 1488.9a - Evidence of export for commodities delivered before export.
... Stocks Under CCC Export Credit Sales Program (GSM-5) Documents Required for Financing § 1488.9a Evidence... 7 Agriculture 10 2010-01-01 2010-01-01 false Evidence of export for commodities delivered before export. 1488.9a Section 1488.9a Agriculture Regulations of the Department of Agriculture (Continued...
Effects of a Guided Internet-Delivered Self-Help Intervention for Adolescents With Chronic Pain.
Voerman, J.S.; Remerie, S.; Westendorp, T.; Timman, R.; Busschbach, J.J.V.; Passchier, J.; de Klerk, C.
Cognitive-behavioral therapy (CBT) is effective in reducing the frequency and intensity of chronic pain in adolescents. However, CBT seems not to be considered acceptable by all adolescents. The main aim of our study was therefore to evaluate the effects of guided Internet-delivered self-help for
Training community therapists to deliver cognitive behavioral therapy in the aftermath of disaster.
Hamblen, Jessica L; Norris, Fran H; Gibson, Laura; Lee, Linda
In this paper we examine the effectiveness of disseminating Cognitive Behavioral Therapy for Postdisaster Distress (CBT-PD) to community therapists in Baton Rouge, Louisiana following Hurricane Katrina. One hundred four therapists attended a two-day training in CBT-PD with on-going case consultation. Pre- and post-training, therapists rated eight core cognitive behavioral therapy elements on their importance, how well they understood how to deliver the element, and how confident they were in their ability to deliver the element. Post-training they completed a CBT-PD knowledge questionnaire and session fidelity forms. Seventy-seven clients completed satisfaction questionnaires and reported on how often they utilized the skills taught in CBT-PD. Therapists showed significant improvements in their ratings of the importance of various elements of cognitive behavioral therapy, their knowledge and understanding of those elements, and their confidence that they could use them effectively. Immediately following the training 90% of therapists demonstrated excellent retention of CBT-PD. Self-report measures from both therapists and clients indicated that critical session elements were delivered. This work suggests that CBT-PD can be applied in a real-world setting and that community therapists can be trained in relatively short time spans with on-going support. This finding is especially important in the disaster field given that communities are likely to find themselves in emergency situations in which a number of non-expert trauma therapists will need to deliver trauma services.
Delivering the Goods : Scaling out Results of Natural Resource Management Research
Harrington, L.; White, J.; Grace, P.; Hodson, D.; Hartkamp, A.D.; Vaughan, C.; Meisner, C.
To help integrated natural resource management (INRM) research "deliver the goods" for many of the world's poor over a large area and in a timely manner, the authors suggest a problem-solving approach that facilitates the scaling out of relevant agricultural practices. They propose seven ways to
An Efficient and Flexible Technical Approach to Develop and Deliver Online Peer Assessment
Miao, Yongwu; Koper, Rob
Miao, Y., & Koper, R. (2007). An Efficient and Flexible Technical Approach to Develop and Deliver Online Peer Assessment. In C. A. Chinn, G. Erkens & S. Puntambekar (Eds.), Proceedings of the 7th Computer Supported Collaborative Learning (CSCL 2007) conference 'Mice, Minds, and Society' (pp.
The $500 Million Question: Can Charter Management Organizations Deliver Quality Education at Scale?
Hall, Kevin; Lake, Robin
Charter school management organizations (CMOs) have emerged as a popular means for bringing charter schooling to scale. Advocates credit CMOs with delivering a coherent model of charter schooling to a growing number of children across numerous sites. Skeptics have wondered whether CMOs constitute an effective management approach, whether they…
Developing Effective Training Skills. A Practical Guide to Designing and Delivering Group Training. Second Edition.
Pont, Tony
This book provides an overview of training in business along with a step-by-step guide for trainers to use in designing and presenting training programs for adults. The 10 chapters cover the following: (1) the training field--what it is; (2) designing the course; (3) delivering the course--the start-up; (4) learning theory; (5) course members; (6)…
Views of Freshmen Students on Foreign Language Courses Delivered via E-Learning
Ozudogru, Fatma; Hismanoglu, Murat
With the increasing number of foreign language courses via e-learning in higher education institutions, it is important to investigate whether the quality of e-learning is up to the standard. This study aimed at finding out the views of freshmen students on foreign language courses delivered via e-learning and revealing whether there were any…
Qualitative assessment of adolescents' views about improving exposure to internet-delivered interventions
Crutzen, R.; de Nooijer, J.; Brouwer, W.; Oenema, A.; Brug, J.
Purpose - The purpose of this paper is to gain first insight into factors which might be associated with exposure to internet-delivered interventions. Design/methodology/approach - Semi-structured focus group interviews were conducted with five groups of Dutch adolescents (n=54), aged 12-17 years.
The Perceived Importance of Youth Educator's Confidence in Delivering Leadership Development Programming
Brumbaugh, Laura; Cater, Melissa
A successful component of programs designed to deliver youth leadership develop programs are youth educators who understand the importance of utilizing research-based information and seeking professional development opportunities. The purpose of this study was to determine youth educator's perceived confidence in leading youth leadership…
Night Gallery: An Innovative Multimedia Strategy for Delivering a General Microbiology Lecture
Dahl, John; Mixter, Phil
In delivering a core science course to pre-health-related majors, the authors sought ways to engage students, make material relevant to life-long learning, and present it in a memorable way. Their goals were to present scientific content fused with history, ethics, public policy, and art in such a way that the students would be provided a unique…
Barriers of delivering oral health care to older people experienced by dentists: a systematic literature review
Bots-Vantspijker, P.C.; Vanobbergen, J.N.; Schols, J.M.; Schaub, R.M.; Bots, C.P.; Baat, C. de
OBJECTIVE: To identify barriers of delivering oral health care to older people experienced by dentists. METHODS: A comprehensive literature search was carried out for studies published in the period January 1990-December 2011, using free text and MESH term search strategies for PubMed (Medline),
Barriers of delivering oral health care to older people experienced by dentists : a systematic literature review
Bots-VantSpijker, Pieternella C.; Vanobbergen, Jacques N. O.; Schols, Jos M. G. A.; Schaub, Rob M. H.; Bots, Casper P.; de Baat, Cees
Objective To identify barriers of delivering oral health care to older people experienced by dentists. Methods A comprehensive literature search was carried out for studies published in the period January 1990-December 2011, using free text and MESH term search strategies for PubMed (Medline),
Enhancing Foreign Language Learning through Listening Strategies Delivered in L1: An Experimental Study
Bozorgian, Hossein; Pillay, Hitendra
Listening used in language teaching refers to a complex process that allows us to understand spoken language. The current study, conducted in Iran with an experimental design, investigated the effectiveness of teaching listening strategies delivered in L1 (Persian) and its effect on listening comprehension in L2. Five listening strategies:…
Evaluation of monophosphoryl lipid A as adjuvant for pulmonary delivered influenza vaccine
Patil, Harshad P.; Murugappan, Senthil; Ter Veer, Wouter; Meijerhof, Tjarko; De Haan, Aalzen; Frijlink, Henderik W.; Wilschut, Jan; Hinrichs, Wouter L.J.; Huckriede, Anke
Prophylaxis against influenza could be improved by the development of a stable, easy to deliver, potent mucosal vaccine. In this study, we spray-freeze-dried (SFD) whole inactivated virus influenza vaccine (WIV) alone or supplemented with monophosphoryl lipid A (MPLA) using inulin as a
A Holistic Approach to Delivering Sustainable Design Education in Civil Engineering
Vemury, Chandra Mouli; Heidrich, Oliver; Thorpe, Neil; Crosbie, Tracey
Purpose: The purpose of this paper is to present pedagogical approaches developed and implemented to deliver sustainable design education (SDE) to second-year undergraduate students on civil engineering programmes in the (then) School of Civil Engineering and Geosciences at Newcastle University. In doing so, the work presented offers an example of…
Vendors Future: Northern Light--Delivering High-Quality Content to a Large Internet Audience.
Wiggins, Richard
Describes a Web-based information service, Northern Light, which demonstrates a new paradigm for serving large populations of users and delivering high-quality content on topics both general and narrow. Discusses performance of the search engine, search syntax, Northern Light's special collection, and pricing. (AEF)
Challenges in Delivering Green Building Projects : Unearthing the Transaction Costs (TCs)
Qian, K.; Chan, E.H.W.; Khalid, A.G.
Delivering green building (GB) projects involve some activities that are atypical in comparison with conventional buildings. Such new activities are characterized by uncertainty, and they incur hidden costs that have not been expected nor are they readily appreciated among the stakeholders. This
Delivering MBA Programs in Emerging Markets: The Challenge of National Culture
Jones, Stephanie
Increasingly, Western-style MBA programs are being delivered in emerging markets, as the developed countries become more and more saturated with MBAs and related offerings. This article, based on the global experience of the author in teaching and assessing MBA modules including thesis and dissertation research and writing, suggests approaches to…
Quantification of the force systems delivered by transpalatal arches activated in the six Burstone geometries
DEFF Research Database (Denmark)
Sakima, Maurício Tatsuei; Dalstra, Michel; Loiola, Angelo Vicentini
Identification machine that recorded the deactivation forces and moments delivered by both terminal ends of the TPAs. Results: The overall force system with the actual values of forces and moments recorded by each type of activation was illustrated and compared with the mathematical model reported by Burstone...
Non-Dam Alternatives for Delivering Water Services at Least Cost and Risk
Directory of Open Access Journals (Sweden)
Michael P. Totten
We present evidence that a value-adding and risk-minimising water planning process can be achieved by shifting from the conventional focus on supply expansion to one that concentrates on efficiently delivering services at and near the point of use. The State of California has two decades of experience with this approach, demonstrating that market-based policy and regulatory innovations can unleash efficiency gains resulting in more utility water services and energy services delivered with less supply expansion at lower costs, while minimising climate-change risk, pollution and the social cost that accompany large infrastructural projects. Efficiency in delivered water services could be accomplished with investments in the range of US$10-25 billion annually, while obviating the need for spending hundreds of billions of dollars on more expensive hydropower and related infrastructural expansion projects. The shift to a regulatory system that encompasses cost-effective end-use efficiency improvements in delivering water and energy services could eliminate the need for an estimated half of all proposed dams globally, thus allowing for the maintenance of other ecosystem service benefits and offer the best hopes of meeting basic human needs for water at a more achievable level of investment.
Using Desktop Videoconferencing to Deliver Interventions to a Preschool Student with Autism
Gibson, Jason L.; Pennington, Robert C.; Stenhoff, Donald M.; Hopper, Jessica S.
The purpose of this study is to evaluate the impact of functional communication training on elopement when consultation support is delivered via desktop videoconferencing. An ABAB design was used to evaluate the effectiveness of functional communication training to reduce the elopement of a preschool student with autism. Intervention development,…
European Society of Cardiology Heart Failure Association Standards for delivering heart failure care
McDonagh, Theresa A.; Blue, Lynda; Clark, Andrew L.; Dahlstroem, Ulf; Ekman, Inger; Lainscak, Mitja; McDonald, Kenneth; Ryder, Mary; Stroemberg, Anna; Jaarsma, Tiny
The management of heart failure (HF) is complex. As a consequence, most cardiology society guidelines now state that HF care should be delivered in a multiprofessional manner. The evidence base for this approach now means that the establishment of HF management programmes is a priority. This
Engaging Micro-Businesses: A Guide for Learning Providers Delivering Skills Provision for Unemployed Adults
National Institute of Adult Continuing Education, 2012
This guide is primarily aimed at skills providers for unemployed adults, but will also be of interest to learning providers that wish to engage micro-businesses for the purpose of delivering other forms of provision such as apprenticeships and work-based learning through full cost recovery. The National Institute of Adult Continuing Education…
A designerly approach to enable organizations to deliver product-service systems
De Lille, C.S.H.; Roscam Abbing, E.; Kleinsmann, M.S.
Design is not only just for products, logo's or websites anymore. More and more companies are embracing design as a way to enable their organization to adapt to changes in society. One of the challenges many organizations face at the moment is how to create value for their customers by delivering
Subjective Probability of Receiving Harm as a Function of Attraction and Harm Delivered.
Schlenker, Barry R.; And Others
It was hypothesized that subjects who liked a source of potential harm would estimate the probability of receiving harm mediated by him as lower than would subjects who disliked the source. To test the hypothesis, subjects were asked to estimate the probability that a liked or disliked confederate would deliver an electric shock on each of 10…
Cost Analysis of Chronic Disease Self-Management Programmes Being Delivered in South Florida
Page, Timothy F.; Palmer, Richard C.
Background: Chronic disease accounts for the majority of healthcare costs. The Chronic Disease Self-Management Programme (CDSMP) has been shown to be effective in reducing the burden of chronic disease. Objectives: The objective of this study was to measure the cost of delivering the Chronic Disease Self-Management Programme (CDSMP) in order to…
Preliminary efficacy of a computer-delivered HIV prevention intervention for African American teenage females.
Klein, Charles H; Card, Josefina J
This study translated SiHLE (Sisters Informing, Healing, Living, and Empowering), a 12-hour Centers for Disease Control and Prevention evidence-based group-level intervention for African American females 14-18 years of age, into a 2-hour computer-delivered individual-level intervention. A randomized controlled trial (n = 178) was conducted to examine the efficacy of the new Multimedia SiHLE intervention. Average condom-protected sex acts (proportion of vaginal sex acts with condoms, last 90 days) for sexually active participants receiving Multimedia SiHLE rose from M = 51% at baseline to M = 71% at 3-month follow-up (t = 2.06, p = .05); no statistically significant difference was found in the control group. Non-sexually active intervention group participants reported a significant increase in condom self-efficacy (t = 2.36, p = .02); no statistically significant difference was found in the control group. The study provides preliminary support for the efficacy of a computer-delivered adaptation of a proven HIV prevention program for African American teenage women. This is consistent with meta-analyses that have shown that computer-delivered interventions, which can often be disseminated at lower per-capita cost than human-delivered interventions, can influence HIV risk behaviors in positive fashion.
Increasing Customer Service Behaviors Using Manager-Delivered Task Clarification and Social Praise
Rice, Anna; Austin, John; Gravina, Nicole
This project assessed an intervention to improve employee customer service behaviors (correct greetings and closing behaviors). A combination of task clarification and manager-delivered social praise resulted in increased correct greeting from 11.5% to 66% and correct closing from 8% to 70%. The effect was maintained at a 48-week follow-up for…
Targeting Misperceptions of Descriptive Drinking Norms: Efficacy of a Computer-Delivered Personalized Normative Feedback Intervention
Neighbors, Clayton; Larimer, Mary E.; Lewis, Melissa A.
The authors evaluated the efficacy of a computer-delivered personalized normative feedback intervention in reducing alcohol consumption among heavy-drinking college students. Participants included 252 students who were randomly assigned to an intervention or control group following a baseline assessment. Immediately after completing measures of…
85 μm core rod fiber amplifier delivering 350 W/m
DEFF Research Database (Denmark)
Johansen, Mette Marie; Michieletto, Mattia; Kristensen, Torben
An improved version of the distributed modal filtering (DMF) rod fiber is tested in a high power setup delivering 350 W/m of extracted signal average power limited by the available pump power. The rod fiber is thoroughly tested to record the transverse modal instability (TMI) behavior and also...
Technical Feasibility of Acoustic Coordinated Reset Therapy for Tinnitus Delivered via Hearing Aids: A Case Study
Directory of Open Access Journals (Sweden)
Christian Hauptmann
Full Text Available Primary tinnitus has a severe negative influence on the quality of life of a substantial portion of the general population. When acoustic coordinated reset (CR neuromodulation stimuli are delivered for several hours per day over several weeks a clinically significant symptom reduction in patients with primary tonal tinnitus has been reported by several clinical sites. Here, we reported the first case where CR neuromodulation was delivered through a hearing aid. A 52-year-old man with chronic primary tonal tinnitus was previously considered untreatable with sound therapy. He initially received the classic CR treatment protocol with signals delivered with the separate proprietary device with his hearing aids removed during treatment. He was subsequently treated with the therapy being deployed through a set of contemporary hearing aids. After 5 months of classic CR treatment with the separate custom device, the THI and VASL/A scores worsened by 57% and 13%/14%, respectively. Using the hearing aid without CR treatment for 5 months no change in tinnitus symptoms was observed. However, after three months of CR treatment delivered through the hearing aids, the THI and VASL/A scores were reduced by 70% and 32%/32%, respectively.
Instructors' Technology Experience and iPad Delivered Intervention Implementation: A Mixed Methods Replication Study
Shanley, Lina; Strand Cary, Mari; Clarke, Ben; Guerreiro, Meg A.; Thier, Michael
Instructor facilitation is an essential element in the successful implementation of technology-based interventions in authentic school settings. This manuscript reports results from two studies conducted during the development of KinderTEK, an iPad delivered kindergarten mathematics intervention, to determine the relationship between…
Delivering Left-Skewed Portfolio Payoff Distributions in the Presence of Transaction Costs
Directory of Open Access Journals (Sweden)
Jacek B Krawczyk
Full Text Available For pension-savers, a low payoff is a financial disaster. Such investors will most likely prefer left-skewed payoff distributions over right-skewed payoff distributions. We explore how such distributions can be delivered. Cautious-relaxed utility measures are cautious in ensuring that payoffs don't fall much below a reference value, but relaxed about exceeding it. We find that the payoff distribution delivered by a cautious-relaxed utility measure has appealing features which payoff distributions delivered by traditional utility functions don't. In particular, cautious-relaxed distributions can have the mass concentrated on the left, hence be left-skewed. However, cautious-relaxed strategies prescribe frequent portfolio adjustments which may be expensive if transaction costs are charged. In contrast, more traditional strategies can be time-invariant. Thus we investigate the impact of transaction costs on the appeal of cautious-relaxed strategies. We find that relatively high transaction fees are required for the cautious-relaxed strategy to lose its appeal. This paper contributes to the literature which compares utility measures by the payoff distributions they produce and finds that a cautious-relaxed utility measure will deliver payoffs that many investors will prefer.
Experiences of non-adherence to Internet-delivered cognitive behavior therapy: A qualitative study
Directory of Open Access Journals (Sweden)
Olof Johansson
Full Text Available Many trials on Internet-delivered psychological treatments have had problems with nonadherence, but not much is known about the subjective reasons for non-adhering. The aim of this study was to explore participants' experiences of non-adherence to Internet-delivered psychological treatment. Grounded theory was used to analyze data from seven in-depth interviews with persons who had non-adhered to a study on Internet-delivered cognitive behavioral therapy for generalized anxiety disorder. The process of non-adherence is described as an interaction between patient factors and treatment factors. A working model theory was generated to illustrate the experience of nonadherence. The model describes a process where treatment features such as workload, text-content complexity and treatment process don't match personal prerequisites regarding daily routines, perceived language skills and treatment expectations respectively, resulting in the decision to nonadhere. Negative effects were also stated as a reason for non-adherence. Several common strategies used for increasing adherence to Internet-delivered therapy in general are by these non-completers regarded as factors directly related to their reason for non-adherence.
Preparedness of South African deep rural SMMEs to deliver e-government services to local communities
CSIR Research Space (South Africa)
Dlodlo, N
Full Text Available This paper reports on a research to assess the readiness of Small, Medium and Micro Enterprises (SMMEs) to deliver e-government services to deep rural communities through information dissemination by the SMMEs. This research was conducted as a case...
Nutrition risk factors among home delivered and congregate meal participants: need for enhancement of nutrition education and counseling among home delivered meal participants.
Wunderlich, S; Bai, Y; Piemonte, J
The short-term impact of nutrition education and counseling intervention on nutrition risk factors among home delivered (HDM) and congregate (CGM) meal participants using Nutrition Survey Risk Screening was studied. A two-year intervention was conducted with 355 participants (n=259 CGM, n=96 HDM). Various nutrition behaviors that affect the nutrition risk score were compared. Congregate and home delivered meal locations in a northern county of New Jersey. CGM and HDM participants in a northern county of New Jersey age 60 and older. CGM participants received regular topical nutrition education and counseling in a classroom format with cooking demo, discussion, and handouts. The HDM participants only received the printed material (same handouts) and counseling by telephone. Demographics, medical condition, risk factors data were collected. All participants completed the 12 items checklist Nutrition Survey Risk Screening. Nutritional behaviors assessed include number of meals eaten per day, servings of fruits and vegetables and nutrition risk score. A score of 6 or more points was defined as persons at high risk nutritionally. The impact of the intervention was evaluated using ANOVA/chi-square on Nutrition Survey Risk Screening. Nutrition education and counseling intervention improved nutrition risk scores; 5.76 to 5.32 (p=0.14) in CGM, 8.1 to 6.1 (peffective nutrition education and counseling.
Determination of the delivered hemodialysis dose using standard methods and on-line clearance monitoring
Directory of Open Access Journals (Sweden)
Vlatković Vlastimir
Full Text Available Background/aim: Delivered dialysis dose has a cumulative effect and significant influence upon the adequacy of dialysis, quality of life and development of co-morbidity at patients on dialysis. Thus, a great attention is given to the optimization of dialysis treatment. On-line Clearance Monitoring (OCM allows a precise and continuous measurement of the delivered dialysis dose. Kt/V index (K = dialyzer clearance of urea; t = dialysis time; V = patient's total body water, measured in real time is used as a unit for expressing the dialysis dose. The aim of this research was to perform a comparative assessment of the delivered dialysis dose by the application of the standard measurement methods and a module for continuous clearance monitoring. Methods. The study encompassed 105 patients who had been on the chronic hemodialysis program for more than three months, three times a week. By random choice, one treatment per each controlled patient was taken. All the treatments understood bicarbonate dialysis. The delivered dialysis dose was determined by the calculation of mathematical models: Urea Reduction Ratio (URR singlepool index Kt/V (spKt/V and by the application of OCM. Results. Urea Reduction Ratio was the most sensitive parameter for the assessment and, at the same time, it was in the strongest correlation with the other two, spKt/V indexes and OCM. The values pointed out an adequate dialysis dose. The URR values were significantly higher in women than in men, p < 0.05. The other applied model for the delivered dialysis dose measurement was Kt/V index. The obtained values showed that the dialysis dose was adequate, and that, according to this parameter, the women had significantly better dialysis, then the men p < 0.05. According to the OCM, the average value was slightly lower than the adequate one. The women had a satisfactory dialysis according to this index as well, while the delivered dialysis dose was insufficient in men. The difference
Internet-Delivered Cognitive Behavioral Therapy to Treat Insomnia: A Systematic Review and Meta-Analysis.
Seyffert, Michael; Lagisetty, Pooja; Landgraf, Jessica; Chopra, Vineet; Pfeiffer, Paul N; Conte, Marisa L; Rogers, Mary A M
Insomnia is of major public health importance. While cognitive behavioral therapy is beneficial, in-person treatment is often unavailable. We assessed the effectiveness of internet-delivered cognitive behavioral therapy for insomnia. The primary objectives were to determine whether online cognitive behavioral therapy for insomnia could improve sleep efficiency and reduce the severity of insomnia in adults. Secondary outcomes included sleep quality, total sleep time, time in bed, sleep onset latency, wake time after sleep onset, and number of nocturnal awakenings. We searched PubMed/MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, PsycInfo, Cochrane Library, Embase, and the Web of Science for randomized trials. Studies were eligible if they were randomized controlled trials in adults that reported application of cognitive behavioral therapy for insomnia via internet delivery. Mean differences in improvement in sleep measures were calculated using the Hartung-Knapp-Sidik-Jonkman method for random effects meta-analysis. We found 15 trials, all utilizing a pretest-posttest randomized control group design. Sleep efficiency was 72% at baseline and improved by 7.2% (95% CI: 5.1%, 9.3%; pcognitive behavioral therapy versus control. Internet-delivered cognitive behavioral therapy resulted in a decrease in the insomnia severity index by 4.3 points (95% CI: -7.1, -1.5; p = 0.017) compared to control. Total sleep time averaged 5.7 hours at baseline and increased by 20 minutes with internet-delivered therapy versus control (95% CI: 9, 31; p = 0.004). The severity of depression decreased by 2.3 points (95% CI: -2.9, -1.7; p = 0.013) in individuals who received internet-delivered cognitive behavioral therapy compared to control. Improvements in sleep efficiency, the insomnia severity index and depression scores with internet-delivered cognitive behavioral therapy were maintained from 4 to 48 weeks after post-treatment assessment. There were no statistically
Randomized controlled trial of telephone-delivered cognitive behavioral therapy for chronic insomnia.
Arnedt, J Todd; Cuddihy, Leisha; Swanson, Leslie M; Pickett, Scott; Aikens, James; Chervin, Ronald D
To compare the efficacy of telephone-delivered cognitive-behavioral therapy for insomnia to an information pamphlet control on sleep and daytime functioning at pretreatment, posttreatment, and 12-wk follow-up. Randomized controlled parallel trial. N/A. Thirty individuals with chronic insomnia (27 women, age 39.1 ± 14.4 years, insomnia duration 8.7 ± 10.7 years). Cognitive behavioral therapy for insomnia (CBTI) delivered in up to eight weekly telephone sessions (CBTI-Phone, n = 15) versus an information pamphlet control (IPC, n = 15). Sleep/wake diary, sleep-related questionnaires (Insomnia Severity Index, Pittsburgh Sleep Quality Index, 16-item Dysfunctional Beliefs and Attitudes about Sleep), and daytime symptom assessments (fatigue, depression, anxiety, and quality of life) were completed at pretreatment, posttreatment, and 12-wk follow-up. Linear mixed models indicated that sleep/wake diary sleep efficiency and total sleep time improved significantly at posttreatment in both groups and remained stable at 12-wk follow-up. More CBTI-Phone than IPC patients showed posttreatment improvements in unhelpful sleep-related cognitions (P Phone patients and small to moderate (Cohen d = -0.1-0.6) for IPC patients. All CBTI-Phone patients completed posttreatment and 12-wk follow-up assessments, but three IPC patients discontinued the study. The findings provide preliminary support for telephone-delivered CBTI in the treatment of chronic insomnia. Future larger-scale studies with more diverse samples are warranted. Some individuals with insomnia may also benefit from pamphlet-delivered CBTI with brief telephone support. Arnedt JT; Cuddihy L; Swanson LM; Pickett S; Aikens J; Chervin RD. Randomized controlled trial of telephone-delivered cognitive behavioral therapy for chronic insomnia. SLEEP 2013;36(3):353-362.
Deposition and pharmacokinetics of flunisolide delivered from pressurized inhalers containing non-CFC and CFC propellants.
Richards, J; Hirst, P; Pitcairn, G; Mahashabde, S; Abramowitz, W; Nolting, A; Newman, S P
Our objective was to assess the deposition and pharmacokinetics of a novel formulation of flunisolide (Aerobid, Forest Laboratories) in hydrofluoroalkane (HFA) 134a delivered by pressurized metered dose inhaler (pMDI). The design was a two-way crossover investigation in 12 healthy male subjects comparing HFA-134a flunisolide by pMDI versus pMDI plus 50 mL spacer device. Four of these subjects also took part in a two-way crossover investigation comparing chlorofluorocarbon (CFC) flunisolide pMDI versus pMDI plus Aerochamber holding chamber. The imaging technique of gamma scintigraphy was used to quantify total and regional lung deposition of flunisolide. Plasma levels of flunisolide and its major metabolite (6beta-OH flunisolide) were also determined. The spacer and Aerochamber reduced oropharyngeal deposition dramatically for both the HFA and CFC products (mean 59.8 to 14.9% (p CFC product) owing to deposition of part of the dose on the walls of the add-on devices themselves. Lung deposition averaged 22.6 and 40.4% (p CFC formulation delivered via the Aerochamber (mean 23.4%) was higher than that for the CFC pMDI alone (mean 17.0%), but this difference was not statistically significant. Lung deposition expressed as percentage ex-device (delivered) dose averaged 68.3% for HFA pMDI plus spacer and 19.7% for CFC pMDI. Plasma levels of flunisolide were higher for the pMDI plus spacer than for pMDI alone, reflecting higher lung deposition via the spacer, but plasma levels of the 6beta-OH flunisolide metabolite were higher for the pMDI alone as a consequence of higher oropharyngeal deposition. When delivered via the spacer, pulmonary targeting of the flunisolide HFA formulation was improved compared with the CFC formulation, which should benefit patients by providing satisfactory asthma therapy from a much-reduced delivered dose of flunisolide.
Impact of home-delivered meal programs on diet and nutrition among older adults: a review.
Zhu, Huichen; An, Ruopeng
Poor diet quality and insufficient nutrient intake is of particular concern among older adults. The Older Americans Act of 1965 authorizes home-delivered meal services to homebound individuals aged 60 years and older. The purpose of this study was to review scientific evidence on the impact of home-delivered meal services on diet and nutrition among recipients. Keyword and reference searches were conducted in Cochrane Library, Google Scholar, PubMed and Web of Science. Inclusion criteria included: study design (randomized controlled trials, cohort studies, pre-post studies, or cross-sectional studies); main outcome (food and nutrient intakes); population (home-delivered meal program participants); country (US); language (articles written in English); and article type (peer-reviewed publications or theses). Eight studies met the inclusion criteria, including two randomized controlled trial studies (from the same intervention), one cohort study, two pre-post studies, and three cross-sectional studies. All but two studies found home-delivered meal programs to significantly improve diet quality, increase nutrient intakes, and reduce food insecurity and nutritional risk among participants. Other beneficial outcomes include increased socialization opportunities, improvement in dietary adherence, and higher quality of life. Home-delivered meal programs improve diet quality and increase nutrient intakes among participants. These programs are also aligned with the federal cost-containment policy to rebalance long-term care away from nursing homes to home- and community-based services by helping older adults maintain independence and remain in their homes and communities as their health and functioning decline. © The Author(s) 2014.
Measuring and benchmarking the quality of two different organizational ways in delivering infant vaccination.
Maurici, M; Paulon, L; Carlino, C; Campolongo, A; Catapano, R; Sgricia, S; Franco, E; Bagnato, B; Benigni, M; D'Anna, C; Di Marzio, L; Ferrante, M; Fraioli, A; Giordani, A; Laudati, F; Mangia, M L; Marchetti, C; Meleleo, C; Papa, R; Perrelli, F; Pozzato, S; Rabbiosi, S; Rossi, S; Seminara, L; Serino, L; Sinopoli, M T; Sorbara, D
The aim of this study was the quality of service evaluation of two different organizational ways in delivering infant vaccination according to a Regional Vaccination Plan. Eleven vaccination centres were selected in two Local Health Units (ASLs) belonging to the Regional Health Service of the Lazio Region, Italy. The services offering paediatric vaccinations for children under three years of age, delivered without an appointment (VACP) or with the need for an appointment (VACL), were investigated. The quality aspects under evaluation were communicational efficiency, organisational efficiency and comfort. Subjective data were collected from different stakeholders and involve the elicitation of best and worst feasible performance conditions for the ASLs when delivering VACP/VACL services. Objective data consists in the observation of current performances of the selected vaccination centres. Quality scorecards were obtained from the combination of all data. Benchmarking between VACP and VACL, i.e., two different organisational ways in delivering infant vaccination, can be performed as a result of the probabilistic meaning of the evaluated scores. An expert of vaccination services, i.e., a virtual combination of patients, doctors and nurses, claims the quality of service delivery of the ASLs under investigation with probability 78.03% and 69.67% for VACP and VACL, respectively. In other words, for short, the quality scores of the ASLs were 78.03% for VACP and 69.67% for VACL. Furthermore our results show how to practically improve the current service delivery. The QuaVaTAR approach can result in improvements of the quality of the ASLs for the two different ways of delivering paediatric vaccinations in a simple and intuitive way.
Randomized Controlled Trial of Telephone-Delivered Cognitive Behavioral Therapy for Chronic Insomnia
Arnedt, J. Todd; Cuddihy, Leisha; Swanson, Leslie M.; Pickett, Scott; Aikens, James; Chervin, Ronald D.
Study Objectives: To compare the efficacy of telephone-delivered cognitive-behavioral therapy for insomnia to an information pamphlet control on sleep and daytime functioning at pretreatment, posttreatment, and 12-wk follow-up. Design: Randomized controlled parallel trial. Setting: N/A. Participants: Thirty individuals with chronic insomnia (27 women, age 39.1 ± 14.4 years, insomnia duration 8.7 ± 10.7 years). Interventions: Cognitive behavioral therapy for insomnia (CBTI) delivered in up to eight weekly telephone sessions (CBTI-Phone, n = 15) versus an information pamphlet control (IPC, n = 15). Measurements and Results: Sleep/wake diary, sleep-related questionnaires (Insomnia Severity Index, Pittsburgh Sleep Quality Index, 16-item Dysfunctional Beliefs and Attitudes about Sleep), and daytime symptom assessments (fatigue, depression, anxiety, and quality of life) were completed at pretreatment, posttreatment, and 12-wk follow-up. Linear mixed models indicated that sleep/wake diary sleep efficiency and total sleep time improved significantly at posttreatment in both groups and remained stable at 12-wk follow-up. More CBTI-Phone than IPC patients showed posttreatment improvements in unhelpful sleep-related cognitions (P Phone patients and small to moderate (Cohen d = -0.1–0.6) for IPC patients. All CBTI-Phone patients completed posttreatment and 12-wk follow-up assessments, but three IPC patients discontinued the study. Conclusions: The findings provide preliminary support for telephone-delivered CBTI in the treatment of chronic insomnia. Future larger-scale studies with more diverse samples are warranted. Some individuals with insomnia may also benefit from pamphlet-delivered CBTI with brief telephone support. Citation: Arnedt JT; Cuddihy L; Swanson LM; Pickett S; Aikens J; Chervin RD. Randomized controlled trial of telephone-delivered cognitive behavioral therapy for chronic insomnia. SLEEP 2013;36(3):353-362. PMID:23450712
Therapeutic Alliance in Internet-Delivered Cognitive Behaviour Therapy for Depression or Generalized Anxiety.
Hadjistavropoulos, Heather D; Pugh, Nicole E; Hesser, Hugo; Andersson, Gerhard
There has been limited research on therapeutic alliance in the context of therapist-assisted Internet-delivered cognitive behaviour therapy (ICBT) when delivered in clinical practice. The present study investigated therapeutic alliance in ICBT delivered to patients seeking treatment for symptoms of depression (n = 83) or generalized anxiety (n = 112) as part of an open dissemination trial. ICBT was provided by 27 registered therapists or 28 graduate students working in six geographically dispersed clinics; therapist-assistance was delivered primarily through secure messages and occasionally telephone calls. The Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9 were collected pre-, mid- and post-treatment, and the Therapeutic Alliance Questionnaire was assessed mid- and post-treatment. Therapeutic alliance ratings were high both at mid-treatment and post-treatment (above 80%). There was no relationship between therapeutic alliance ratings and improvement on primary outcomes. Among patients treated for depression, lower ratings of mid-treatment alliance were associated with concurrent treatment by a psychiatrist and fewer phone calls and emails from their therapist. Among patients treated for generalized anxiety, ratings of mid-treatment alliance were higher among registered providers as compared to graduate students. Multiple directions for future research on therapeutic alliance in ICBT are offered, including suggestions for developing a new measure of therapeutic alliance specific to ICBT and measuring therapeutic alliance throughout the treatment process. Copyright © 2016 John Wiley & Sons, Ltd. This research demonstrated that therapeutic alliance ratings were very strong at both mid- and post-treatment among patients who received Internet-delivered cognitive behaviour therapy (ICBT) for depression or anxiety in clinical practice. Among patients receiving ICBT for depression, lower ratings of therapeutic alliance were associated with
Who Delivers without Water? A Multi Country Analysis of Water and Sanitation in the Childbirth Environment.
Gon, Giorgia; Restrepo-Méndez, María Clara; Campbell, Oona M R; Barros, Aluísio J D; Woodd, Susannah; Benova, Lenka; Graham, Wendy J
Hygiene during childbirth is essential to the health of mothers and newborns, irrespective of where birth takes place. This paper investigates the status of water and sanitation in both the home and facility childbirth environments, and for whom and where this is a more significant problem. We used three datasets: a global dataset, with information on the home environment from 58 countries, and two datasets for each of four countries in Eastern Africa: a healthcare facility dataset, and a dataset that incorporated information on facilities and the home environment to create a comprehensive description of birth environments in those countries. We constructed indices of improved water, and improved water and sanitation combined (WATSAN), for the home and healthcare facilities. The Joint Monitoring Program was used to construct indices for household; we tailored them to the facility context-household and facility indices include different components. We described what proportion of women delivered in an environment with improved WATSAN. For those women who delivered at home, we calculated what proportion had improved WATSAN by socio-economic status, education and rural-urban status. Among women delivering at home (58 countries), coverage of improved WATSAN by region varied from 9% to 53%. Fewer than 15% of women who delivered at home in Sub-Saharan Africa, had access to water and sanitation infrastructure (range 0.1% to 37%). This was worse among the poorest, the less educated and those living in rural areas. In Eastern Africa, where we looked at both the home and facility childbirth environment, a third of women delivered in an environment with improved water in Uganda and Rwanda; whereas, 18% of women in Kenya and 7% in Tanzania delivered with improved water and sanitation. Across the four countries, less than half of the facility deliveries had improved water, or improved water and sanitation in the childbirth environment. Access to water and sanitation during
Can physical therapists deliver a pain coping skills program? An examination of training processes and outcomes.
Bryant, Christina; Lewis, Prudence; Bennell, Kim L; Ahamed, Yasmin; Crough, Denae; Jull, Gwendolen A; Kenardy, Justin; Nicholas, Michael K; Keefe, Francis J
Physical therapists are well established as providers of treatments for common, painful, and disabling conditions, such as knee osteoarthritis (OA). Thus, they are well placed to deliver treatments that integrate physical and psychosocial elements. Attention is usually given to outcomes of such programs, but few studies have examined the processes and outcomes of training physical therapists to deliver such treatments. The aim of this study was to describe the processes in training physical therapists: (1) to deliver a standardized pain coping skills treatment and (2) to evaluate the effectiveness of that training. This study was an analysis of data relating to therapist performance in a randomized clinical trial. Eleven physical therapists were trained to deliver a 10-session pain coping skills training program for people with knee OA as part of a randomized controlled trial (N=222). The initial training was provided in a workshop format and included extensive, ongoing supervision by a psychologist and rigorous use of well-defined performance criteria to assess competence. Adherence to the program, ratings of performance, and use of advanced skills were all measured against these criteria in a sample (n=74, 10%) of the audio recordings of the intervention sessions. Overall, the physical therapists achieved a very high standard of treatment delivery, with 96.6% adherence to the program and mean performance ratings all in the satisfactory range. These results were maintained throughout the intervention and across all sessions. Only 10% of the delivered sessions were analyzed, and the physical therapists who took part in the study were a self-selected group. This study demonstrated that a systematic approach to training and accrediting physical therapists to deliver a standardized pain coping skills program can result in high and sustained levels of adherence to the program. Training fidelity was achieved in this group of motivated clinicians, but the supervision
Do new anesthesia ventilators deliver small tidal volumes accurately during volume-controlled ventilation?
Bachiller, Patricia R; McDonough, Joseph M; Feldman, Jeffrey M
During mechanical ventilation of infants and neonates, small changes in tidal volume may lead to hypo- or hyperventilation, barotrauma, or volutrauma. Partly because breathing circuit compliance and fresh gas flow affect tidal volume delivery by traditional anesthesia ventilators in volume-controlled ventilation (VCV) mode, pressure-controlled ventilation (PCV) using a circle breathing system has become a common approach to minimizing the risk of mechanical ventilation for small patients, although delivered tidal volume is not assured during PCV. A new generation of anesthesia machine ventilators addresses the problems of VCV by adjusting for fresh gas flow and for the compliance of the breathing circuit. In this study, we evaluated the accuracy of new anesthesia ventilators to deliver small tidal volumes. Four anesthesia ventilator systems were evaluated to determine the accuracy of volume delivery to the airway during VCV at tidal volume settings of 100, 200, and 500 mL under different conditions of breathing circuit compliance (fully extended and fully contracted circuits) and lung compliance. A mechanical test lung (adult and infant) was used to simulate lung compliances ranging from 0.0025 to 0.03 L/cm H(2)O. Volumes and pressures were measured using a calibrated screen pneumotachograph and custom software. We tested the Smartvent 7900, Avance, and Aisys anesthesia ventilator systems (GE Healthcare, Madison, WI) and the Apollo anesthesia ventilator (Draeger Medical, Telford, PA). The Smartvent 7900 and Avance ventilators use inspiratory flow sensors to control the volume delivered, whereas the Aisys and Apollo ventilators compensate for the compliance of the circuit. We found that the anesthesia ventilators that use compliance compensation (Aisys and Apollo) accurately delivered both large and small tidal volumes to the airway of the test lung under conditions of normal and low lung compliance during VCV (ranging from 95.5% to 106.2% of the set tidal volume
Who Delivers without Water? A Multi Country Analysis of Water and Sanitation in the Childbirth Environment.
Directory of Open Access Journals (Sweden)
Giorgia Gon
Full Text Available Hygiene during childbirth is essential to the health of mothers and newborns, irrespective of where birth takes place. This paper investigates the status of water and sanitation in both the home and facility childbirth environments, and for whom and where this is a more significant problem.We used three datasets: a global dataset, with information on the home environment from 58 countries, and two datasets for each of four countries in Eastern Africa: a healthcare facility dataset, and a dataset that incorporated information on facilities and the home environment to create a comprehensive description of birth environments in those countries. We constructed indices of improved water, and improved water and sanitation combined (WATSAN, for the home and healthcare facilities. The Joint Monitoring Program was used to construct indices for household; we tailored them to the facility context-household and facility indices include different components. We described what proportion of women delivered in an environment with improved WATSAN. For those women who delivered at home, we calculated what proportion had improved WATSAN by socio-economic status, education and rural-urban status.Among women delivering at home (58 countries, coverage of improved WATSAN by region varied from 9% to 53%. Fewer than 15% of women who delivered at home in Sub-Saharan Africa, had access to water and sanitation infrastructure (range 0.1% to 37%. This was worse among the poorest, the less educated and those living in rural areas. In Eastern Africa, where we looked at both the home and facility childbirth environment, a third of women delivered in an environment with improved water in Uganda and Rwanda; whereas, 18% of women in Kenya and 7% in Tanzania delivered with improved water and sanitation. Across the four countries, less than half of the facility deliveries had improved water, or improved water and sanitation in the childbirth environment.Access to water and
Psychological therapies (remotely delivered) for the management of chronic and recurrent pain in children and adolescents.
Fisher, Emma; Law, Emily; Palermo, Tonya M; Eccleston, Christopher
Chronic pain is common during childhood and adolescence and is associated with negative outcomes such as increased severity of pain, reduced function (e.g. missing school), and low mood (e.g. high levels of depression and anxiety). Psychological therapies, traditionally delivered face-to-face with a therapist, are efficacious at reducing pain intensity and disability. However, new and innovative technology is being used to deliver these psychological therapies remotely, meaning barriers to access to treatment such as distance and cost can be removed or reduced. Therapies delivered with technological devices, such as the Internet, computer-based programmes, smartphone applications, or via the telephone, can be used to deliver treatment to children and adolescents with chronic pain. To determine the efficacy of psychological therapies delivered remotely compared to waiting-list, treatment-as-usual, or active control treatments, for the management of chronic pain in children and adolescents. We searched four databases (CENTRAL, MEDLINE, EMBASE, and PsycINFO) from inception to June 2014 for randomised controlled trials of remotely delivered psychological interventions for children and adolescents (0 to 18 years of age) with chronic pain. We searched for chronic pain conditions including, but not exclusive to, headache, recurrent abdominal pain, musculoskeletal pain, and neuropathic pain. We also searched online trial registries for potential trials. A citation and reference search for all included studies was conducted. All included studies were randomised controlled trials that investigated the efficacy of a psychological therapy delivered remotely via the Internet, smartphone device, computer-based programme, audiotapes, or over the phone in comparison to an active, treatment-as-usual, or waiting-list control. We considered blended treatments, which used a combination of technology and face-to-face interaction. We excluded interventions solely delivered face
Development of fiber-delivered laser peening system to prevent stress corrosion cracking of reactor components
Energy Technology Data Exchange (ETDEWEB)
Sano, Y.; Kimura, M.; Yoda, M.; Mukai, N.; Sato, K.; Uehara, T.; Ito, T.; Shimamura, M.; Sudo, A.; Suezono, N. [Toshiba Corp., Yokohama (Japan)
The authors have developed a system to deliver water-penetrable intense laser pulses of frequency-doubled Nd:YAG laser through optical fiber. The system is capable of improving a residual stress on water immersed metal material remotely, which is effective to prevent the initiation of stress corrosion cracking (SCC) of reactor components. Experimental results showed that a compressive residual stress with enough amplitude and depth was built in the surface layer of type 304 stainless steel (SUS304) by irradiating laser pulses through optical fiber with diameter of 1 mm. A prototype peening head with miniaturized dimensions of 88 mm x 46 mm x 25 mm was assembled to con-firm the accessibility to the heat affected zone (HAZ) along weld lines of a reactor core shroud. The accessibility was significantly improved owing to the flexible optical fiber and the miniaturized peening head. The fiber delivered system opens up the possibility of new applications of laser peening. (author)
Twelve tips for developing and delivering a massive open online course in medical education.
Pickering, James D; Henningsohn, Lars; DeRuiter, Marco C; de Jong, Peter G M; Reinders, Marlies E J
Massive open online courses (MOOCs) are a novel mode of online learning. They are typically based on higher education courses and can attract a high number of learners, often in the thousands. They are distinct from on-campus education and deliver the learning objectives through a series of short videos, recommended readings and discussion fora, alongside automated assessments. Within medical education the role of MOOCs remains unclear, with recent proposals including continuing professional development, interprofessional education or integration into campus-based blended learning curricula. In this twelve tips article, we aim to provide a framework for readers to use when developing, delivering and evaluating a MOOC within medical education based on the literature and our own experience. Practical advice is provided on how to design the appropriate curriculum, engage with learners on the platform, select suitable assessments, and comprehensively evaluate the impact of your course.
Delivering information skills training at a health professionals continuing professional development conference: an evaluation.
Lawton, Aoife; Manning, Padraig; Lawler, Fiona
In this feature, guest writer Aoife Lawton discusses the outcomes of an information skills workshop delivered at a continuing professional development conference for health and social care professionals in Ireland. The primary aim of the study was to evaluate perceptions of the effectiveness of the workshop. The study provides details of how, through collaborative partnership, the workshop was developed and delivered. Application of an adapted version of the Kirkpatrick model of evaluation is presented alongside details of what impact the event had on the attendees both immediately after the workshop and 3 months post-workshop. The authors also reflect on the benefits delivery of the workshops had for professional health library practice and service improvement. H. S. © 2017 Health Libraries Group.
Act. Innovate. Deliver. Reducing energy demand sustainably. eceee Summer Study Proceedings. V. 1-4
Energy Technology Data Exchange (ETDEWEB)
Broussous, Christel; Jover, Corisande (ICE - International Consulting on Energy, Burgeap Group, L' Ile-Saint-Denis (France)) (eds.)
The European Council for an Energy Efficient Economy (eceee) promotes the understanding of energy efficiency in the society and contributes to making energy efficiency work in practice. The conference covered the following topics: The foundations of future energy policies; Initiating change and breaking walls; Policy implementation: learning from the past, improving the future; Monitoring and evaluation: understanding change and how to deliver energy efficiency; Residential and commercial sectors: delivering lower energy use in buildings; Energy efficiency in industry; Energy efficiency in transport and mobility; Innovative buildings technologies; Dynamics of consumption. The proceedings are published in four volumes, and/or on one USB-memory stick, and contains 195 contributions (all separately indexed for ETDE)
Effective Retinal Penetration of Lipophilic and Lipid-Conjugated Hydrophilic Agents Delivered by Engineered Liposomes.
Lee, Junsung; Goh, Unbyeol; Lee, Hyoung-Jin; Kim, Jiyoung; Jeong, Moonkyoung; Park, Ji-Ho
Efficient delivery of drugs to the retina is critical but difficult to achieve with current methods. There have been a number of attempts to use intravitreal injection of liposomes, artificial vesicles composed of a phospholipid bilayer, to overcome the limitations of conventional intravitreal injection (short retention time, toxicity, poor penetration, etc.). Here, we report an optimal liposomal formulation that can diffuse through the vitreous humor, deliver the incorporated agents to all retinal layers effectively, and maintain them for a relatively long time. We first delivered lipophilic compounds and phospholipid-conjugated hydrophilic agents to the inner limiting membrane using engineered liposomes. Subsequently, the agents penetrated the retina deeply, presumably via extracellular vesicles, nanoscale vesicles secreted from retinal-associated cells. These results suggest that this engineered liposomal formulation can leverage the biological transport system for effective retinal penetration of lipophilic and lipid-conjugated agents.
Randomized trials on consider this, a tailored, internet-delivered smoking prevention program for adolescents.
Buller, David B; Borland, Ron; Woodall, W Gill; Hall, John R; Hines, Joan M; Burris-Woodall, Patricia; Cutter, Gary R; Miller, Caroline; Balmford, James; Starling, Randall; Ax, Bryan; Saba, Laura
The Internet may be an effective medium for delivering smoking prevention to children. Consider This, an Internet-based program, was hypothesized to reduce expectations concerning smoking and smoking prevalence. Group-randomized pretest-posttest controlled trials were conducted in Australia (n = 2,077) and the United States (n = 1,234) in schools containing Grades 6 through 9. Australian children using Consider This reported reduced 30-day smoking prevalence. This reduction was mediated by decreased subjective norms. The amount of program exposure was low in many classes, but program use displayed a dose-response relationship with reduced smoking prevalence. American children only reported lower expectations for smoking in the future. Intervening to prevent smoking is a challenge, and this data suggest small benefits from an Internet-based program that are unlikely to be of practical significance unless increased by improved implementation. Implementation remains the major challenge to delivering interventions via the Internet, both for health educators and researchers.
Multicomponent, Enantioselective Michael-Michael-Aldol-β-Lactonizations Delivering Complex β-Lactones.
Van, Khoi N; Romo, Daniel
Optically active, tertiary amine Lewis bases react with unsaturated acid chlorides to deliver chiral, α,β-unsaturated acylammonium salts. These intermediates participate in a catalytic, enantioselective, three-component process delivering bi- and tricyclic β-lactones through a Michael-Michael-aldol-β-lactonization. In a single operation, the described multicomponent, organocascade process forms complex bi- and tricyclic β-lactones by generating four new bonds, two rings, and up to four contiguous stereocenters. In the racemic series, yields of 22-75% were achieved using 4-pyrrolidinopyridine as Lewis base. In the enantioselective series employing isothiourea catalysts, a kinetic resolution of the initially formed racemic Michael adduct appears operative, providing yields of 46% to quantitative (based on 50% max) with up to 94:6 er. Some evidence for a dynamic kinetic asymmetric transformation for tricyclic-β-lactone 1d was obtained following optimization (yields up to 61%, 94:6 er) through a presumed reversible Michael.
Delivering men's health interventions in English Premier League football clubs: key design characteristics.
Pringle, A; Zwolinsky, S; McKenna, J; Daly-Smith, A; Robertson, S; White, A
To investigate the key design characteristics of Premier League Health (PLH), a national programme of men's health improvement delivered in/by 16 English Premier League (EPL) football clubs. Health Trainers (HTs) were hired by EPL clubs to deliver PLH. HTs were the focus of investigations aimed at identifying the active design characteristics of male-specific health promotion interventions. Semi-structured interviews led by researchers were performed with 13/16 HTs and identified the key design characteristics influential in (I) reaching and (II) helping participants adopt health improvement interventions delivered in professional football club settings. HTs believed that combining the appeal of football alongside EPL clubs, offered a unique opportunity to reach adult males, including hard-to-engage-men (HTEM). Awareness raising events held on match days aimed to connect with men, but outreach activities were especially important for engaging participants. Following initial reach, familiar settings, such as the club stadia and community venues were also important for ensuring regular involvement in health improvement sessions. Interventions shaped around men's health needs and delivered at times when participants could more easily attend, were factors which helped to engage men. Supportive social environments and a range of exercise modes and delivery options were also seen by HTs as being similarly important. Both the informality and familiarity of EPL clubs were viewed by HTs as having substantial advantages over conventional NHS settings for reaching and engaging men. Importantly, HTs contributed substantial skills to the delivery of PLH. Although, top flight professional football clubs can recruit men, including those regarded as hard-to-engage into health improvement programmes, considerable attention to delivery refinement is needed to support male participants adopting interventions aimed at promoting healthy lifestyles. Copyright © 2013 The Royal Society
Neopuff T-piece resuscitator: does device design affect delivered ventilation?
Hinder, Murray; Jani, Pranav; Priyadarshi, Archana; McEwan, Alistair; Tracy, Mark
The T-piece resuscitator (TPR) is in common use worldwide to deliver positive pressure ventilation during resuscitation of infants ventilation performance is limited to preterm infant and animal studies. Efficacy of providing PEEP and the use of TPR during term infant resuscitation are not established. The aim of this study is to determine if delivered ventilation with the Neopuff brand TPR varied with differing (preterm to term) test lung compliances (Crs) and set peak inspiratory pressures (PIP). A single operator experienced in newborn resuscitation provided positive pressure ventilation in a randomised sequence to three different Crs models (0.5, 1 and 3 mL/cmH2O) at three different set PIP (20, 30 and 40 cmH2O). Set PEEP (5 cmH2O), gas flow rate and inflation rate were the same for each sequence. A total of 1087 inflations were analysed. The delivered mean PEEP was Crs dependent across set PIP range, rising from 4.9 to 8.2 cmH2O. At set PIP 40 cmH2O and Crs 3 mL/cmH2O, the delivered mean PIP was significantly lower at 35.3 cmH2O. As Crs increases, the Neopuff TPR can produce clinically significant levels of auto-PEEP and thus may not be optimal for the resuscitation of term infants with healthy lungs. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Who delivers where? The effect of obstetric risk on facility delivery in East Africa.
Virgo, Sandra; Gon, Giorgia; Cavallaro, Francesca L; Graham, Wendy; Woodd, Susannah
Skilled attendance at birth is key for the survival of pregnant women. This study investigates whether women at increased risk of maternal and newborn complications in four East African countries are more likely to deliver in a health facility than those at lower risk. Demographic and Health Survey data for Kenya 2014, Rwanda 2014-15, Tanzania 2015-16 and Uganda 2011 were used to study women with a live birth in the three years preceding the survey. A three-level obstetric risk index was created using known risk factors. Generalised linear Poisson regression was used to investigate the association between obstetric risk and facility delivery. We analysed data from 13 119 women across the four countries of whom 42-45% were considered at medium risk and 12-17% at high risk, and the remainder were at low risk. In Rwanda, 93% of all women delivered in facilities but this was lower (59-66%) in the other three countries. There was no association between a woman's obstetric risk level and her place of delivery in any country; greater wealth and more education were, however, independently strongly associated with facility delivery. In four East African countries, women at higher obstetric risk were not more likely to deliver in a facility than those with lower risk. This calls for a renewed focus on antenatal risk screening and improved communication on birth planning to ensure women with an increased chance of maternal and newborn complications are supported to deliver in facilities with skilled care. © 2017 John Wiley & Sons Ltd.
Developing a Peer Support Protocol for Improving Veterans' Engagement to Computer-Delivered Cognitive Behavioural Therapy.
Ray, John M; Kemp, Lakiesha L; Hubbard, Amanda; Cucciare, Michael A
Computer-delivered cognitive behavioural therapy (cCBT) is an effective alternative to provider-delivered treatment for depression and anxiety, but high attrition poses a significant challenge to its use. Peer support is a feasible approach to improving cCBT engagement, but less is known about its acceptability among Veterans. To obtain feedback from Veterans (n = 24) with depression and/or anxiety on their preferences for (a) activities of Veterans Administration Peer Support Specialists (VA PSS) in helping Veterans use Moving Forward, a cCBT-based protocol developed by VA, and (b) methods for delivering support to Veterans using this programme. Four focus groups (5-7 Veterans per group) provided feedback to be used in the development of a peer-supported engagement intervention to help Veterans with depression and anxiety use Moving Forward. Content areas included roles that a VA PSS might play in supporting the use of and engagement in Moving Forward, as well as methods of delivering that support. Veteran preferences for PSS activity focused on practical aspects of using Moving Forward, including orientation to the programme, technical support, and monitoring progress. Feedback also suggested that Veterans preferred more personal roles for the PSS, including emotional support, as well as application of Moving Forward to 'real life' problems. The findings extend the literature on online, patient-facing mental health protocols by identifying emotional support and 'real life' skills application as Veteran-preferred components of a peer-support protocol designed to enhance use of and engagement in cCBT for depression and anxiety.
An exploratory study of specialist and generalist teachers: predicting self efficacy in delivering primary physical education
Breslin, Gavin; Hanna, Donncha; Lowry, Ruth G; McKee, David; Haughey, Tandy; Moore, Nicole
We aimed to determine whether primary school teachers' motivational regulations to exercise and self efficacy in delivering a physical education (PE) lesson are different based on prior PE training. Two groups of qualified primary school teachers were recruited; PE specialists and a group of generalist primary school teachers who also teach PE. All teachers completed the Behavioural Regulation in Exercise Questionnaire-2, International Physical Activity Questionnaire and the Teachers' Sense o...
5G-ICN : Delivering ICN Services over 5G using Network Slicing
Ravindran, Ravishankar; Chakraborti, Asit; Amin, Syed Obaid; Azgin, Aytac; Wang, Guoqiang
The challenging requirements of 5G--from both the applications and the architecture perspectives--motivate the need to explore the feasibility of delivering services over new network architectures. As 5G proposes application-centric network slicing, which enables the use of new data planes realizable over a programmable compute, storage, and transport infrastructure, we consider Information-centric Networking (ICN) as a candidate network architecture to realize 5G objectives. This can co-exis...
Bacterial type IV secretion: conjugation systems adapted to deliver effector molecules to host cells
Christie, Peter J.; Vogel, Joseph P.
Several bacterial pathogens utilize conjugation machines to export effector molecules during infection. Such systems are members of the type IV or 'adapted conjugation' secretion family. The prototypical type IV system is the Agrobacterium tumefaciens T-DNA transfer machine, which delivers oncogenic nucleoprotein particles to plant cells. Other pathogens, including Bordetella pertussis, Legionella pneumophila, Brucella spp. and Helicobacter pylori, use type IV machines to export effector prot...
Pilot and feasibility study of a parenting intervention delivered by parent peers.
Butler, Ashley M; Titus, Courtney
Preventive parenting interventions delivered by parent peer specialists may be a viable alternative to professional-led interventions and offer an advantage of increasing access in medically underserved areas. The objective of this pilot study was to assess the feasibility and preliminary outcomes of a 10-session, peer specialist-delivered preventive parenting intervention (Smart and Secure Children) for child disruptive behavior. The intervention was evaluated among a small sample of parents (N = 15) of preschoolers (2-5 years) residing in medically underserved communities. Pediatricians referred families to the intervention, which was delivered in primary care practices within medically underserved communities. To determine feasibility, we calculated percentages of pediatricians who referred parents to the intervention, parent peer specialists who completed 40-h interventionist and leadership training, and the average number of sessions attended by parents. Enrolled parents completed questionnaires assessing child disruptive behavior, parenting stress and parenting competence at pre-and post-intervention. Descriptive statistics demonstrated the majority of pediatricians within the clinics referred families, and all parent peer specialists completed training to deliver the intervention. On average, 60% of sessions were attended by parents. Pairwise t-tests showed pre-to-post-intervention improvements in number of child disruptive behaviors perceived as a problem by parents, parenting stress and parenting competence. No significant change was found in parent-reported frequency of child disruptive behaviors. Results suggests adequate feasibility of the Smart and Secure Children Intervention, and that it holds promise for improving parenting stress and competence, and decreasing the number of child behaviors that are perceived as a problem by parents. Future directions for research are discussed.
Effects of paired transcutaneous electrical stimulation delivered at single and dual sites over lumbosacral spinal cord.
Sayenko, Dimitry G; Atkinson, Darryn A; Floyd, Terrance C; Gorodnichev, Ruslan M; Moshonkina, Tatiana R; Harkema, Susan J; Edgerton, V Reggie; Gerasimenko, Yury P
It was demonstrated previously that transcutaneous electrical stimulation of multiple sites over the spinal cord is more effective in inducing robust locomotor behavior as compared to the stimulation of single sites alone in both animal and human models. To explore the effects and mechanisms of interactions during multi-site spinal cord stimulation we delivered transcutaneous electrical stimulation to the single or dual locations over the spinal cord corresponding to approximately L2 and S1 segments. Spinally evoked motor potentials in the leg muscles were investigated using single and paired pulses of 1ms duration with conditioning-test intervals (CTIs) of 5 and 50ms. We observed considerable post-stimulation modulatory effects which depended on CTIs, as well as on whether the paired stimuli were delivered at a single or dual locations, the rostro-caudal relation between the conditioning and test stimuli, and on the muscle studied. At CTI-5, the paired stimulation delivered at single locations (L2 or S1) provided strong inhibitory effects, evidenced by the attenuation of the compound responses as compared with responses from either single site. In contrast, during L2-S1 paradigm, the compound responses were potentiated. At CTI-50, the magnitude of inhibition did not differ among paired stimulation paradigms. Our results suggest that electrical stimuli delivered to dual sites over the lumbosacral enlargement in rostral-to-caudal order, may recruit different populations of motor neurons initially through projecting sensory and intraspinal connections and then directly, resulting in potentiation of the compound spinally evoked motor potentials. The interactive and synergistic effects indicate multi-segmental convergence of descending and ascending influences on the neuronal circuitries during electrical spinal cord stimulation. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Agile Development Processes: Delivering a Successful Data Management Platform Now and in the Future
Deaubl, E.; Lowry, S.
Developing a flexible, extensible architecture for scientific data archival and management is a monumental task under older, big design, up-front methodologies. We will describe how we are using agile development techniques in our service oriented architecture (SOA)-based platform to integrate astronomer and operator input into the development process, deliver functional software earlier, and ensure that the software is maintainable and extensible in the future.
Targeted decorin gene therapy delivered with adeno-associated virus effectively retards corneal neovascularization in vivo.
Directory of Open Access Journals (Sweden)
Rajiv R Mohan
Full Text Available Decorin, small leucine-rich proteoglycan, has been shown to modulate angiogenesis in nonocular tissues. This study tested a hypothesis that tissue-selective targeted decorin gene therapy delivered to the rabbit stroma with adeno-associated virus serotype 5 (AAV5 impedes corneal neovascularization (CNV in vivo without significant side effects. An established rabbit CNV model was used. Targeted decorin gene therapy in the rabbit stroma was delivered with a single topical AAV5 titer (100 µl; 5×10(12 vg/ml application onto the stroma for two minutes after removing corneal epithelium. The levels of CNV were examined with stereomicroscopy, H&E staining, lectin, collagen type IV, CD31 immunocytochemistry and CD31 immunoblotting. Real-time PCR quantified mRNA expression of pro- and anti-angiogenic genes. Corneal health in live animals was monitored with clinical, slit-lamp and optical coherence tomography biomicroscopic examinations. Selective decorin delivery into stroma showed significant 52% (p<0.05, 66% (p<0.001, and 63% (p<0.01 reduction at early (day 5, mid (day 10, and late (day 14 stages of CNV in decorin-delivered rabbit corneas compared to control (no decorin delivered corneas in morphometric analysis. The H&E staining, lectin, collagen type IV, CD31 immunostaining (57-65, p<0.5, and CD31 immunoblotting (62-67%, p<0.05 supported morphometric findings. Quantitative PCR studies demonstrated decorin gene therapy down-regulated expression of VEGF, MCP1 and angiopoietin (pro-angiogenic and up-regulated PEDF (anti-angiogenic genes. The clinical, biomicroscopy and transmission electron microscopy studies revealed that AAV5-mediated decorin gene therapy is safe for the cornea. Tissue-targeted AAV5-mediated decorin gene therapy decreases CNV with no major side effects, and could potentially be used for treating patients.
Critical organizational challenges in delivering business value from IT:the Perspective of Lebanese CIOs
Nicolian, Nazareth; Welch, Christine; Read, Martin; Roberts, Martyn
The collective body of theoretical and empirical research in Information Systems (IS) comes mainly from the West. While there is emerging IS research in some developing countries and parts of the Middle East, the research agenda in Lebanon is so far non-existent. This study forms part of a larger research project to explore and analyze the perceived value of IS and the organizational competencies needed to deliver that value in Lebanon. Many of the challenges faced by Lebanese organizations a...
Readiness of health facilities to deliver safe male circumcision services in Tanzania: a descriptive study
Frank Felix Mosha; Mwita Wambura; Mwanga, Joseph R.; Mosha, Jacklin F; Gerry Mshana; John Changalucha
Assessing the readiness of health facilities to deliver safe male circumcision services is more important in sub-Saharan Africa because of the inadequacy state of health facilities in many ways. The World Health Organization recommends that only facilities equipped with available trained staff, capable to perform at least minor surgery, able to offer minimum MC package and appropriate equipment for resuscitation, and compliant with requirements for sterilization and infection control should b...
Method and apparatus for delivering high power laser energy over long distances
Zediker, Mark S; Rinzler, Charles C; Faircloth, Brian O; Koblick, Yeshaya; Moxley, Joel F
Systems, devices and methods for the transmission and delivery of high power laser energy deep into the earth and for the suppression of associated nonlinear phenomena. Systems, devices and methods for the laser drilling of a borehole in the earth. These systems can deliver high power laser energy down a deep borehole, while maintaining the high power to advance such boreholes deep into the earth and at highly efficient advancement rates.
Current perspectives on Internet delivered cognitive behavioral therapy for adults with anxiety and related disorders
Mewton L; Smith J; Rossouw P; Andrews G
Louise Mewton, Jessica Smith, Pieter Rossouw, Gavin Andrews Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW, Australia Abstract: The aim of the current review is to provide a summary of research into Internet-delivered cognitive behavioral therapy (iCBT) for anxiety disorders. We include 37 randomized controlled trials that examined the efficacy of iCBT programs in adults (aged over 18 years), as compared with waiting list or active control. Th...
Rice, Anna; Austin, John; Gravina, Nicole
This project assessed an intervention to improve employee customer service behaviors (correct greetings and closing behaviors). A combination of task clarification and manager-delivered social praise resulted in increased correct greeting from 11.5% to 66% and correct closing from 8% to 70%. The effect was maintained at a 48-week follow-up for employees who were present during the initial study period, but not for more recently hired employees. The results suggest that task clarification comb...
A brief individualized computer-delivered sexual risk reduction intervention increases HIV/AIDS preventive behavior.
Kiene, Susan M; Barta, William D
One objective of translational science is to identify elements of human immunodeficiency virus (HIV) risk-reduction interventions that have been shown to be effective and find new ways of delivering these interventions to the community to ensure that they reach the widest possible audience of at-risk individuals. The current study reports the development and evaluation of a computer-delivered, theory-based, individually tailored HIV risk-reduction intervention. This study evaluated the effectiveness of a custom computerized HIV/AIDS risk reduction intervention at increasing HIV/AIDS preventive behaviors in a randomized trial with 157 college students. The intervention content and delivery were based on the Information-Motivation-Behavioral Skills Model of Health Behavior Change and used Motivational Interviewing techniques. Participants completed a baseline assessment of HIV prevention information, motivation, behavioral skills and behavior, attended two brief computer-delivered intervention sessions, and completed a follow-up assessment. As compared to the control group (a nutrition education tutorial), participants who interacted with the computer-delivered HIV/AIDS risk reduction intervention exhibited a significant increase in risk reduction behavior. Specifically, participants reported a greater frequency of keeping condoms available and displayed greater condom-related knowledge at a four-week follow-up session; among sexually active participants, there was a significant increase in self-reported condom use. Delivery of brief individually tailored HIV/AIDS risk reduction interventions via computer may be an effective HIV/AIDS prevention approach for adolescents. More research is needed to further support the effectiveness of this type of intervention and determine the generalizability of these findings to economically and educationally disadvantaged adolescents.
Negative effects of Internet interventions : A qualitative content analysis of patients' experiences with treatments delivered online
Rozental, Alexander; Boettcher, Johanna; Andersson, Gerhard; Schmidt, B; Carlbring, Per
Internet interventions have been shown to be a viable alternative to face-to-face treatments. However, not all patients benefit from such treatments, and it is possible that some may experience negative effects. The current study explored patients' reported negative experiences while undergoing treatments delivered via the Internet. Data from four large clinical trials (total N = 558) revealed that 9.3% of patients encountered some type of negative effects. Qualitative content analysis was us...
Preterm uterine contractions ultimately delivered at term: safe but not out of danger.
Ganer Herman, Hadas; Miremberg, Hadas; Dekalo, Ann; Barda, Giulia; Bar, Jacob; Kovo, Michal
Patients with pregnancies complicated with premature uterine contractions (PMC), but delivered at term are considered as false preterm labor (PTL), and represent a common obstetric complication. We aimed to assess obstetric and neonatal outcomes of pregnancies complicated with PMC, but delivered at term, as compared to term normal pregnancies. Obstetric, maternal and neonatal outcomes of singleton pregnancies complicated with PMC between 24-33(6)/7 weeks (PMC group), necessitating hospitalization and treatment with tocolytics and/or steroids, during 2009-2014, were reviewed. The study group included only cases who eventually delivered ≥37 weeks, which were compared to a control group of subsequent term singleton deliveries who had not experienced PMC during pregnancy. Neonatal adverse composite outcome included: phototherapy, RDS, sepsis, blood transfusion, cerebral injury, NICU admission. The PMC group (n=497) was characterized by higher rates of nulliparity (p=0.002), infertility treatments (p=0.02), and polyhydramnios (p<0.001), as compared to controls (n=497). Labor was characterized by higher rates of instrumental deliveries (p=0.03), non-reassuring fetal heart rate tracings (p<0.001) prolonged third stage of labor (p=0.04), and increased rate of post-partum maternal anemia (Hb<8g/dL) p=0.004, in the PMC group as compared to controls. Neonates in the PMC groups had lower birth weights compared to controls, 3149g±429 vs. 3318g±1.1, p<0.001, respectively. By logistic regression analysis, PMC during pregnancy was independently associated with neonatal birth-weight <3rd percentile (adjusted OR 4.6, 95% CI 1.5-13.7). Pregnancies complicated with PMC, even-though delivered at term, entail adverse obstetric and neonatal outcomes, and may warrant continued high risk follow up. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Antibiotic-Resistant Gram Negative Bacilli in Meals Delivered at a General Hospital, Italy
Maria Rosa Anna Plano; Anna Maria Di Noto; Alberto Firenze; Sonia Sciortino; Caterina Mammina
This study aimed at detecting the presence of antibiotic-resistant Gram-negatives in samples of meals delivered at the University General Hospital of Palermo, Italy. Antibiotic resistant Gram negatives were isolated in July—September 2007 ffrom cold dishes and food contact surfaces and utensils. Bacterial strains were submitted to susceptibility test and subtyped by random amplification of polymorphic DNA (RAPD). Forty-six of 55 (83.6%) food samples and 14 of 17 (82.3%) environmental swabs ...
Development of a video-delivered relaxation treatment of late-life anxiety for veterans.
Gould, Christine E; Zapata, Aimee Marie L; Bruce, Janine; Bereknyei Merrell, Sylvia; Wetherell, Julie Loebach; O'Hara, Ruth; Kuhn, Eric; Goldstein, Mary K; Beaudreau, Sherry A
Behavioral treatments reduce anxiety, yet many older adults may not have access to these efficacious treatments. To address this need, we developed and evaluated the feasibility and acceptability of a video-delivered anxiety treatment for older Veterans. This treatment program, BREATHE (Breathing, Relaxation, and Education for Anxiety Treatment in the Home Environment), combines psychoeducation, diaphragmatic breathing, and progressive muscle relaxation training with engagement in activities. A mixed methods concurrent study design was used to examine the clarity of the treatment videos. We conducted semi-structured interviews with 20 Veterans (M age = 69.5, SD = 7.3 years; 55% White, Non-Hispanic) and collected ratings of video clarity. Quantitative ratings revealed that 100% of participants generally or definitely could follow breathing and relaxation video instructions. Qualitative findings, however, demonstrated more variability in the extent to which each video segment was clear. Participants identified both immediate benefits and motivation challenges associated with a video-delivered treatment. Participants suggested that some patients may need encouragement, whereas others need face-to-face therapy. Quantitative ratings of video clarity and qualitative findings highlight the feasibility of a video-delivered treatment for older Veterans with anxiety. Our findings demonstrate the importance of ensuring patients can follow instructions provided in self-directed treatments and the role that an iterative testing process has in addressing these issues. Next steps include testing the treatment videos with older Veterans with anxiety disorders.
Delivering care to oncology patients in the community: an innovative integrated approach.
LENUS (Irish Health Repository)
Hanan, Terry
A community oncology nursing programme was developed in Ireland between the hospital and community health services for patients receiving systemic cancer therapy, in response to a service need. A robust evaluation of the pilot programme was undertaken, which found that defined clinical procedures traditionally undertaken in hospitals were safely undertaken in the patient\\'s home with no adverse effects. There was a dramatic decrease in hospital attendances for these defined clinical procedures, and hospital capacity was consequently freed up. Patients valued having aspects of their care delivered at home and reported that it improved their quality of life, including reduced hospital visits and travel time. Community nurses expanded their scope of practice and became partners with oncology day-ward nurses in caring for these patients. Community nurses developed the competence and confidence to safely deliver cancer care in the community. This initiative shows that defined elements of acute cancer care can be safely delivered in the community so long as the training and support are provided. The findings and recommendations of the evaluation resulted in university accreditation and approval for national roll-out of the programme. Integration of services between primary and secondary care is a key priority. This innovative programme is a good example of shared integrated care that benefits both patients and health-care providers.
Photoacoustic drug delivery: the effect of laser parameters on the spatial distribution of delivered drug
Shangguan, HanQun; Casperson, Lee W.; Shearin, Alan; Gregory, Kenton W.; Prahl, Scott A.
Photoacoustic drug delivery is a technique for delivering drugs to localized areas by timing laser-induced pressure transients to coincide with a bolus of drug. This study explores the effects of target material, laser energy, absorption coefficient, fiber size, repetition rate, and number of pulses on the spatial distribution of delivered drug. A microsecond flash-lamp pumped dye laser delivered 30-100 mJ pulses through optical fibers with diameters of 300-1000 micrometers . Vapor bubbles were created 1-5 mm above clear gelatin targets submerged in mineral oil containing a hydrophobic dye (D&C Red#17). The absorption coefficient of the oil-dye solution was varied from 50-300 cm-1. Spatially unconfined geometry was investigated. We have found that while the dye can be driven a few millimeters into the gels in both the axial and radial directions, the penetration was less than 500 micrometers when the gel surface remained macroscopically undamaged. Increasing the distance between the fiber tip and target, or decreasing the pulse energy reduced the extend of the delivery.
Interest in a Twitter-delivered weight loss program among women of childbearing age.
Waring, Molly E; Schneider, Kristin L; Appelhans, Bradley M; Simas, Tiffany A Moore; Xiao, Rui S; Whited, Matthew C; Busch, Andrew M; Evans, Martinus M; Pagoto, Sherry L
Weight management through the childbearing years is important, yet few women have access to efficacious weight loss programs. Online social network-delivered programs may increase reach and thus impact. The aim of this study was to gauge interest in a Twitter-based weight loss intervention among women of childbearing age and the feasibility of recruitment via Twitter. We recruited English-speaking women aged 18-45 years (N = 63) from Twitter to complete an anonymous online survey including open-ended questions about program advantages and concerns. Forty percent of participants were obese and 83 % were trying to lose weight. Eighty-one percent were interested in a Twitter-delivered weight loss program. Interest was high in all subgroups (62-100 %). Participants (59 %) cited program advantages, including convenience, support/accountability, and privacy. Concerns (59 %) included questions about privacy, support/accountability, engagement, efficacy, and technology barriers. Research is needed to develop and evaluate social media-delivered interventions, and to develop methods for recruiting participants directly from Twitter.
Feasibility of breast preserving therapy with single fraction in situ radiotherapy delivered intraoperatively.
Ollila, David W; Klauber-DeMore, Nancy; Tesche, Leora J; Kuzmiak, Cherie M; Pavic, Dag; Goyal, Lav K; Lian, Jun; Chang, Sha; Livasy, Chad A; Sherron, Rachel F; Sartor, Carolyn I
Accelerated partial breast irradiation (APBI) has gained widespread interest as a means of improving the convenience and availability of breast conserving radiotherapy. Intraoperative radiation therapy (IORT) is an APBI technique that delivers breast radiotherapy as a single dose at the time of partial mastectomy. We adapted the technique of Veronesi to deliver IORT prior to tumor excision to improve delivery to the region at risk and reduce the volume of normal tissue irradiated. Patients age >or=55 with ultrasonographically defined tumors surgery using ultrasound tumor definition, selecting cone size and electron energy to optimize dose distribution. In the operating room, the surgeon retracted the skin over the tumor, cone was placed and radiotherapy delivered. Standard partial mastectomy was then performed. Twenty-three patients were enrolled in the study. Eighteen patients completed IORT with 10 patients having successful IORT no additional local therapy necessary. In five patients, the intraoperative radiation therapy served as the boost and in three patients unsuspected larger tumors or multicentric disease necessitated a mastectomy. The majority of patients had a good to excellent cosmetic result. Single fraction in situ IORT prior to partial mastectomy is feasible for patients with small breast cancers in achieving a good to excellent cosmetic result. Based on this early preliminary data, we plan to expand our feasibility trial.
Balancing patient care and student education: learning to deliver bad news in an optometry teaching clinic.
Spafford, Marlee M; Schryer, Catherine F; Creutz, Stefan
Learning to counsel patients in a teaching clinic or hospital occurs in the presence of the competing agendas of patient care and student education. We wondered about the challenges that these tensions create for clinical novices learning to deliver bad news to patients. In this preliminary study, we audio-taped and transcribed the interviews of seven senior optometry students and six optometrist instructors at a Canadian optometry teaching clinic. The participants described their experiences in learning to deliver bad news. Using a grounded theory approach, our analysis was informed by situated learning and activity theory. Optometry students received formal classroom training regarding how to deliver bad news, including exposure to the medically-based six-step SPIKES protocol (Baile et al. The Oncologist, 5, 302-311, 2000). Yet, application of this protocol to the teaching clinic was limited by the lack of exposure most instructors had received to this strategy. Determinants of the students' complex learning process during their clinical apprenticeship, included: (i) knowing one's place, (ii) knowing one's audience, (iii) knowing through feedback, and (iv) knowing who speaks. The experiences of these participants pointed toward the need for: (1) more instructional "scaffolding" (Bruner and Sherwood Play: Its role in development and evolution, p. 280, 1976) in the clinical setting when the learning task is complex, and (2) explicit discussions about the impacts that unfold when the activities of patient care and student education overlap. We reflect on the possible consequences to student education and patient care in the absence of these changes.
Evaluation of a parent-delivered early language enrichment programme: evidence from a randomised controlled trial.
Burgoyne, Kelly; Gardner, Rachel; Whiteley, Helen; Snowling, Margaret J; Hulme, Charles
It is widely believed that increasing parental involvement can improve children's educational outcomes although we lack good evidence for such claims. This study evaluated the effectiveness of a parent-delivered early language enrichment programme. We conducted a randomised controlled trial (RCT) with 208 preschool children and their parents living in socially diverse areas in the United Kingdom. Families were allocated to an oral language programme (N = 103) or an active control programme targeting motor skills (N = 105). Parents delivered the programmes to their child at home in daily 20-min sessions over 30 weeks of teaching. Children receiving the language programme made significantly larger gains in language (d = .21) and narrative skills (d = .36) than children receiving the motor skills programme at immediate posttest. Effects on language were maintained 6 months later (d = .34), and at this point, the language group also scored higher on tests of early literacy (d values=.35 and .42). There was no evidence that the movement programme improved motor skills. This study provides evidence for the effectiveness of a parent-delivered language enrichment programme. Further large-scale evaluations of the programme are needed to confirm and extend these findings. © 2017 Association for Child and Adolescent Mental Health.
Internet-delivered acceptance-based behaviour therapy for generalized anxiety disorder: A randomized controlled trial.
Dahlin, Mats; Andersson, Gerhard; Magnusson, Kristoffer; Johansson, Tomas; Sjögren, Johan; Håkansson, Andreas; Pettersson, Magnus; Kadowaki, Åsa; Cuijpers, Pim; Carlbring, Per
Generalized anxiety disorder (GAD) is a disabling condition which can be treated with cognitive behaviour therapy (CBT). The present study tested the effects of therapist-guided internet-delivered acceptance-based behaviour therapy on symptoms of GAD and quality of life. An audio CD with acceptance and mindfulness exercises and a separate workbook were also included in the treatment. Participants diagnosed with GAD (N = 103) were randomly allocated to immediate therapist-guided internet-delivered acceptance-based behaviour therapy or to a waiting-list control condition. A six month follow-up was also included. Results using hierarchical linear modelling showed moderate to large effects on symptoms of GAD (Cohen's d = 0.70 to 0.98), moderate effects on depressive symptoms (Cohen's d = 0.51 to 0.56), and no effect on quality of life. Follow-up data showed maintained effects. While there was a 20% dropout rate, sensitivity analyses showed that dropouts did not differ in their degree of change during treatment. To conclude, our study suggests that internet-delivered acceptance-based behaviour therapy can be effective in reducing the symptoms of GAD. Copyright © 2015 Elsevier Ltd. All rights reserved.
Using Lunar Impact Glasses to Inform the Amount of Organic Material Delivered to the Early Earth
Nguyen, Pham; Zellner, Nicolle
The delivery of organic material via comets and asteroids during the early history of Earth plays an important role in some theories about the origin of life on Earth. Given the close proximity of the Moon to the Earth, the Moon's impact history can be used to estimate the amount of organic material delivered to the early Earth. Analysis of lunar impact glasses, derived from energetic impacts on the Moon, provide valuable data that can be used to interpret the Moon's impact flux. Here we present the results of a study of the non-volatile lithophile element compositions of over 500 impact glass samples from the Apollo 14, 16, and 17 landing sites, along with associated ages of a subset of them. Our analyses show that many of the impact glasses possess compositions exotic to the local regolith in which they were found. Coupled with their ages, these glasses suggest material transport from distant regions of the Moon and may allow an estimate of the number of lunar (and terrestrial) impactors in a given time period. These results have important implications for constraining the Moon's impact flux and also the amount of organic material delivered to the early Earth. Results of our preliminary study, which investigates the amounts of organic material delivered by comets and asteroids to the Moon (and Earth), will be presented.
Nominal effective radiation doses delivered during clinical trials of boron neutron capture therapy
Energy Technology Data Exchange (ETDEWEB)
Capala, J.; Diaz, A.Z.; Chanana, A.D.
Boron neutron capture therapy (BNCT) is a binary system that, in theory, should selectively deliver lethal, high linear energy transfer (LET) radiation to tumor cells dispersed within normal tissues. It is based on the nuclear reaction 10-B(n, {alpha})7-Li, which occurs when the stable nucleus of boron-10 captures a thermal neutron. Due to the relatively high cross-section of the 10-B nucleus for thermal neutron capture and short ranges of the products of this reaction, tumor cells in the volume exposed to thermal neutrons and containing sufficiently high concentration of 10-B would receive a much higher radiation dose than the normal cells contained within the exposed volume. Nevertheless, radiation dose deposited in normal tissue by gamma and fast neutron contamination of the neutron beam, as well as neutron capture in nitrogen, 14-N(n,p)14-C, hydrogen, 1-H(n,{gamma})2-H, and in boron present in blood and normal cells, limits the dose that can be delivered to tumor cells. It is, therefore, imperative for the success of the BNCT the dosed delivered to normal tissues be accurately determined in order to optimize the irradiation geometry and to limit the volume of normal tissue exposed to thermal neutrons. These are the major objectives of BNCT treatment planning.
Assessing Program Sustainability in an Eating Disorder Prevention Effectiveness Trial Delivered by College Clinicians
Rohde, Paul; Shaw, Heather; Butryn, Meghan L.; Stice, Eric
Sustainability of the Body Project, a dissonance-based selective eating disorder prevention program supported by efficacy and effectiveness trials, has not previously been examined. This mixed-methods study collected qualitative and quantitative data on training, supervision, and the intervention from 27 mental health clinicians from eight US universities who participated in an effectiveness trial and quantitative data on 2-year sustainability of program delivery. Clinicians, who were primarily masters-level mental health providers, had limited experience delivering manualized interventions. They rated the training and manual favorably, noting that they particularly liked the role-plays of session activities and intervention rationale, but requested more discussion of processes and group management issues. Clinicians were satisfied receiving emailed supervision based on videotape review. They reported enjoying delivering the Body Project but reported some challenges with the manualized format and time constraints. Most clinicians anticipated running more groups after the study ended but only four universities (50%) reported providing additional Body Project groups at the 1-year follow-up assessment and sustained delivery of the groups decreased substantially two years after study completion, with only one university (12%) continuing to deliver groups. The most commonly reported barriers for conducting additional groups were limited time and high staff turnover. PMID:26143559
Feasibility and Acceptability of Delivering a Postpartum Weight Loss Intervention via Facebook: A Pilot Study.
Waring, Molly E; Moore Simas, Tiffany A; Oleski, Jessica; Xiao, Rui S; Mulcahy, Julie A; May, Christine N; Pagoto, Sherry L
To evaluate the feasibility and acceptability of a Facebook-delivered postpartum weight loss intervention. Overweight and obese postpartum women received a 12-week weight loss intervention via Facebook. Feasibility outcomes were recruitment, retention, engagement, and acceptability. Weight loss was an exploratory outcome. Participants (n = 19) were 3.5 (SD 2.2) months postpartum with a baseline body mass index of 30.1 (SD 4.2) kg/m 2 . Retention was 95%. Forty-two percent of participants visibly engaged on the last day of the intervention, and 100% in the last 4 weeks; 88% were likely or very likely to participate again and 82% were likely or very likely to recommend the program to a postpartum friend. Average 12-week weight loss was 4.8% (SD 4.2%); 58% lost ≥5%. Findings suggested that this Facebook-delivered intervention is feasible and acceptable and supports research to test efficacy for weight loss. Research is needed to determine how best to engage participants in social network-delivered weight loss interventions. Copyright © 2017 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.
[Ozone therapy combined with sulfasalazine delivered via a colon therapy system for treatment of ulcerative colitis].
Geng, Yan; Wang, Wei; Ma, Qiang; Peng, Li-qiong; Liang, Zhong-hui
To assess the therapeutic effect of ozone therapy combined with sulfasalazine sulfasalazine delivered via a colon therapy system in the treatment of distal ulcerative colitis. This prospective randomized controlled clinical trial involved 54 patients with mild to moderate active distal ulcerative colitis, who were randomize into 3 groups in accordance with the inclusion criteria (n=18). Each group was given sulfasalazine at the daily dose of 2 g, and in colon therapy group and ozone therapy plus sulfasalazine therapy group, sulfasalazine was delivered via a colon therapy system on a daily basis; the control group received sulfasalazine via retention enema only. At 0, 2, and 4 weeks of the treatment, colonoscopy was performed to evaluate the disease activity, and biopsy samples were obtained at 0 and 4 weeks for histological examination. In comparison with colon therapy group and control group, ozone therapy plus colon therapy resulted in more rapid alleviation of the clinical symptoms and better histological improvement without any adverse effects. Ozone therapy combined with sulfasalazine delivered via a colon therapy system is feasible and effective for treatment of ulcerative colitis.
Change management in primary care: design and evaluation of an internet-delivered course.
Fox, N; O'Rourke, A; Roberts, C; Walker, J
To deliver and evaluate an internet course in change management for primary care professionals. A 12-week course delivered over the internet. Respondents were allocated into two groups: one had access to the course tutor individually, while the other could also communicate with the rest of the learner group. Learning outcomes were assessed by means of pre- and post-intervention questionnaires and by interviews with some participants. 111 primary care professionals. Subjects showed significant improvements on all learning outcomes. The group with access to the course tutor alone completed more units and had greater improvements in their learning outcomes. More of this group completed the course and completed a portfolio. Respondents who could communicate with other members of the group did not find this a positive experience. The internet can be used to deliver learning in change management to primary care professionals. Access to a discussion forum did not improve, and possibly impaired learning. More work is needed on the mentoring of internet learning.
Energy Provider: Delivered Energy Efficiency: A global stock-taking based on case studies
Energy Technology Data Exchange (ETDEWEB)
In 2011 the IEA and the Regulatory Assistance Project (RAP) took on a work programme focused on the role of energy providers in delivering energy efficiency to end-users. This work was part of the IEA's contribution to the PEPDEE Task Group, which falls under the umbrella of the International Partnership on Energy Efficiency Cooperation (IPEEC). In addition to organizing regional dialogues between governments, regulators, and energy providers, the PEPDEE work stream conducted global stock-takings of regulatory mechanisms adopted by governments to obligate or encourage energy providers to delivery energy savings and the energy savings activities of energy providers. For its part the IEA conducted a global review of energy provider-delivered energy savings programmes. The IEA reached out to energy providers to identify the energy savings activities they engaged in. Some 250 energy saving activities were considered, and 41 detailed case studies spanning 18 countries were developed. Geographic balance was a major consideration, and much effort was expended identifying energy provider-delivered energy savings case studies from around the world. Taken together these case studies represent over USD 1 billion in annual spending, or about 8% of estimated energy provider spending on energy efficiency.
Can a Remotely Delivered Auditory Training Program Improve Speech-in-Noise Understanding?
Abrams, Harvey B; Bock, Kirsten; Irey, Ryan L
The aims of this study were to determine if a remotely delivered, Internet-based auditory training (AT) program improved speech-in-noise understanding and if the number of hours spent engaged in the program influenced postintervention speech-in-noise understanding. Twenty-nine first-time hearing aid users were randomized into an AT group (hearing aids + 3 week remotely delivered, Internet-based auditory training program) or a control group (hearing aids alone). The Hearing in Noise Test (Nilsson, Soli, & Sullivan, 1994) and the Words-in-Noise test (Wilson, 2003) were administered to both groups at baseline + 1 week and immediately at the completion of the 3 weeks of auditory training. Speech-in-noise understanding improved for both groups at the completion of the study; however, there was not a statistically significant difference in postintervention improvement between the AT and control groups. Although the number of hours the participants engaged in the AT program was far fewer than prescribed, time on task influenced the postintervention Words-in-Noise but not Hearing in Noise Test scores. Although remotely delivered, Internet-based AT programs represent an attractive alternative to resource-intensive, clinic-based interventions, their demonstrated efficacy continues to remain a challenge due in part to issues associated with compliance.
A Pilot Study of Trauma-Focused Cognitive-Behavioral Therapy Delivered via Telehealth Technology.
Stewart, Regan W; Orengo-Aguayo, Rosaura E; Cohen, Judith A; Mannarino, Anthony P; de Arellano, Michael A
Significant barriers exist in access to evidence-based, trauma-focused treatment among youth from economically disadvantaged backgrounds, those living in rural areas, and belonging to a racial and ethnic minority group, despite the high prevalence rates of trauma exposure among these underserved groups. The present study is proof-of-concept pilot of trauma-focused cognitive-behavioral therapy (TF-CBT) delivered to underserved trauma-exposed youth ( N = 15) via telehealth technology (i.e., via one-on-one videoconferencing), aimed at addressing barriers in access to TF treatment. This pilot study provides preliminary evidence of the ability to successfully deliver TF-CBT via a telehealth delivery format. Results demonstrated clinically meaningful symptom change posttreatment (large effect sizes for youth-reported ( d = 2.93) and caregiver-reported ( d = 1.38) reduction in posttraumatic stress disorder symptoms), with no treatment attrition (0% dropout). These findings are promising in showing treatment effects that are comparable with TF-CBT delivered in an in-person, office-based setting and an important first step in determining how to best address the mental health needs of trauma-exposed youth with barriers in access to care.
Surfactant deficiency in full-term newborns with transient tachypnea delivered by elective C-section.
Estorgato, Geovana Rhoden; Fiori, Humberto Holmer; da Silva Ribeiro, Manoel Antonio; de Paula, Davi; Garcia, Pedro Celiny Ramos; Mattiello, Rita; Fiori, Renato Machado
Previous studies have suggested that full-term newborns delivered by elective cesarean section who develop transient tachypnea have low gastric microbubble counts. In the present study, microbubble concentrations in oral fluid samples were used to evaluate pulmonary maturity. To evaluate lung maturity in full-term newborns delivered by elective caesarean section using the stable microbubble test in oral aspirates collected at birth. The study involved newborns with gestational age >37 weeks delivered by elective cesarean section. Oral fluid samples were obtained in the delivery room immediately after birth, and gastric fluid was collected within the first hour of life. Samples were frozen and analyzed by two blinded researchers. The sample comprised 544 newborns. Twenty-two were diagnosed with transient tachypnea of the newborn by the assisting physician, and required admission to the Neonatal Intensive or Intermediate Care Unit. The median (interquartile range) of the number of microbubbles in the oral samples of these patients was 67.5 (45-150) microbubbles/mm(2) . The remaining 498 newborns without respiratory difficulties had a count of 350 (150-750) microbubbles/mm(2) -P neonates with respiratory difficulties, and of 600 (216-1125) microbubbles/mm(2) -P surfactant dysfunction. Pediatr Pulmonol. 2016;51:596-600. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.
Collaborative Engagement Approaches For Delivering Sustainable Infrastructure Projects In The AEC Sector
Directory of Open Access Journals (Sweden)
Adetola, Alaba
Full Text Available The public sector has traditionally financed and operated infrastructure projects using resources from taxes and various levies (e.g. fuel taxes, road user charges. However, the rapid increase in human population growth coupled with extended globalisation complexities and associated social/political/economic challenges have placed new demands on the purveyors and operators of infrastructure projects. The importance of delivering quality infrastructure has been underlined by the United Nations declaration of the Millennium Development Goals; as has the provision of 'adequate' basic structures and facilities necessary for the well-being of urban populations in developing countries. Thus, in an effort to finance developing countries' infrastructure needs, most countries have adopted some form of public-private collaboration strategy. This paper critically reviews these collaborative engagement approaches, identifies and highlights 10 critical themes that need to be appropriately captured and aligned to existing business models in order to successfully deliver sustainable infrastructure projects. Research findings show that infrastructure services can be delivered in many ways, and through various routes. For example, a purely public approach can cause problems such as slow and ineffective decision-making, inefficient organisational and institutional augmentation, and lack of competition and inefficiency (collectively known as government failure. On the other hand, adopting a purely private approach can cause problems such as inequalities in the distribution of infrastructure services (known as market failure. Thus, to overcome both government and market failures, a collaborative approach is advocated which incorporates the strengths of both of these polarised positions.
Delivering a medical school elective with massive open online course (MOOC) technology.
Robinson, Robert
The educational technology of massive open online courses (MOOCs) has been successfully applied in a wide variety of disciplines and are an intense focus of educational research at this time. Educators are now looking to MOOC technology as a means to improve professional medical education, but very little is known about how medical MOOCs compare with traditional content delivery. A retrospective analysis of the course evaluations for the Medicine as a Business elective by fourth-year medical students at Southern Illinois University School of Medicine (SIU-SOM) for the 2012-2015 academic years was conducted. This course was delivered by small group flipped classroom discussions for 2012-2014 and delivered via MOOC technology in 2015. Learner ratings were compared between the two course delivery methods using routinely collected course evaluations. Course enrollment has ranged from 6-19 students per year in the 2012-2015 academic years. Student evaluations of the course are favorable in the areas of effective teaching, accurate course objectives, meeting personal learning objectives, recommending the course to other students, and overall when rated on a 5-point Likert scale. The majority of all student ratings (76-95%) of this elective course are for the highest possible choice (Strongly agree or Excellent) for any criteria, regardless if the course was delivered via a traditional or MOOC format. Statistical analysis of these ratings suggests that the Effective Teacher and Overall Evaluations did not statistically differ between the two delivery formats. Student ratings of this elective course were highly similar when delivered in a flipped classroom format or by using MOOC technology. The primary advantage of this new course format is flexibility of time and place for learners, allowing them to complete the course objectives when convenient for them. The course evaluations suggest this is a change that is acceptable to the target audience. This study suggests that
In vitro magnetic stimulation: a simple stimulation device to deliver defined low intensity electromagnetic fields
Directory of Open Access Journals (Sweden)
Stephanie Grehl
Full Text Available Non-invasive electromagnetic field brain stimulation (NIBS appears to benefit human neurological and psychiatric conditions, although the optimal stimulation parameters and underlying mechanisms remain unclear. Although in vitro studies have begun to elucidate cellular mechanisms, stimulation is delivered by a range of coils (from commercially available human stimulation coils to laboratory-built circuits so that the electromagnetic fields induced within the tissue to produce the reported effects are ill-defined.Here we develop a simple in vitro stimulation device with plug-and-play features that allow delivery of a range of stimulation parameters. We chose to test low intensity repetitive magnetic stimulation (LI-rMS delivered at 3 frequencies to hindbrain explant cultures containing the olivocerebellar pathway. We used computational modelling to define the parameters of a stimulation circuit and coil that deliver a unidirectional homogeneous magnetic field of known intensity and direction, and therefore a predictable electric field, to the target. We built the coil to be compatible with culture requirements: stimulation within an incubator; a flat surface allowing consistent position and magnetic field direction; location outside the culture plate to maintain sterility and no heating or vibration. Measurements at the explant confirmed the induced magnetic field was homogenous and matched the simulation results. To validate our system we investigated biological effects following LI-rMS at 1 Hz, 10 Hz and biomimetic high frequency (BHFS, which we have previously shown induces neural circuit reorganisation. We found that gene expression was modified by LI-rMS in a frequency-related manner. Four hours after a single 10-minute stimulation session, the number of c-fos positive cells increased, indicating that our stimulation activated the tissue. Also, after 14 days of LI-rMS, the expression of genes normally present in the tissue was differentially
Some like to join, others to deliver. An econometric analysis of farmers' relationships with agricultural co-operatives
Gardebroek, C.; Pascucci, S.
In many European countries, farmers are a member of a processing or marketing co-operative, and most of these farmers also deliver their products to that co-operative. However, an extensive dataset of Italian farmers shows that not all members deliver to their co-op, and that there are also
78 FR 20116 - Draft Guidance for Industry and Food and Drug Administration Staff; Glass Syringes for Delivering...
... availability of draft guidance for industry and FDA staff entitled ``Glass Syringes for Delivering Drug and... availability of a draft guidance for industry entitled ``Glass Syringes for Delivering Drug and Biological... HUMAN SERVICES Food and Drug Administration Draft Guidance for Industry and Food and Drug Administration...
The ABC's of Delivering A Research-Driven Adventure Learning Program From the Field
Pregont, P.; Porsild, M.
A is for anchoring the delivery of your research to your audience in a standard-aligned curriculum. B is for BGAN Satellite Communication System assisting in delivering real-time authentic media. C is for a collaborative online learning environment to engage learners" Z is for the peaceful sleep you will get once your program is up and running! As part of Team GoNorth! (http://www.PolarHusky.com) it is our job to deliver adventure learning. We set out to do this back when the computer was a 4-foot, 50-lb box powered by a hand-crank where one would have a window of ten minutes in a 24-hour period to catch the satellite (before Al Gore created the Internet!). Every year we review the quantum leaps in what is now possible from the field and in the classroom, and over the years we have wrestled technical issues, solutions and numerous re-structures in the process of our of curriculum development. With this presentation we will provide some basic ABC's on how you can remained focused on your research, yet deliver an adventure learning program for learners to investigate real-world issues within your scientific research. Our scales are most likely different. The volume of our curriculum is an annual production of 4-500 pages to be used from Kindergarden through 12th grade around the world. The framework of our online learning environment must be able to supports millions of users at a time. "In the field" means on a a 3-4 month dogsled expedition - so sending out our live updates involve thawing out the computers and setting up the satellite communication system to work in a ground blizzard! But regardless of the scope and location of your field research, you can probably build on some of our experiences in the planning of an upcoming adventure learning program to engage learners of all or any ages in your scientific explorations!
Websites as a mode of delivering mental health information: perceptions from the Australian public.
Leach, Liana S; Christensen, Helen; Griffiths, Kathy M; Jorm, Anthony F; Mackinnon, Andrew J
Many people with a mental disorder do not access help from mental health services. Internet websites may be a useful tool for disseminating mental health information to those who remain untreated, however little is known about people's perceptions of websites as mental health information sources. The current study examined characteristics that may influence belief in the helpfulness of websites as modes of delivering information about mental health. The study compared belief in the helpfulness websites to two traditional sources (bibliotherapy and health educators). A total of 3,998 Australians aged 18 and above were surveyed. Logistic regression was used to explore the factors associated with rating a website, book and health educator as helpful sources of mental health information for a person described as having either depression, depression with suicidal thoughts, early schizophrenia or chronic schizophrenia. Factors investigated were demographics, exposure to mental illness, beliefs about dealing with mental illness alone, and personal and perceived stigmatising attitudes. Considerably more participants rated bibliotherapy and health educators as helpful in comparison to websites. Predictors of rating a website and book as helpful were identical; younger age, belief that it is helpful to deal with mental illness alone and being presented with depression and early schizophrenia vignettes in comparison to chronic schizophrenia. Predictors of rating a health educator as helpful were younger age, less personal stigma and being presented with a depression (without suicidal thoughts) vignette in comparison to chronic schizophrenia. These findings suggest the need for multiple modes of delivering mental health information. While many people feel that information delivered face-to-face is likely to be helpful, websites and other tools that maintain anonymity may be preferred by those who choose to or find themselves dealing with mental illness alone.
Therapeutic Potential of Delivering Arsenic Trioxide into HPV-Infected Cervical Cancer Cells Using Liposomal Nanotechnology
Wang, Xiaoyan; Li, Dong; Ghali, Lucy; Xia, Ruidong; Munoz, Leonardo P.; Garelick, Hemda; Bell, Celia; Wen, Xuesong
Arsenic trioxide (ATO) has been used successfully to treat acute promyelocytic leukaemia, and since this discovery, it has also been researched as a possible treatment for other haematological and solid cancers. Even though many positive results have been found in the laboratory, wider clinical use of ATO has been compromised by its toxicity at higher concentrations. The aim of this study was to explore an improved method for delivering ATO using liposomal nanotechnology to evaluate whether this could reduce drug toxicity and improve the efficacy of ATO in treating human papillomavirus (HPV)-associated cancers. HeLa, C33a, and human keratinocytes were exposed to 5 μm of ATO in both free and liposomal forms for 48 h. The stability of the prepared samples was tested using inductively coupled plasma optical emission spectrometer (ICP-OES) to measure the intracellular arsenic concentrations after treatment. Fluorescent double-immunocytochemical staining was carried out to evaluate the protein expression levels of HPV-E6 oncogene and caspase-3. Cell apoptosis was analysed by flow cytometry. Results showed that liposomal ATO was more effective than free ATO in reducing protein levels of HPV-E6 and inducing cell apoptosis in HeLa cells. Moreover, lower toxicity was observed when liposomal-delivered ATO was used. This could be explained by lower intracellular concentrations of arsenic. The slowly accumulated intracellular ATO through liposomal delivery might act as a reservoir which releases ATO gradually to maintain its anti-HPV effects. To conclude, liposome-delivered ATO could protect cells from the direct toxic effects induced by higher concentrations of intracellular ATO. Different pathways may be involved in this process, depending on local architecture of the tissues and HPV status.
Delivering safeguarding children services in primary care: responding to national child protection policy.
Appleton, Jane V
This study set out to examine how Primary Care Organisations (PCOs) in England manage, organise and deliver their safeguarding children responsibilities. In the light of changing organisational configurations across primary care, a wealth of policy directives and a climate of extensive media attention around child protection, this paper focuses on how PCOs respond to national policy and deliver safeguarding children services. This study, based in England, United Kingdom (UK), used a telephone survey method incorporating semi-structured qualitative interviews with Designated Child Protection Nurses. A maximum variation sampling strategy was used to identify two to three PCOs within each of the original 28 Strategic Health Authority sites. From the 64 PCOs approached, 60 Designated Nurses or their representatives agreed to participate in the research, with a response rate of 94%. Data analysis was informed primarily by Lincoln and Guba's (1985) three stages of a) unitising, b) categorising and c) pattern search. The findings outline how and to what extent PCOs respond to the national policy and organise and deliver their child protection services. The paper highlights some of the key challenges facing PCOs, in particular, safeguarding moving off the primary care agenda, child protection staff recruitment difficulties, a proliferation and overload of policy, resource implications for additional staff training, challenges to collaborative working, high referral thresholds to social care services and cutbacks in public health nursing services. This paper concludes by offering some suggestions about how child protection services could be improved as primary care faces another major reorganisation with the demise of Primary Care Trusts in April 2013.
Feasibility and preliminary efficacy of remotely delivering cognitive training to people with schizophrenia using tablets.
Biagianti, Bruno; Fisher, Melissa; Howard, Lisa; Rowlands, Abby; Vinogradov, Sophia; Woolley, Joshua
Limited access to Cognitive Training (CT) for people with schizophrenia (SZ) prevents widespread adoption of this intervention. Delivering CT remotely via tablets may increase accessibility, improve scheduling flexibility, and diminish patient burden. In this reanalysis of data from a larger trial of CT, we compared two samples of individuals with SZ who chose to complete 40 h of CT either on desktop computers in the laboratory (N = 33) or remotely via iPads (N = 41). We examined attrition rates and adherence to training, and investigated whether remote iPad-based CT and in-person desktop-based CT induced significantly different improvements in cognitive and real-world functioning. The attrition rate was 36.6%. On average, participants completed 3.06 h of CT per week. There were no significant between-group differences in attrition and adherence to CT requirements. Participants who completed iPad-based CT were significantly younger and had lower symptoms at baseline compared to participants who completed CT on the lab desktops. Controlling for age and symptom severity, rANCOVA showed that iPad-based and desktop-based CT similarly and significantly improved verbal learning and problem solving. Main effects of time, at trend level significance, were evident in global cognition, verbal memory, quality of life, and social functioning. All group by time interactions were non-significant except for verbal memory, where iPad users showed greater gains. Within-group effect sizes for changes in outcomes were in the small range. Although underpowered and not randomized, this study demonstrates that delivering CT remotely to people with SZ using tablets is feasible and results in retention rates, adherence, and cognitive and functional outcome improvements that are comparable to those observed when CT is delivered in the laboratory. This has important implications in terms of scalability and dissemination of CT. These results require confirmation in larger samples.
Can school counselors deliver cognitive-behavioral treatment for social anxiety effectively? A randomized controlled trial.
Masia Warner, Carrie; Colognori, Daniela; Brice, Chad; Herzig, Kathleen; Mufson, Laura; Lynch, Chelsea; Reiss, Philip T; Petkova, Eva; Fox, Jeremy; Moceri, Dominic C; Ryan, Julie; Klein, Rachel G
Social anxiety disorder (SAD) typically onsets in adolescence and is associated with multiple impairments. Despite promising clinical interventions, most socially anxious adolescents remain untreated. To address this clinical neglect, we developed a school-based, 12-week group intervention for youth with SAD, Skills for Academic and Social Success (SASS). When implemented by psychologists, SASS has been found effective. To promote dissemination and optimize treatment access, we tested whether school counselors could be effective treatment providers. We randomized 138, ninth through 11th graders with SAD to one of three conditions: (a) SASS delivered by school counselors (C-SASS), (b) SASS delivered by psychologists (P-SASS), or (c) a control condition, Skills for Life (SFL), a nonspecific counseling program. Blind, independent, evaluations were conducted with parents and adolescents at baseline, post-intervention, and 5 months beyond treatment completion. We hypothesized that C-SASS and P-SASS would be superior to the control, immediately after treatment and at follow-up. No prediction was made about the relative efficacy of C-SASS and P-SASS. Compared to controls, adolescents treated with C-SASS or P-SASS experienced significantly greater improvement and reductions of anxiety at the end of treatment and follow-up. There were no significant differences between SASS delivered by school counselors and psychologists. With training, school counselors are effective treatment providers to adolescents with social anxiety, yielding benefits comparable to those obtained by specialized psychologists. Questions remain regarding means to maintain counselors' practice standards without external support. © 2016 Association for Child and Adolescent Mental Health.
Developing a computer delivered, theory based intervention for guideline implementation in general practice
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Ashworth Mark
Full Text Available Abstract Background Non-adherence to clinical guidelines has been identified as a consistent finding in general practice. The purpose of this study was to develop theory-informed, computer-delivered interventions to promote the implementation of guidelines in general practice. Specifically, our aim was to develop computer-delivered prompts to promote guideline adherence for antibiotic prescribing in respiratory tract infections (RTIs, and adherence to recommendations for secondary stroke prevention. Methods A qualitative design was used involving 33 face-to-face interviews with general practitioners (GPs. The prompts used in the interventions were initially developed using aspects of social cognitive theory, drawing on nationally recommended standards for clinical content. The prompts were then presented to GPs during interviews, and iteratively modified and refined based on interview feedback. Inductive thematic analysis was employed to identify responses to the prompts and factors involved in the decision to use them. Results GPs reported being more likely to use the prompts if they were perceived as offering support and choice, but less likely to use them if they were perceived as being a method of enforcement. Attitudes towards using the prompts were also related to anticipated patient outcomes, individual prescriber differences, accessibility and presentation of prompts and acceptability of guidelines. Comments on the prompts were largely positive after modifying them based on participant feedback. Conclusions Acceptability and satisfaction with computer-delivered prompts to follow guidelines may be increased by working with practitioners to ensure that the prompts will be perceived as valuable tools that can support GPs' practice.
A dynamic system for delivering controlled bromine and chlorine vapor exposures to weanling swine skin.
Snider, Thomas H; Perry, Mark R; Richter, William R; Plahovinsak, Jennifer L; Rogers, James; Reid, Frances M; Graham, John S
Assessing the hazards of accidental exposure to toxic industrial chemical (TIC) vapors and evaluating therapeutic compounds or treatment regimens require the development of appropriate animal models. The objective of this project was to develop an exposure system for delivering controlled vapor concentrations of TICs to the skin of anesthetized weanling pigs. Injury levels targeted for study were superficial dermal (SD) and deep dermal (DD) skin lesions as defined histopathologically. The exposure system was capable of simultaneously delivering chlorine or bromine vapor to four, 3-cm diameter exposure cups placed over skin between the axillary and inguinal areas of the ventral abdomen. Vapor concentrations were generated by mixing saturated bromine or chlorine vapor with either dried dilution air or nitrogen. Bromine exposure concentrations ranged from 6.5 × 10(-4) to 1.03 g/L, and exposure durations ranged from 1 to 45 min. A 7-min skin exposure to bromine vapors at 0.59 g/L was sufficient to produce SD injuries, while a 17-min exposure produced a DD injury. Chlorine exposure concentrations ranged from 1.0 to 2.9 g/L (saturated vapor concentration) for exposures ranging from 3 to 90 min. Saturated chlorine vapor challenges for up to 30 min did not induce significant dermal injuries, whereas saturated chlorine vapor with wetted material on the skin surface for 30-60 min induced SD injuries. DD chlorine injuries could not be induced with this system. The vapor exposure system described in this study provides a means for safely regulating, quantifying and delivering TIC vapors to the skin of weanling swine as a model to evaluate therapeutic treatments.
Extraorally delivered photobiomodulation therapy for prevention of oropharyngeal mucositis in pediatric patients undergoing hematopoietic cell transplantation
Duncan, Christine N.; Yaroslavsky, Anna N.; London, Wendy B.; Juliano, Amy F.; Sonis, Stephen T.; Adnan, Ather; Treister, Nathaniel S.
Background: Oral mucositis (OM) is a painful consequence of myeloablative hematopoietic cell transplantation (HCT). Extraorally delivered photobiomodulation therapy (PBMT) is a promising novel intervention for the prevention of OM in children. Objectives: With funding from an NIDCR R34 planning grant, the objectives of this study are 1) to model the dosimetry of external PBMT and the optimal device parameters for the planned clinical trial, and 2) to plan and design a placebo-controlled Phase 2 multicenter clinical trial to determine whether extraorally delivered PBMT can reduce the duration of severe OM in children, with intent for implementation under subsequent U01 funding. Methods: External PBMT dosimetry will be evaluated using pediatric head and neck MRI studies to obtain serial measurements of different tissues that will then be used to develop a sophisticated computational model. We plan to conduct a placebocontrolled Phase 2 multicenter clinical trial in which patients 4 to 21 years of age will be randomized 1:1:1 to receive external PBMT dose 1x, external PBMT dose 2x, or sham PBMT starting from conditioning, daily until day +20 post- HCT. Significance: Extraorally delivered PBMT is a feasible, potentially efficacious intervention that could improve the quality of life for all children undergoing myeloablative HCT. The planned Phase 2 study, based on rigorous dose modeling and with detailed attention to uniform delivery of therapy and OM assessments, will provide critical efficacy data and the potential basis for a subsequent definitive Phase 3 trial. Grant Support: NIDCR R34 DE025908-01
Individualized, home-based interactive training of cerebral palsy children delivered through the Internet
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Petersen Tue H
Full Text Available Abstract Background The available health resources limit the amount of therapy that may be offered to children with cerebral palsy and the amount of training in each session may be insufficient to drive the neuroplastic changes, which are necessary for functional improvements to take place. The aim of this pilot study was to provide proof of concept that individualized and supervised interactive home-based training delivered through the internet may provide an efficient way of maintaining intensive training of children with cerebral palsy over prolonged periods. Methods 9 children (aged 9-13 years with cerebral palsy were included in the study. Motor, perceptual and cognitive abilities were evaluated before and after 20 weeks of home-based training delivered through the internet. Results The children and their families reported great enthusiasm with the training system and all experienced subjective improvements in motor abilities and self-esteem. The children on average trained for 74 hours during a 20 week period equalling just over 30 minutes per day. Significant improvements in functional muscle strength measured as the frontal and lateral step-up and sit-to-stand tests were observed. Assessment of Motor and processing skills also showed significant increases. Endurance measured as the Bruce test showed a significant improvement, whereas there was no significant change in the 6 min walking test. Balance (Romberg was unchanged. Visual perceptual abilities increased significantly. Conclusions We conclude that it is feasible to deliver interactive training of children with cerebral palsy at home through the internet and thereby ensure more intensive and longer lasting training than what is normally offered to this group.
Readiness of health facilities to deliver safe male circumcision services in Tanzania: a descriptive study
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Frank Felix Mosha
Full Text Available Assessing the readiness of health facilities to deliver safe male circumcision services is more important in sub-Saharan Africa because of the inadequacy state of health facilities in many ways. The World Health Organization recommends that only facilities equipped with available trained staff, capable to perform at least minor surgery, able to offer minimum MC package and appropriate equipment for resuscitation, and compliant with requirements for sterilization and infection control should be allowed to deliver safe circumcision services. A cross-sectional study using quantitative data collection technique was conducted to assess the readiness of the health facilities to deliver safe circumcision services in selected districts of Tanzania. All hospitals, health centres and 30% of all dispensaries in these districts were selected to participate in the study. Face-toface questionnaires were administered to the heads of the health facilities and to health practitioners. Overall, 49/69 (59% of the facilities visited provided circumcision services and only 46/203 (24% of the health practitioners performed circumcision procedures. These were mainly assistant medical officers and clinical officers. The vast majority – 190/203 (95% – of the health practitioners require additional training prior to providing circumcision services. Most facilities – 63/69 (91% – had all basic supplies (gloves, basin, chlorine and waste disposal necessary for infection prevention, 44/69 (65% provided condoms, HIV counselling and testing, and sexuallytransmitted infections services, while 62/69 (90% had the capability to perform at least minor surgery. However, only 25/69 (36% and 15/69 (22% of the facilities had functioning sterilization equipment and appropriate resuscitation equipment, respectively. There is readiness for roll out of circumcision services; however, more practitioners need to be trained on circumcision procedures, demand forecasting
Rationale and design: telephone-delivered behavioral skills interventions for Blacks with type 2 diabetes
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Strom Joni L
Full Text Available Abstract Background African Americans with Type 2 diabetes (T2DM have higher prevalence of diabetes, poorer metabolic control, and greater risk for complications and death compared to American Whites. Poor outcomes in African Americans with T2DM can be attributed to patient, provider, and health systems level factors. Provider and health system factors account for Methods/Design We describe an ongoing four-year randomized clinical trial, using a 2 × 2 factorial design, which will test the efficacy of separate and combined telephone-delivered, diabetes knowledge/information and motivation/behavioral skills training interventions in high risk African Americans with poorly controlled T2DM (HbA1c ≥ 9%. Two-hundred thirty-two (232 male and female African-American participants, 18 years of age or older and with an HbA1c ≥ 9%, will be randomized into one of four groups for 12-weeks of phone interventions: (1 an education group, (2 a motivation/skills group, (3 a combined group or (4 a usual care/general health education group. Participants will be followed for 12-months to ascertain the effect of the interventions on glycemic control. Our primary hypothesis is that among African Americans with poorly controlled T2DM, patients randomized to the combined diabetes knowledge/information and motivation/behavioral skills training intervention will have significantly greater reduction in HbA1c at 12 months of follow-up compared to the usual care/general health education group. Discussion Results from this study will provide important insight into how best to deliver diabetes education and skills training in ethnic minorities and whether combined knowledge/information and motivation/behavioral skills training is superior to the usual method of delivering diabetes education for African Americans with poorly controlled T2DM. Trial registration National Institutes of Health Clinical Trials Registry (ClinicalTrials.gov identifier# NCT00929838.
Evaluation of a training programme to induct medical students in delivering public health talks.
Tan, Ngiap Chuan; Mitesh, Shah; Koh, Yi Ling Eileen; Ang, Seng Bin; Chan, Hian Hui Vincent; How, Choon How; Tay, Ee Guan; Hwang, Siew Wai
It is uncommon for medical students to deliver public health talks as part of their medical education curriculum. This study evaluated the effectiveness of a novel training programme that required medical students to deliver public health talks during their family medicine (FM) clerkship in a Singapore primary care institution. The FM faculty staff guided teams of third-year medical students to select appropriate topics for health talks that were to be conducted at designated polyclinics. The talks were video-recorded and appraised for clarity, content and delivery. The appraisal was done by the student's peers and assigned faculty staff. The audience was surveyed to determine their satisfaction level and understanding of the talks. The students also self-rated the effectiveness of this new teaching activity. A total of 120 medical students completed a questionnaire to rate the effectiveness of the new teaching activity. 85.8% of the students felt confident about the delivery of their talks, 95.8% reported having learnt how to deliver talks and 92.5% perceived this new training modality as useful in their medical education. Based on the results of the audience survey, the speakers were perceived as knowledgeable (53.1%), confident (51.3%) and professional (39.0%). Assessment of 15 video-recorded talks showed satisfactory delivery of the talks by the students. The majority of the students reported a favourable overall learning experience under this new training programme. This finding is supported by the positive feedback garnered from the audience, peers of the medical students and the faculty staff.
Parks and gardens in poetic reminiscences used to deliver philosophic ideas
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Drozdova Maria Sergeevna
Full Text Available The paper focuses on analyzing the image of parks and gardens that helps to deliver philosophic ideas in fiction. The research bases on the novel "The French Lieutenant's Woman" by John Fowles. The literary hermeneutics and reception-aesthetics methods are used. The paper deals with the reminiscences from Alfred Tennyson's and Thomas Hardy's poetry. The author draws a conclusion about their meaning for understanding the sense of the novel and John Fowles's philosophic ideas as a whole.
Enterasys Networks delivers 10-Gigabit ethernet for the enterprise with new matrix E1 switching family
Enterasys Networks Inc., today announced its new Matrix E1 family of 10-Gigabit and Gigabit Ethernet switches. The Matrix E1 Optical Access Switch (OAS) enables organizations to deliver applications at 10-Gb speeds across a single fibre optic pair. Jacques Altaber, deputy leader of IT at CERN said "High-bandwith solutions are essential to leveraging more computing power, so 10-Gb Ethernet is the next logical step for us...The Matrix E1 allows us to provide the networking support that our scientists need and gives us a certain future for bandwidth and computing expansion".
Trichorionic Quadruplet Delivered Beyond 36 Weeks of Gestation: A Case Report and Literature Review
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Fawaz E. Edris
Full Text Available Following one year of secondary fertility, a couple conceived with a quadruplet after transfer of three embryos through IVF-ICSI. At 36 weeks and 2 days of gestation, the mother developed gestational induced hypertension and delivered the next day by caesarean section. Pathology confirmed the zygosity to be trichorionic quadramniotic and all four babies were discharged home with their mother on postoperative day 3. Herein, we describe a successfully managed high-risk pregnancy case. A review of the literature was conducted and to our knowledge no other cases with similar criteria ever reached such advanced gestational age.
Individualized, home-based interactive training of cerebral palsy children delivered through the Internet
DEFF Research Database (Denmark)
Bilde, Peder E; Kliim-Due, Mette; Rasmussen, Betina
The available health resources limit the amount of therapy that may be offered to children with cerebral palsy and the amount of training in each session may be insufficient to drive the neuroplastic changes, which are necessary for functional improvements to take place. The aim of this pilot study...... was to provide proof of concept that individualized and supervised interactive home-based training delivered through the internet may provide an efficient way of maintaining intensive training of children with cerebral palsy over prolonged periods....
The CIO playbook strategies and best practices for IT leaders to deliver value
Colisto, Nicholas R
Praise for The CIO Playbook "The most trusted advisors chief information officers have are other CIOs, and Nicholas Colisto capitalizes beautifully on that fact in The CIO Playbook. This highly readable guide to succeeding in one of the toughest jobs in the C-suite features a step-by-step framework that is practical, focused, and quite specific. The strategies Nicholas describes come to life through anecdotes and straightforward advice from many of the industry's most respected CIOs who share their advice on everything from partnering with business colleagues to innovating and delivering res
Caries prevalence in Danish pre-school children delivered vaginally and by caesarean section
DEFF Research Database (Denmark)
Barfod, Mette Nelun; Christensen, Lisa Bøge; Twetman, Svante Henrik Agardh
-section). MATERIALS AND METHODS: The study had an observational cohort protocol based on extracted information from governmental databases and nationwide registers concerning birth, social and educational levels and dental status. Children born at the Copenhagen University Hospital in 2005 were eligible and the final......-section had a higher mean value in comparison with those delivered vaginally (dmfs 6.8 vs 3.2), but the difference was not statistically significant. There was a significant relationship between caries prevalence and low family income in the total study group (OR = 5.8, p
A cost comparison of introducing and delivering pneumococcal, rotavirus and human papillomavirus vaccines in Rwanda.
Ngabo, Fidèle; Levin, Ann; Wang, Susan A; Gatera, Maurice; Rugambwa, Celse; Kayonga, Celestin; Donnen, Philippe; Lepage, Philippe; Hutubessy, Raymond
Detailed cost evaluations of delivery of new vaccines such as pneumococcal conjugate, human papillomavirus (HPV), and rotavirus vaccines in low and middle-income countries are scarce. This paper differs from others by comparing the costs of introducing multiple vaccines in a single country and then assessing the financial and economic impact at the time and implications for the future. The objective of the analysis was to understand the introduction and delivery cost per dose or per child of the three new vaccines in Rwanda to inform domestic and external financial resource mobilization. Start-up, recurrent, and capital costs from a government perspective were collected in 2012. Since pneumococcal conjugate and HPV vaccines had already been introduced, cost data for those vaccines were collected retrospectively while prospective (projected) costing was done for rotavirus vaccine. The financial unit cost per fully immunized child (or girl for HPV vaccine) of delivering 3 doses of each vaccine (without costs related to vaccine procurement) was $0.37 for rotavirus (RotaTeq(®)) vaccine, $0.54 for pneumococcal (Prevnar(®)) vaccine in pre-filled syringes, and $10.23 for HPV (Gardasil (®)) vaccine. The financial delivery costs of Prevnar(®) and RotaTeq(®) were similar since both were delivered using existing health system infrastructure to deliver infant vaccines at health centers. The total financial cost of delivering Gardasil(®) was higher than those of the two infant vaccines due to greater resource requirements associated with creating a new vaccine delivery system in for a new target population of 12-year-old girls who have not previously been served by the existing routine infant immunization program. The analysis indicates that service delivery strategies have an important influence on costs of introducing new vaccines and costs per girl reached with HPV vaccine are higher than the other two vaccines because of its delivery strategy. Documented information
Costs of delivering human papillomavirus vaccination to schoolgirls in Mwanza Region, Tanzania
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Quentin Wilm
Full Text Available Abstract Background Cervical cancer is the leading cause of female cancer-related deaths in Tanzania. Vaccination against human papillomavirus (HPV offers a new opportunity to control this disease. This study aimed to estimate the costs of a school-based HPV vaccination project in three districts in Mwanza Region (NCT ID: NCT01173900, Tanzania and to model incremental scaled-up costs of a regional vaccination program. Methods We first conducted a top-down cost analysis of the vaccination project, comparing observed costs of age-based (girls born in 1998 and class-based (class 6 vaccine delivery in a total of 134 primary schools. Based on the observed project costs, we then modeled incremental costs of a scaled-up vaccination program for Mwanza Region from the perspective of the Tanzanian government, assuming that HPV vaccines would be delivered through the Expanded Programme on Immunization (EPI. Results Total economic project costs for delivering 3 doses of HPV vaccine to 4,211 girls were estimated at about US$349,400 (including a vaccine price of US$5 per dose. Costs per fully-immunized girl were lower for class-based delivery than for age-based delivery. Incremental economic scaled-up costs for class-based vaccination of 50,290 girls in Mwanza Region were estimated at US$1.3 million. Economic scaled-up costs per fully-immunized girl were US$26.41, including HPV vaccine at US$5 per dose. Excluding vaccine costs, vaccine could be delivered at an incremental economic cost of US$3.09 per dose and US$9.76 per fully-immunized girl. Financial scaled-up costs, excluding costs of the vaccine and salaries of existing staff were estimated at US$1.73 per dose. Conclusions Project costs of class-based vaccination were found to be below those of age-based vaccination because of more eligible girls being identified and higher vaccine uptake. We estimate that vaccine can be delivered at costs that would make HPV vaccination a very cost-effective intervention
Joining Forces: Collaborating Internationally to Deliver High-Quality, Online Postgraduate Education in Pain Management
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Elizabeth Devonshire
Full Text Available The effective management of pain is a complex and costly global issue, requiring a range of innovative educational strategies to enable culturally appropriate and high-quality health care provision. In response to this issue, the Pain Management Research Institute at the University of Sydney (Sydney, Australia has established several strategic alliances with other overseas universities to deliver online postgraduate education in pain management. The present article discusses the rationale for joining forces, and the approach adopted in creating and maintaining these alliances. It also provides insights into the benefits, challenges and opportunities associated with collaborative educational initiatives of this nature, from institutional, academic and student perspectives.
A model for low dose effects of low-LET radiation delivered at high dose rates
Schöllnberger, H.; Stewart, R.D.; Mitchel, R.E.J.
In vitro studies show that protective tumour-reducing effects occur for low dose rates (mGy per minute). To account for these phenomena, we have previously developed stochastic and deterministic multi-stage cancer models that include radiation-induced adaptations in DNA repair processes and radical scavenging. Here, these models are extended to account for the induction of radioprotective mechanisms for low doses of low LET radiation delivered at high dose rates. Cellular adaptations in DNA repair are related to temporal changes in the amount of DNA damage in a cell. The combined effects of endogenous DNA damage, background radiation and artificial irradiation are considered. PMID:22318364
Reduced folate, increased vitamin B(12) and homocysteine concentrations in women delivering preterm.
Dhobale, Madhavi; Chavan, Preeti; Kulkarni, Asmita; Mehendale, Savita; Pisal, Hemlata; Joshi, Sadhana
Maternal nutrition is an important determinant of the duration of pregnancy and fetal growth, and thereby influences pregnancy outcome. Folic acid and vitamin B(12) are involved in one-carbon metabolism and are reported to underlie intrauterine programming of adult diseases. In the present study, the levels of folate, vitamin B(12) and homocysteine were measured in mothers delivering preterm (PT; gestation epigenetic regulation of vital genes involved in the fetal programming of adult diseases, further studies need to be undertaken to understand their role in preterm deliveries. Copyright © 2012 S. Karger AG, Basel.
Enter the Matrix: Building Creative Industry through Delivering Insights in Comics
Hafiz Ahmad Aziz; Alvanov Zpalanzani; Setiawan Sabana
Comic is a media which delivers its content through visual sequence. This media has negative preference in Indonesia's community because viewed as mild entertainment for children. Yet in modern society, comics observed and researched as one of media which could penetrate deep within its reader's mind. In re-create cultural insight through comic, the content must encrypt into visual and sequential mode which form a matrix of insight. This matrix will encompasses the effective transformation of...
The Effects of Internet-Delivered Mindfulness Training on Stress, Coping, and Mindfulness in University Students
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David Messer
Full Text Available Internet-delivered mindfulness and relaxation training were compared with each other and a no-treatment control on stress, coping, and mindfulness measures. Participants (n = 114 were assessed before and after treatment, and their compliance with the intervention they received was tracked. The treatments were received at a time, place, and computer of the participants' choosing with the proviso that three exercises be completed during each of three successive weeks. Both mindfulness and relaxation reduced stress, but only mindfulness training increased mindfulness and reduced emotion-focused coping.
Delivering "Just-In-Time" Smoking Cessation Support Via Mobile Phones: Current Knowledge and Future Directions.
Naughton, Felix
Smoking lapses early on during a quit attempt are highly predictive of failing to quit. A large proportion of these lapses are driven by cravings brought about by situational and environmental cues. Use of cognitive-behavioral lapse prevention strategies to combat cue-induced cravings is associated with a reduced risk of lapse, but evidence is lacking in how these strategies can be effectively promoted. Unlike most traditional methods of delivering behavioral support, mobile phones can in principle deliver automated support, including lapse prevention strategy recommendations, Just-In-Time (JIT) for when a smoker is most vulnerable, and prevent early lapse. JIT support can be activated by smokers themselves (user-triggered), by prespecified rules (server-triggered) or through sensors that dynamically monitor a smoker's context and trigger support when a high risk environment is sensed (context-triggered), also known as a Just-In-Time Adaptive Intervention (JITAI). However, research suggests that user-triggered JIT cessation support is seldom used and existing server-triggered JIT support is likely to lack sufficient accuracy to effectively target high-risk situations in real time. Evaluations of mobile phone cessation interventions that include user and/or server-triggered JIT support have yet to adequately assess whether this improves management of high risk situations. While context-triggered systems have the greatest potential to deliver JIT support, there are, as yet, no impact evaluations of such systems. Although it may soon be feasible to learn about and monitor a smoker's context unobtrusively using their smartphone without burdensome data entry, there are several potential advantages to involving the smoker in data collection. This commentary describes the current knowledge on the potential for mobile phones to deliver automated support to help smokers manage or cope with high risk environments or situations for smoking, known as JIT support. The article
Galois theory lectures delivered at the University of Notre Dame by Emil Artin
Artin, Emil
In the nineteenth century, French mathematician Evariste Galois developed the Galois theory of groups-one of the most penetrating concepts in modem mathematics. The elements of the theory are clearly presented in this second, revised edition of a volume of lectures delivered by noted mathematician Emil Artin. The book has been edited by Dr. Arthur N. Milgram, who has also supplemented the work with a Section on Applications.The first section deals with linear algebra, including fields, vector spaces, homogeneous linear equations, determinants, and other topics. A second section considers ext
Peer-Delivered Recovery Support Services for Addictions in the United States: A Systematic Review.
Bassuk, Ellen L; Hanson, Justine; Greene, R Neil; Richard, Molly; Laudet, Alexandre
This systematic review identifies, appraises, and summarizes the evidence on the effectiveness of peer-delivered recovery support services for people in recovery from alcohol and drug addiction. Nine studies met criteria for inclusion in the review. They were assessed for quality and outcomes including substance use and recovery-related factors. Despite significant methodological limitations found in the included studies, the body of evidence suggests salutary effects on participants. Current limitations and recommendations for future research are discussed. Copyright © 2016 Elsevier Inc. All rights reserved.
Feasibility of Delivering a Dance Intervention for SubAcute Stroke in a Rehabilitation Hospital Setting
Demers, Marika; McKinley, Patricia
Dance can be a promising treatment intervention used in rehabilitation for individuals with disabilities to address physical, cognitive and psychological impairments. The aim of this pilot study was to determine the feasibility of a modified dance intervention as an adjunct therapy designed for people with subacute stroke, in a rehabilitation setting. Using a descriptive qualitative study design, a biweekly 45-min dance intervention was offered to individuals with a subacute stroke followed in a rehabilitation hospital, over 4 weeks. The dance intervention followed the structure of an usual dance class, but the exercises were modified and progressed to meet each individual's needs. The dance intervention, delivered in a group format, was feasible in a rehabilitation setting. A 45-min dance class of moderate intensity was of appropriate duration and intensity for individuals with subacute stroke to avoid excessive fatigue and to deliver the appropriate level of challenge. The overall satisfaction of the participants towards the dance class, the availability of space and equipment, and the low level of risks contributed to the feasibility of a dance intervention designed for individuals in the subacute stage of post-stroke recovery. PMID:25785497
Feasibility of Delivering a Dance Intervention for SubAcute Stroke in a Rehabilitation Hospital Setting
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Marika Demers
Full Text Available Dance can be a promising treatment intervention used in rehabilitation for individuals with disabilities to address physical, cognitive and psychological impairments. The aim of this pilot study was to determine the feasibility of a modified dance intervention as an adjunct therapy designed for people with subacute stroke, in a rehabilitation setting. Using a descriptive qualitative study design, a biweekly 45-min dance intervention was offered to individuals with a subacute stroke followed in a rehabilitation hospital, over 4 weeks. The dance intervention followed the structure of an usual dance class, but the exercises were modified and progressed to meet each individual's needs. The dance intervention, delivered in a group format, was feasible in a rehabilitation setting. A 45-min dance class of moderate intensity was of appropriate duration and intensity for individuals with subacute stroke to avoid excessive fatigue and to deliver the appropriate level of challenge. The overall satisfaction of the participants towards the dance class, the availability of space and equipment, and the low level of risks contributed to the feasibility of a dance intervention designed for individuals in the subacute stage of post-stroke recovery.
Feasibility of Training and Delivering Compassionate Touch in Long-Term Care.
Han, Areum; Kunik, Mark E
Limited evidence supports the use of therapeutic touch for people with dementia (PWD). Interventions incorporating a person-centered approach to touch delivered by staff may benefit PWD and staff in long-term care settings. The Compassionate Touch ® (CT) program provides skilled human touch and a compassionate presence following a person-centered approach and touch protocol. The purpose of this study was to determine the feasibility of training and delivering CT. An online survey was sent via email to 112 staff who attended the CT coach training. Descriptive statistics and thematic analysis were used to analyze closed-and open-ended questions of the survey. Twenty-four staff members completed the survey and reported positive perspectives about the training, use of the program, and benefits for PWD and themselves. Five themes emerged, including (1) benefits for residents, (2) challenges in using CT, (3) when to use CT, (4) training staff, and (5) needed support. Preliminary findings from the present research show potential benefits of using the CT program for residents, challenges participants faced in using the program and training other staff, and support needed to overcome these challenges. Programs such as CT may benefit PWD and staff in residential care settings.
Inhaler Training Delivered by Internet-Based Home Videoconferencing Improves Technique and Quality of Life.
Thomas, Rachel M; Locke, Emily R; Woo, Deborah M; Nguyen, Ethan H K; Press, Valerie G; Layouni, Troy A; Trittschuh, Emily H; Reiber, Gayle E; Fan, Vincent S
COPD is common, and inhaled medications can reduce the risk of exacerbations. Incorrect inhaler use is also common and may lead to worse symptoms and increased exacerbations. We examined whether inhaler training could be delivered using Internet-based home videoconferencing and its effect on inhaler technique, self-efficacy, quality of life, and adherence. In this pre-post pilot study, participants with COPD had 3 monthly Internet-based home videoconference visits with a pharmacist who provided inhaler training using teach-to-goal methodology. Participants completed mailed questionnaires to ascertain COPD severity, self-efficacy, health literacy, quality of life, adherence, and satisfaction with the intervention. A total of 41 participants completed at least one, and 38 completed all 3 home videoconference visits. During each visit, technique improved for all inhalers, with significant improvements for the albuterol metered-dose inhaler, budesonide/formoterol metered-dose inhaler, and tiotropium dry powder inhaler. Improved technique was sustained for nearly all inhalers at 1 and 2 months. Quality of life measured with the Chronic Respiratory Questionnaire improved following the training: dyspnea (+0.3 points, P = .01), fatigue (+0.6 points, P training using teach-to-goal methodology delivered by home videoconference is a promising means to provide training to patients with COPD that can improve technique, quality of life, self-efficacy, and adherence. Copyright © 2017 by Daedalus Enterprises.
The role of learning and customer orientation for delivering service quality to patients.
Bellou, Victoria
This study seeks to investigate the impact that learning orientation, internal and external customer orientation have on quality of care delivered to patients. Additionally, given the differences between managerial and non-managerial employees regarding organizational value perception and focus on the needs of internal customers and patients, the study aims to examine potential variations in these relationships. The study took place in ten out of 31 public hospitals operating in the five largest districts in continental Greece. Hospitals were chosen on a random basis. Out of 800 questionnaires that were personally administered, 499 usable responses were gathered. The extent to which employees create and use knowledge and focus on satisfying the needs of both internal customers and patients is indicative of the quality of care provided. In addition, only managerial employees believe that learning orientation reinforces quality of care. The fact that employees rated quality of care delivered to patients and that most employees had extended tenure should be taken into consideration when interpreting these findings. Top management needs to create a strong and clear culture that emphasizes learning, as well as internal customer and patient orientation, and infuse them among all organizational members. Moreover, human resource management policies should be aligned to meeting or exceeding patients' requests and expectations. The paper enhances existing knowledge with regard to the antecedents of offering medical care of high quality.
A qualitative examination of psychology graduate students' experiences with guided Internet-delivered cognitive behaviour therapy
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Lindsay N. Friesen
Full Text Available Guided Internet-delivered cognitive behaviour therapy (ICBT is efficacious for the treatment of a variety of clinical disorders (Spek et al., 2007, yet minimal research has investigated training students in guided ICBT. To contribute to the training literature, through qualitative interviews, this study explored how ICBT was perceived by student therapists (n = 12 trained in guided ICBT. Additionally, facilitators and challenges encountered by students learning guided ICBT were examined. Qualitative analysis revealed that students perceived training to enhance their professional skills in guided ICBT such as how to gain informed consent, address emergencies, and facilitate communication over the Internet. Students described guided ICBT as beneficial for novice therapists learning cognitive behavior therapy as asynchronous communication allowed them to reflect on their clinical emails and seek supervision. Further, students perceived guided ICBT as an important skill for future practice and an avenue to improve patient access to mental health care. Specific facilitators of learning guided ICBT included having access to formal and peer supervision as well as technical assistance, ICBT modules, a functional web application, and detailed policies and procedures for the practice of guided ICBT. Challenges in delivering guided ICBT were also identified by participants such as finding time to learn the approach given other academic commitments, working with non-responsive clients, addressing multiple complex topics over email, and communicating through asynchronous emails. Based on the feedback collected from participants, recommendations for training in guided ICBT are offered along with future research directions.
Alginate-Based Edible Films Delivering Probiotic Bacteria to Sliced Ham Pretreated with High Pressure Processing
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Foteini Pavli
Full Text Available The aim of the present work was to evaluate the efficacy of Na-alginate edible films as vehicles for delivering probiotic bacteria to sliced ham with or without pretreatment using high pressure processing (HPP. Three strains of probiotic bacteria were incorporated in Na-alginate forming solution. Ham slices (with or without pretreatment using HPP at 500 MPa for 2 min were packed under vacuum in contact with the films and then stored at 4, 8 and 12 °C for 66, 47 and 40 days, respectively. Microbiological analysis was performed in parallel with pH and color measurements. Sensory characteristics were assessed, while the presence and the relative abundance of each probiotic strain during storage was evaluated using pulsed field gel electrophoresis. In ham slices without HPP treatment, probiotic bacteria were enumerated above 106 CFU/g during storage at all temperatures. Same results were obtained in cases of HPP treated samples, but pH measurements showed differences with the latter ones exhibiting higher values. Sensory evaluation revealed that probiotic samples had a more acidic taste and odor than the control ones, however these characteristics were markedly compromised in samples treated with HPP. Overall, the results of the study are promising since probiotic bacteria were successfully delivered in the products by edible films regardless of the HPP treatment.
Student nurses perceptions of spirituality and competence in delivering spiritual care: a European pilot study.
Ross, Linda; van Leeuwen, René; Baldacchino, Donia; Giske, Tove; McSherry, Wilfred; Narayanasamy, Aru; Downes, Carmel; Jarvis, Paul; Schep-Akkerman, Annemiek
Spiritual care is expected of nurses, but it is not clear how undergraduates can achieve competency in spiritual care at point of registration as required by nursing/midwifery regulatory bodies. To describe undergraduate nurses'/midwives' perceptions of spirituality/spiritual care, their perceived competence in delivering spiritual care, and to test out the proposed method and suitability of measures for a larger multinational follow-on study. Cross-sectional, multinational, descriptive survey design. Author administered questionnaires were completed by 86% of the intended convenience sample of 618 undergraduate nurses/midwives from 6 universities in 4 European countries in 2010. Students held a broad view of spirituality/spiritual care and considered themselves to be marginally more competent than not in spiritual care. They were predominantly Christian and reported high levels of spiritual wellbeing and spiritual attitude and involvement. The proposed method and measures were appropriate and are being used in a follow-on study. The following are worthy of further investigation: whether the pilot study findings hold in student samples from more diverse cultural backgrounds; whether students' perceptions of spirituality can be broadened to include the full range of spiritual needs patients may encounter and whether their competence can be enhanced by education to better equip them to deliver spiritual care; identification of factors contributing to acquisition of spiritual caring skills and spiritual care competency. © 2013.
Psychological therapies (Internet-delivered) for the management of chronic pain in adults.
Eccleston, Christopher; Fisher, Emma; Craig, Lorraine; Duggan, Geoffrey B; Rosser, Benjamin A; Keogh, Edmund
Chronic pain (i.e. pain lasting longer than three months) is common. Psychological therapies (e.g. cognitive behavioural therapy) can help people to cope with pain, depression and disability that can occur with such pain. Treatments currently are delivered via hospital out-patient consultation (face-to-face) or more recently through the Internet. This review looks at the evidence for psychological therapies delivered via the Internet for adults with chronic pain. Our objective was to evaluate whether Internet-delivered psychological therapies improve pain symptoms, reduce disability, and improve depression and anxiety for adults with chronic pain. Secondary outcomes included satisfaction with treatment/treatment acceptability and quality of life. We searched CENTRAL (Cochrane Library), MEDLINE, EMBASE and PsycINFO from inception to November 2013 for randomised controlled trials (RCTs) investigating psychological therapies delivered via the Internet to adults with a chronic pain condition. Potential RCTs were also identified from reference lists of included studies and relevant review articles. In addition, RCTs were also searched for in trial registries. Peer-reviewed RCTs were identified and read in full for inclusion. We included studies if they used the Internet to deliver the primary therapy, contained sufficient psychotherapeutic content, and promoted self-management of chronic pain. Studies were excluded if the number of participants in any arm of the trial was less than 20 at the point of extraction. Fifteen studies met the inclusion criteria and data were extracted. Risk of bias assessments were conducted for all included studies. We categorised studies by condition (headache or non-headache conditions). Four primary outcomes; pain symptoms, disability, depression, and anxiety, and two secondary outcomes; satisfaction/acceptability and quality of life were extracted for each study immediately post-treatment and at follow-up (defined as 3 to 12 months post
Internet-delivered obesity treatment improves symptoms of and risk for depression.
Naparstek, Jacob; Wing, Rena R; Xu, Xiaomeng; Leahey, Tricia M
In-person lifestyle interventions for obesity treatment yield significant improvements in depression. These improvements may be attributed to the excellent weight losses produced by in-person interventions. In contrast, Internet programs yield more modest weight losses, and their effect on depression is unknown. This study is the first to examine whether Internet-delivered obesity treatment impacts depressive symptoms. Participants (N = 136) were randomized to either a community campaign plus Internet behavioral weight loss (IBWL) or community campaign alone (Control). IBWL did not include online social support components. A measure of depressive symptoms was administered, and weight was objectively assessed. Of the total sample, 24% met the clinical cutoff for elevated depression risk at baseline. IBWL participants lost more weight during treatment (P = 0.005) and experienced significantly greater improvements in depressive symptoms (P = 0.02). Among participants who met the clinical cutoff for elevated risk for depression at baseline, those assigned to IBWL had greater improvements in depressive symptoms during treatment compared to Control (P = 0.033). Consequently, at post-treatment, a smaller percentage of IBWL participants were at elevated risk for depression. This study is the first to show that Internet-delivered obesity treatment improves depression risk and depressive symptoms in individuals with overweight or obesity. © 2017 The Obesity Society.
Maternal Child and Family Health Nurses: Delivering a Unique Nursing Speciality.
Fraser, Sarah; Grant, Julian; Mannix, Trudi
Introduction This study aimed to describe Maternal Child and Family Health Nurses' (MCaFHNs) perception of their role across Australia. MCaFHNs deliver services to positively influence the growth and development of children in the early years. Little is known about their role as they deliver care to children and families in Australia. Methods This study used in-depth qualitative inquiry. Sixteen expert MCaFHNs from the eight jurisdictions in Australia took part in semi-structured interviews conducted from April 2013 to August 2013. The data were transcribed verbatim, validated by participants, and analysed thematically. Results The results indicated that the MCaFHNs' role is embedded in the principles of primary health care under an umbrella of universal service delivery with increasing overall complexity. Health promotion and early intervention are key components of the role, with services focused heavily on child growth and development and maternal mental health. Delivery of services by MCaFHNs was enriched by specific approaches to care, such as working in partnership with families, and all aspects of the role were enabled by essential specialist skills and knowledge. Discussion While role descriptors, educational backgrounds and experiences vary, participants overwhelmingly report similarities in practice. This study identified tangible reasons for the development of a nationally consistent role and practice in Australia, enabling consistency and equity of best models of practice. Such a description is essential to enable transferability and comparison with nurses working in similar contexts internationally.
An evaluation of a collaborative bibliotherapy scheme delivered via a library service.
Macdonald, J; Vallance, D; McGrath, M
This paper reports on the evaluation of a bibliotherapy scheme delivered via a local library service, in conjunction with General Practice (GP) practices, local social welfare agencies and through self-referral. The Read Yourself Well (RYW) scheme was based on principles established from other similar schemes and as a way of delivering support for adults experiencing mild to moderate mental health problems for whom clinical treatments are not appropriate. The intervention consisted of initial referral and evaluation by the scheme bibliotherapist, a one-hour session at the beginning and end of the intervention where a purpose-designed questionnaire and two mental health assessments were carried out (the General Health Questionnaire and the Clinical Outcomes in Routine Evaluation questionnaire). Contact and support from the bibliotherapist was provided during the intervention period. One hundred and fifty-seven participants were recruited to the evaluation of whom 114 provided full data. Statistical analyses of the mental health scores showed significant improvements post treatment, for, both male and female participants, for all three referral routes, and for participants who were previously library users, and those who joined the library service to participate in the RYW scheme. The results of this large sample evaluation support the proposal that library-based bibliotherapy can be effective in the treatment of mental health problems. © 2012 John Wiley & Sons Ltd.
Developing and delivering food systems training programs for 21st century audiences
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Troy Hahn
Full Text Available Expectations for training programmes today are very different from expectations for training programmes in the past, because today's audiences are not only multigenerational, but the younger generations learn in distinctly different ways from older, more traditional audiences. To meet the needs of these multigenerational audiences, the Auburn University Food Systems Institute (AUFSI has developed on-demand, online courses that offer a variety of ways for learners to interact with training materials. For example, a typical course may offer not only traditional text, but audio, video, simulations, and more. In addition, AUFSI has developed supporting educational tools such as interactive virtual tours and video games. This approach to creating courses is a response to the different levels of experiences of the generations as well as different expectations of how materials should be delivered. In order to be effective, training materials need to be designed to appeal to this multigenerational audience. Traditionalists (born before 1946 prefer face-to-face training programmes. Baby Boomers (born 1946-1964 are more accepting of technology. Generations X (born 1965-1980, Y (born 1981- 2000 and C (born after 2000, however, expect to receive training at their convenience, to have it delivered electronically, and to be entertained as well as educated.
How to Deliver Open Sustainable Innovation: An Integrated Approach for a Sustainable Marketable Product
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Francesco Cappa
Full Text Available The adoption of open innovation and peer production, powered by 3D printing technology, is transforming traditional manufacturing methods towards a "third industrial revolution". The purpose of this research is to provide empirical evidence for an integrated approach, based on collaborative product development and peer production, combined with 3D printing, to deliver more sustainable, yet competitive, marketable products. In particular, this experimental study is conducted in the context of mobile forensics, an emerging market where limited expensive products exist and alternative solutions are needed. The technical viability and economic feasibility of the prototype developed in this research validate the proposed integrated approach, which could be a game-changer in the field of mobile forensics, as well as in other sectors. The sustainability improvements with this approach are a reduction of the total cost, thereby making it affordable for lower income users, and a decrease in energy consumption and pollutant emissions. The validated integrated approach offers start-up opportunities to develop and deliver more sustainable, marketable products, towards the paradigm of Open Sustainable Innovation. While the device developed and tested in this research has similar features to existing products, the methodology, implementation, and motivation are original.
Predictors in Internet-delivered cognitive behavior therapy and behavioral stress management for severe health anxiety.
Hedman, Erik; Andersson, Erik; Lekander, Mats; Ljótsson, Brjánn
Severe health anxiety can be effectively treated with exposure-based Internet-delivered cognitive behavior therapy (ICBT), but information about which factors that predict outcome is scarce. Using data from a recently conducted RCT comparing ICBT (n = 79) with Internet-delivered behavioral stress management (IBSM) (n = 79) the presented study investigated predictors of treatment outcome. Analyses were conducted using a two-step linear regression approach and the dependent variable was operationalized both as end state health anxiety at post-treatment and as baseline-to post-treatment improvement. A hypothesis driven approach was used where predictors expected to influence outcome were based on a previous predictor study by our research group. As hypothesized, the results showed that baseline health anxiety and treatment adherence predicted both end state health anxiety and improvement. In addition, anxiety sensitivity, treatment credibility, and working alliance were significant predictors of health anxiety improvement. Demographic variables, i.e. age, gender, marital status, computer skills, educational level, and having children, had no significant predictive value. We conclude that it is possible to predict a substantial proportion of the outcome variance in ICBT and IBSM for severe health anxiety. The findings of the present study can be of high clinical value as they provide information about factors of importance for outcome in the treatment of severe health anxiety. Copyright © 2014 Elsevier Ltd. All rights reserved.
Preparing promotoras to deliver health programs for Hispanic communities: training processes and curricula.
Koskan, Alexis M; Friedman, Daniela B; Brandt, Heather M; Walsemann, Katrina M; Messias, DeAnne K H
Training is an essential component of health programs that incorporate promotoras de salud (the Spanish term for community health workers) in the delivery of health education and behavioral interventions to Hispanics. During training sessions, promotoras are exposed to information and skill-building activities they need to implement the health programs. This analysis was one component of a broader study which explored program planners' approaches to recruiting and training promotoras to deliver and sustain health promotion programs for Hispanic women. The purpose of this study was to examine promotora-curriculum and training processes used to prepare promotoras to deliver health programs. The authors examined transcripts of 12 in-depth interviews with program planners and conducted a content analysis of seven different training materials used in their respective promotora programs. Interview themes and narratives included program planners' varying conceptualizations of promotora-training, including their personal definitions of "training the trainer," the practice of training a cadre of promotoras before selecting those best fit for the program, and the importance of providing goal-directed, in-depth training and supervision for promotoras. The content analysis revealed a variety of strategies used to make the training materials interactive and culturally competent. Study implications describe the importance of planners' provision of ongoing, goal-directed, and supervised training using both appropriate language and interactive methods to engage and teach promotoras.
The Leicester Model of Interprofessional education: developing, delivering and learning from student voices for 10 years.
Anderson, Elizabeth S; Lennox, Angela
There are few sustained interprofessional learning opportunities in practice which engage the whole cohort of health and social care students across a region, the Leicester Model of Interprofessional Education is such an example. Since 1995 the Leicester Model has evolved to enable health and social care students to learn about the complexities of delivering multi-agency care in a range of health and social care settings. The learning environment is situated at the front line of service delivery. The education model takes students through a cycle of learning and applies a problem-solving, experiential learning approach which promotes deep learning. Follow-up data indicates that deep learning is achieved. This paper describes the original setting and presents the evaluation outcomes of the Leicester Model's "Health in the Community" course, which is delivered in city-centre communities, where inequalities in health are greatest. It traces a ten-year trajectory of interprofessional student group evaluations which helped shape this learning experience. Year-on-year positive student outcomes indicate the potential of the model to motivate and prepare future professionals for team working. Its sustainability has been achieved through ensuring the integration of education research in the development process, engagement of practitioners who value the student contributions to team working, placing patients central to the learning experience and establishing working partnerships between Higher Education Institutions, local health and social care organizations and the voluntary sector.
Developing Sustainable Cancer Education Programs: Training Public Health Students to Deliver Cancer 101 in Puerto Rico.
Rivera, Y M; Moreno, L; Briant, K J; Vélez, H; Jiménez, J C; Torres, J; Vadaparampil, S T; Muñoz-Antonia, T; Quinn, G P
The use of promotores to educate Hispanic communities about different health topics has been proven successful, albeit with limitations in program sustainability. The goal of this study was to develop a sustainable train-the-trainer model to train graduate public health (PH) students to disseminate cancer education among communities in Puerto Rico (PR). Graduate students (n = 32) from Ponce Health Sciences University's (PHSU) PH program participated in a 2-day Cáncer 101 training, where they learned how to deliver nine cancer modules to the community. Cancer knowledge was assessed before and after the training via 54 items measuring discussed concepts. Participants also assessed the training's effectiveness by completing a training evaluation informed by social cognitive theory (SCT) constructs of self-efficacy, outcome expectations, facilitation, and observational learning. Participants were mainly female (78.1 %), 26.7 ± 3.9 years old, and enrolled in a Masters-level program (81.3 %). Participants reported an average 11.38-point increase in cancer knowledge after attending the training [t(31) = 14.88, p reporting satisfactory comments in the open-ended responses and high scores on measured SCT constructs. The Cáncer 101 training program effectively prepared students to deliver cancer education to local communities. Training graduate PH students to educate communities about health issues is an innovative, and potentially sustainable, way to reach underserved populations.
Bone delivers its energy information to fat and islets through osteocalcin.
Chen, Xiang; Tian, Hao-ming; Yu, Xi-jie
Bone has emerged as a novel endocrine organ for its ability to produce hormones and involvement in several regulatory feedback loops. Osteocalcin (OCN) is released into bloodstream during bone resorption and has been demonstrated to exert endocrine regulation on islets, fat and male testis to form feedback loops. We hypothesize that bone delivers its energy metabolism signals to related energy-regulating organs through OCN based on the following evidence: First, OCN has close interactions with islets and fat, and it shows ability to stimulate islets and fat to secret insulin and adiponectin, respectively. Islets and fat are important organs involved in energy metabolism. Second, OCN undergoes physiological fluctuations during a lifetime. In children and adolescents, during the development of osteoporosis or after bone fracture, OCN level increases significantly. The elevated OCN at these stages represents enhanced bone turnover and metabolic activity, which require more energy supply. Therefore, the metabolic activity of bone and the energy-related organs like fat and islets are closely linked by circulating OCN. Through systemic release of OCN, bone delivers its energy-demanding information to other organs to satisfy its energy requirement. © 2012 Tianjin Hospital and Blackwell Publishing Asia Pty Ltd.
Ketamine and midazolam delivered by patient-controlled analgesia in relieving pain associated with burns dressings.
MacPherson, Ross D; Woods, David; Penfold, Joanna
A study involving the use of a mixture of ketamine and midazolam delivered via patient-controlled analgesia (PCA) device was trialed to assess its effectiveness in reducing pain associated with repeated burns dressings in an adult population. Patients undergoing burns dressings changes were given a PCA device of ketamine and midazolam to use during the procedure. The aims were to investigate the efficacy of the device and to ascertain what (if any) adverse effects were associated with its use. During the trial period, 44 patients who underwent 95 separate procedures were enrolled. The effectiveness of the device was rated (out of 10) by both staff and patients with the mean scores being 8.47 and 8.50, respectively. In all but 1 case, the proposed procedure was carried out successfully. Thirteen patients reported a total of 23 adverse effects, with hallucinations (11) being the most common. The use of ketamine/midazolam delivered by PCA was shown to be an effective means of pain control during burns dressings as assessed by both staff and patients. The incidence of adverse events was low.
Do school based anti-smoking campaigns delivered by oral health therapists work?
Matias, M A; Steindl, S R; Plonka, K A; Pukkallus, M; Palmer, J; Holcombe, T; Seymour, G J; Marshall, R I
The dental profession has a pivotal role in cancer prevention. In Queensland, oral health therapists (OHTs) are in a unique position to provide quality smoking cessation programmes and intervention strategies to young adolescents through the school based oral health services they provide. This study undertook a smoking cessation and prevention programme targeted to female high school students in a dental setting. An oral health therapist delivered an anti-smoking message and educated adolescents of the health-risk effects of smoking. A total of 1217 female students were recruited with 621 (51%) in the intervention group and 596 (49%) in the control group. There was a significant improvement in the knowledge of both systemic and oral health effects of smoking in the intervention group (p smoking related conditions. A smoking cessation and prevention programme targeted to female high school students in a dental setting provides a novel means of delivering an anti-smoking message and educating adolescents of the health-risk effects of smoking. © 2013 Australian Dental Association.
Voice Over the Internet Protocol as a Medium for Delivering Reading Intervention
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Craig Wright
Full Text Available Voice Over the Internet Protocol (VoIP holds promise as a platform by which services can be delivered to students in rural and remote regions who have reading difficulties. VoIP is an Internet-based protocol that allows two or more individuals to videoconference from remote locations. This study used a single-case research design to investigate whether VoIP would produce significant gains in reading ability in BM, a 10-year-old with long-standing word-level reading problems. BM was provided with a theoretically motivated reading intervention 4 times weekly. The intervention was delivered remotely using the Apple iChat software. Substantial growth in regular- and nonword reading covaried with onset and removal of treatment. Treatment gains were maintained at 10-week follow-up. Meaningful gains were also seen in text-reading accuracy and reading comprehension. VoIP-based instruction represents an important avenue for future research and is a teaching method that holds much promise for rural and remote students.
Targeting the vaginal mucosa with human papillomavirus pseudovirion vaccines delivering simian immunodeficiency virus DNA.
Gordon, Shari N; Kines, Rhonda C; Kutsyna, Galyna; Ma, Zhong-Min; Hryniewicz, Anna; Roberts, Jeffery N; Fenizia, Claudio; Hidajat, Rachmat; Brocca-Cofano, Egidio; Cuburu, Nicolas; Buck, Christopher B; Bernardo, Marcelino L; Robert-Guroff, Marjorie; Miller, Christopher J; Graham, Barney S; Lowy, Douglas R; Schiller, John T; Franchini, Genoveffa
The majority of HIV infections occur via mucosal transmission. Vaccines that induce memory T and B cells in the female genital tract may prevent the establishment and systemic dissemination of HIV. We tested the immunogenicity of a vaccine that uses human papillomavirus (HPV)-based gene transfer vectors, also called pseudovirions (PsVs), to deliver SIV genes to the vaginal epithelium. Our findings demonstrate that this vaccine platform induces gene expression in the genital tract in both cynomolgus and rhesus macaques. Intravaginal vaccination with HPV16, HPV45, and HPV58 PsVs delivering SIV Gag DNA induced Gag-specific Abs in serum and the vaginal tract, and T cell responses in blood, vaginal mucosa, and draining lymph nodes that rapidly expanded following intravaginal exposure to SIV(mac251.) HPV PsV-based vehicles are immunogenic, which warrant further testing as vaccine candidates for HIV and may provide a useful model to evaluate the benefits and risks of inducing high levels of SIV-specific immune responses at mucosal sites prior to SIV infection.
Service Quality of Delivered Care from the Perception of Women with Caesarean Section and Normal Delivery
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Jafar S. Tabrizi
Full Text Available Background: Our aim was to determine the service quality of delivered care for people with Caesarean Section and Normal Delivery. Methods: A cross-sectional study was conducted among 200 people who had caesarean section and normal delivery in Al-Zahra Teaching Hospital in Tabriz, north western Iran. Service quality was calculated using: Service Quality = 10 – (Importance × Performance based on importance and performance of service quality aspects from the postpartum women"s perspective.A hierarchical regression analysis was applied in two steps using the enter method to examine the associations between demographics and SQ scores. Data were analysed using the SPSS-17 software. Results: "Confidentiality", "autonomy", "choice of care provider" and "communication" achieved scores at the highest level of quality; and "support group", "prompt attention", "prevention and early detection", "continuity of care", "dignity", "safety", "accessibility and "basic amenities" got service quality score less than eight. Statistically significant relationship was found between service quality score and continuity of care (P=0.008. Conclusion: A notable gap between the participants" expectations and what they have actually received in most aspects of provided care. So, there is an opportunityto improve the quality of delivered care.
Assessing Delivered Services Quality in Emergency Department of Imam Reza Hospital, Tabriz, Iran: 2011
Directory of Open Access Journals (Sweden)
Jafar Sadegh Tabrizi
Full Text Available Background and objectives: The satisfaction of emergency department (ED patients is considered as an important indicator of hospitals quality. This study aimed to evaluate service quality (SQ from patients' perspective in ED. Material and Methods: A cross-sectional study was conducted with 120 admitted patients in emergency department of Imam Reza hospital of Tabriz University of Medical Sciences in 2011. Service Quality was measured using researcher-developed questionnaire. Questionnaire content validity was reviewed and confirmed by 10 experts and its reliability was confirmed based on Cronbach's alpha index (α = 0. 827. A measure of service quality was derived by combining the relative importance and actual performance of ED staffs. Service Quality was calculated using SQ = 10–(Importance×Performance. Independent Samples Test and Analysis of Variance were conducted to compare SQ score between categorical variables. Data were analyzed using the SPSS-17 statistical package. Results: From the customers' point of view, the average service quality score was 8.77 of 10. Furthermore, confidentiality, dignity and availability achieved the highest and of nutritional services, safety, cost and continuity of care got the lowest SQ scores from the patients' perspective. Conclusion : Improving quality of delivered care in ED depends on the understanding of the current situation and its weaknesses. It is possible to improve quality of delivered care by implementing effective interventions according to the results of study findings and by considering focus on dimensions which have worst quality.
Increasing self-regulatory energy using an Internet-based training application delivered by smartphone technology.
Cranwell, Jo; Benford, Steve; Houghton, Robert J; Golembewski, Michael; Golembewksi, Michael; Fischer, Joel E; Hagger, Martin S
Self-control resources can be defined in terms of "energy." Repeated attempts to override desires and impulses can result in a state of reduced self-control energy termed "ego depletion" leading to a reduced capacity to regulate future self-control behaviors effectively. Regular practice or "training" on self-control tasks may improve an individual's capacity to overcome ego depletion effectively. The current research tested the effectiveness of training using a novel Internet-based smartphone application to improve self-control and reduce ego depletion. In two experiments, participants were randomly assigned to either an experimental group, which received a daily program of self-control training using a modified Stroop-task Internet-based application delivered via smartphone to participants over a 4-week period, or a no-training control group. Participants assigned to the experimental group performed significantly better on post-training laboratory self-control tasks relative to participants in the control group. Findings support the hypothesized training effect on self-control and highlight the effectiveness of a novel Internet-based application delivered by smartphone as a practical means to administer and monitor a self-control training program. The smartphone training application has considerable advantages over other means to train self-control adopted in previous studies in that it has increased ecological validity and enables effective monitoring of compliance with the training program.
Ultrasound-Targeted Microbubble Destruction to Deliver siRNA Cancer Therapy
Carson, Andrew R; McTiernan, Charles F; Lavery, Linda; Grata, Michelle; Leng, Xiaoping; Wang, Jianjun; Chen, Xucai; Villanueva, Flordeliza S
Microbubble contrast agents can specifically deliver nucleic acids to target tissues when exposed to ultrasound treatment parameters that mediate microbubble destruction. In this study, we evaluated whether microbubbles and ultrasound targeted microbubble destruction (UTMD) could be used to enhance delivery of EGFR-directed small inhibitory RNA (siRNA) to murine squamous cell carcinomas. Custom designed microbubbles efficiently bound siRNA and mediated RNAse protection. UTMD-mediated delivery of microbubbles loaded with EGFR-directed siRNA to murine squamous carcinoma cells in vitro reduced EGFR expression and EGF-dependent growth, relative to delivery of control siRNA. Similarly, serial UTMD-mediated delivery of EGFR siRNA to squamous cell carcinoma in vivo decreased EGFR expression and increased tumor doubling times, relative to controls receiving EGFR siRNA loaded microbubbles but not ultrasound or control siRNA loaded microbubbles and UTMD. Taken together, our results offer a preclinical proof of concept for customized microbubbles and UTMD to deliver gene-targeted siRNA for cancer therapy. PMID:23010078
Retrospective study on the performance of porcelain laminate veneers delivered by undergraduate dental students.
Murphy, E; Ziada, H M; Allen, P F
The aim of this study was to retrospectively evaluate the clinical performance of porcelain laminate veneer restorations delivered by undergraduate students at the Department of Restorative Dentistry, University Dental School and Hospital Cork and to analyze the factors that influence their prognosis and their effect on periodontal health. Patients who had veneers fitted over a period of 5 yrs. were recalled for evaluation. The recall protocol took the form of a questionnaire and a full clinical examination of the teeth involved and contra lateral control teeth. In all, 29 patients with 62 porcelain veneers were examined, only 2 of which were in the mandible. 77% of patients had veneers fitted due to discolouration, 13% in order to alter the shape or size of teeth and 10% due to palatal erosion. On the date of recall 89% of veneers had never debonded or fractured, 6% had to be rebonded since the date of insertion and 5% presented with a fracture. From this study it appears that porcelain laminate veneers are successful in the treatment of discoloured and irregular configured anterior teeth. It shows that undergraduate students can deliver satisfactory veneer restorations.
Effect of Physician-Delivered Patient Education on the Quality of Bowel Preparation for Screening Colonoscopy
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Tze-Yu Shieh
Full Text Available Background. Inadequate bowel preparation is common in outpatients undergoing screening colonoscopy because of unawareness and poor adherence to instruction. Methods. Herein, 105 consecutive outpatients referred for screening colonoscopy were enrolled in this prospective, colonoscopist-blinded study. The patients were assigned to an intensive-education group, with 10 minutes of physician-delivered education, or to standard care. At the time of colonoscopy, the quality of bowel preparation was assessed using the Boston Bowel Preparation Scale (BBPS. The primary outcome was a BBPS score ≥5. The secondary outcomes were the mean BBPS score, insertion time, adenoma detection rate, and number of adenomas detected. Results. We analyzed 39 patients who received intensive education and 60 controls. The percentage of adequate bowel preparations with a BBPS score ≥5 was higher in the intensive-education group than in the control group (97.4% versus 80.0%; P=0.01. The adjusted odds ratio for having a BBPS score ≥5 in the intensive-education group was 10.2 (95% confidence interval = 1.23–84.3; P=0.03. Other secondary outcomes were similar in the 2 groups. Conclusions. Physician-delivered education consisting of a brief counseling session in addition to written instructions improves the quality of bowel preparation in outpatients undergoing screening colonoscopy.
Delivering patient education by group videoconferencing into the home: Lessons learnt from the Telehealth Literacy Project.
Banbury, Annie; Parkinson, Lynne; Nancarrow, Susan; Dart, Jared; Gray, Leonard C; Buckley, Jennene
We examined the procedures for implementing group videoconference (VC) education for older people delivered into the home environment to identify the most common themes affecting the optimum delivery of VC home-based groups to older people. Participants (n = 52) were involved in a six-week group VC patient education program. There were a total of 44 sessions, undertaken by nine groups, with an average of four participants (range 1-7) and the facilitator. Participants could see and hear each other in real-time whilst in their homes with customised tablets or a desktop computer. The data presented here are based on a program log maintained by the facilitator throughout the implementation phase of the project and post intervention. The VC group experience is influenced by factors including the VC device location, connection processes, meeting times, use of visual aids and test calls. Social presence can be improved by communication protocols and strategies. Robust information technology (IT) support is essential in mitigating technical problems to enhance users' experience. Group patient education can be delivered by VC into homes of older people. However, careful pre-program planning, training and support should be considered when implementing such programs. © The Author(s) 2016.
Practitioner Perspectives on Delivering Integrative Medicine in a Large, Acute Care Hospital
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Kent C. Nate
Full Text Available Background. We describe the process and challenges of delivering integrative medicine (IM at a large, acute care hospital, from the perspectives of IM practitioners. To date, minimal literature that addresses the delivery of IM care in an inpatient setting from this perspective exists. Methods. Fifteen IM practitioners were interviewed about their experience delivering IM services at Abbott Northwestern Hospital (ANW, a 630-bed tertiary care hospital. Themes were drawn from codes developed through analysis of the data. Results. Analysis of interview transcripts highlighted challenges of ensuring efficient use of IM practitioner resources across a large hospital, the IM practitioner role in affecting patient experiences, and the ways practitioners navigated differences in IM and conventional medicine cultures in an inpatient setting. Conclusions. IM practitioners favorably viewed their role in patient care, but this work existed within the context of challenges related to balancing supply and demand for services and to integrating an IM program into the established culture of a large hospital. Hospitals planning IM programs should carefully assess the supply and demand dynamics of offering IM in a hospital, advocate for the unique IM practitioner role in patient care, and actively support integration of conventional and complementary approaches.
Service quality of delivered care from the perception of women with caesarean section and normal delivery.
Tabrizi, Jafar S; Askari, Samira; Fardiazar, Zahra; Koshavar, Hossein; Gholipour, Kamal
Our aim was to determine the service quality of delivered care for people with Caesarean Section and Normal Delivery. A cross-sectional study was conducted among 200 people who had caesarean section and normal delivery in Al-Zahra Teaching Hospital in Tabriz, north western Iran. Service quality was calculated using: Service Quality = 10 - (Importance × Performance) based on importance and performance of service quality aspects from the postpartum women's perspective.A hierarchical regression analysis was applied in two steps using the enter method to examine the associations between demographics and SQ scores. Data were analysed using the SPSS-17 software. "Confidentiality", "autonomy", "choice of care provider" and "communication" achieved scores at the highest level of quality; and "support group", "prompt attention", "prevention and early detection", "continuity of care", "dignity", "safety", "accessibility and "basic amenities" got service quality score less than eight. Statistically significant relationship was found between service quality score and continuity of care (P=0.008). A notable gap between the participants" expectations and what they have actually received in most aspects of provided care. So, there is an opportunityto improve the quality of delivered care.
Effectiveness of Group-Delivered Cognitive Therapy and Treatment Length in Women Veterans with PTSD
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Diane T. Castillo
Full Text Available The effectiveness and length of group-delivered cognitive treatment for Posttraumatic Stress Disorder (PTSD was examined in a sample of women veterans. The sample included 271 primarily non-Hispanic white (61% and Hispanic (25% women veterans treated in 8-, 10-, or 12-group length sessions with manualized cognitive therapy for PTSD. Outcome was measured with the PTSD Symptom Checklist (PCL in an intention-to-treat analysis (N = 271, in completer subjects (n = 172, and with group as the unit of analysis (n = 47 groups. Significant decreases in PTSD were found in the full sample (effect size [ES] range = 0.27 to 0.38, completers (ES range = 0.37 to 0.54, and group as the unit of analysis (ES range = 0.71 to 0.92, suggesting effectiveness of cognitive group treatment for PTSD. PCL scores significantly improved in the 8, 10, and 12 group lengths, with no differences between each. Clinical improvement showed a third decreasing 10 or more PCL points and 22% no longer meeting PTSD diagnostic criteria, with the best results in the 10-session group. The results suggest group-delivered cognitive therapy is an effective, efficient, time-limited treatment for PTSD.
Comparison of Breast Crawl Between Infants Delivered by Vaginal Delivery and Cesarean Section.
Heidarzadeh, Mohammad; Hakimi, Sevil; Habibelahi, Abbas; Mohammadi, Marzieh; Shahrak, Shakiba Pourasad
Exclusive breastfeeding is the single most cost-effective intervention to reduce infant mortality. Breast crawl (BC) is deemed a natural way for the baby to behave immediately after delivery. BC is the method that may help initiation of breastfeeding in the most natural way. The aim of this study is to compare successful BC between neonates born through vaginal delivery and those born through cesarean section (CS) and factors associated with a positive outcome. Participants were mothers who delivered their babies during the period of October 2012 to December 2013 in Alzahra Hospital in Tabriz, through cesarean or vaginal delivery. Infants were placed prone on their mothers' abdomen after delivery. Data show that babies delivered through vaginal delivery had significantly more success in BC than babies born through the cesarean delivery (88.01% versus 11.21%). Moreover, babies in the CS group used significantly less time to achieve BC (45 versus 28 minutes). There is a remarkable difference in completion and length of time used to achieve BC between infants with regard to the delivery mode. Encouraging BC in all dyads, especially in cesarean births, may unduly delay the infant's first breastfeed.
Impact of student pharmacist-delivered asthma education on child and caregiver knowledge.
Elliott, Jennifer Padden; Marcotullio, Nicole; Skoner, David P; Lunney, Phil; Gentile, Deborah A
To evaluate the effectiveness of asthma education delivered by student pharmacists and to assess the impact of child and caregiver baseline asthma knowledge on asthma control in children. Student pharmacists developed and implemented asthma self-management education interventions for children and their caregivers and performed asthma screenings for children at a series of asthma camps. Eighty-seven children, ages 5-17 years, and their caregivers were enrolled in this study. A previously validated asthma questionnaire was modified to assess asthma knowledge among children and adults. Asthma knowledge increased significantly in children following participation in the education intervention (peducation intervention, however, did not increase caregiver knowledge of asthma. A significant association was observed between caregiver baseline asthma knowledge and better asthma control in their children (p=0.019). The results of this study demonstrate that student pharmacist-delivered asthma education can positively impact asthma knowledge in children, and that caregivers' knowledge of asthma is strongly correlated with better asthma control in their children.
Exploiting bilosomes for delivering bioactive polysaccharide isolated from Enteromorpha intestinalis for hacking hepatocellular carcinoma.
Matloub, Azza Abdelmageed; Salama, Alaa Hamed; Aglan, Hadeer Ahmed; AbouSamra, Mona Mahmoud; ElSouda, Sahar Salah Mohamed; Ahmed, Hanaa Hamdy
Bile salts containing vesicles (bilosomes) represent a portentous vesicular carrier that showed prosperous results in delivering active moieties in the gastrointestinal tract (GIT). In this study, bilosomes were exploited to deliver sulfated polysaccharide-protein complexes of Enteromorpha intestinalis (EHEM) and enhance its activity against hepatocellular carcinoma as well as resist harsh GIT conditions. Bilosomes were prepared using the sodium salt of three different bile acids (cholic, deoxycholic, taurodeoxycholic) and two different nonionic surfactants (Span 40 and 65). The effects of experimental variables were thoroughly studied to obtain an optimum formulation loading EHEM. The selected formulation (EH-Bilo-2) prepared with sodium cholate and Span 65 displayed nano-sized (181.1 ± 16.80 nm) spherical vesicles with reasonable entrapment efficiency (71.60 ± 0.25%) and controlled release properties; and thus was investigated as anti-hepatocarcinogenic candidate for in vivo studies. Treatment of hepatocellular carcinoma (HCC) bearing rats with EH-Bilo-2 experienced significant decrease in serum α-fetoprotein, endoglin, lipocalin-2, and heat shock protein 70 levels vs. the untreated counterparts. Furthermore, the photomicrographs of their liver tissue sections showed focal area of degenerated pleomorphic hepatocytes with fine fibrosis originating from the portal area. Thus, the optimized bilosomal formulation is a promising delegate for tackling hepatocellular carcinoma owing to its powerful anti-cancer and anti-angiogenic activity.
Gerontological Social Work Student-Delivered Respite: A Community-University Partnership Pilot Program.
Washington, Tiffany R; Tachman, Jacqueline A
This study describes a community-university partnership to support a gerontological social work student-delivered respite program, the Houseguest Program (Houseguest). Houseguest was designed using a community-engaged scholarship model of integrating research, teaching, and service. Houseguest was piloted with a small group of community-dwelling, coresiding dementia caregivers and care recipients. We examined caregivers' experiences with student-delivered respite using qualitative data analysis. Thematic analysis produced 8 themes: (a) respite from full time caregiving role, (b) information on caregiving strategies, (c) no-cost supportive services, (d) opportunity for care recipients to socialize, (e) tailored activities for care recipients, (f) rapport-building between students and family dyad, (g) reciprocity between students and family dyad, and (h) program continuation. We conclude with a proposed community-engaged scholarship model for dementia caregiving. Through a community-university partnership, Houseguest reduced the impact of caregiver burden and created an opportunity for students to serve families affected by dementia through respite and tailored activities.
A technician-delivered 'virtual clinic' for triaging low-risk glaucoma referrals.
Kotecha, A; Brookes, J; Foster, P J
PurposeThe purpose of this study is to describe the outcomes of a technician-delivered glaucoma referral triaging service with 'virtual review' of resultant data by a consultant ophthalmologist.Patients and methodsThe Glaucoma Screening Clinic reviewed new optometrist or GP-initiated glaucoma suspect referrals into a specialist ophthalmic hospital. Patients underwent testing by three ophthalmic technicians in a dedicated clinical facility. Data were reviewed at a different time and date by a consultant glaucoma ophthalmologist. Approximately 10% of discharged patients were reviewed in a face-to-face consultant-led clinic to examine the false-negative rate of the service.ResultsBetween 1 March 2014 and 31 March 2016, 1380 patients were seen in the clinic. The number of patients discharged following consultant virtual review was 855 (62%). The positive predictive value of onward referrals was 84%. Three of the 82 patients brought back for face-to-face review were deemed to require treatment, equating to negative predictive value of 96%.ConclusionsOur technician-delivered glaucoma referral triaging clinic incorporates consultant 'virtual review' to provide a service model that significantly reduces the number of onward referrals into the glaucoma outpatient department. This model may be an alternative to departments where there are difficulties in implementing optometrist-led community-based referral refinement schemes.
Exploratory research to design a school nurse-delivered intervention to treat adolescent overweight and obesity.
Gellar, Lauren; Druker, Sue; Osganian, Stavroula K; Gapinski, Mary Ann; Lapelle, Nancy; Pbert, Lori
In preparation for a pilot study to evaluate the efficacy of a school nurse-delivered intervention, focus groups were conducted to gain insight into the perceptions of stakeholders regarding the design and implementation of the intervention. Fifteen focus groups at participating schools. One hundred subjects, including overweight and obese high school students, parents, high school nurses, and staff. Stakeholders' perceptions. Focus groups were audiotaped and transcribed verbatim. Theme instances related to the research aim were identified, coded, and sorted into theme categories. Major topics discussed included teen issues, family support, intervention implementation-related concerns, and curriculum content. Teen issues included dealing with peer pressure, avoiding emotional eating, and support from friends. Many participants thought it should be the teen's choice to involve parents. Confidentiality was the most commonly identified potential barrier to implementation. Recommendations for nutrition and physical activity curriculum content focused on concrete, practical strategies. Results of this research provided insight into stakeholder's needs and perceptions regarding the content and structure of a school nurse-delivered intervention to treat adolescent overweight and obesity. Findings were used in the design and implementation of intervention protocols and materials. Copyright © 2012 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.
Implementation of a teacher-delivered sex education programme: obstacles and facilitating factors.
Buston, Katie; Wight, Daniel; Hart, Graham; Scott, Sue
Interventions are unlikely to achieve their desired aims unless they are implemented as intended. This paper focuses on factors that impeded or facilitated the implementation of a specially designed sex education programme, SHARE, which 13 Scottish schools were allocated to deliver in a randomized trial. Drawing on qualitative and quantitative data provided by teachers, we describe how this intervention was not fully implemented by all teachers or in all schools. Fidelity to the programme was aided by intensive teacher training, compatibility with existing Personal and Social Education (PSE) provision, and senior management support. It was hindered by competition for curriculum time, brevity of lessons, low priority accorded to PSE by senior management, particularly in relation to timetabling, and teachers' limited experience and ability in use of role-play. The nature of the adoption process, staff absence and turnover, theoretical understanding of the package, and commitment to the research were also factors influencing the extent of implementation across and within schools. The lessons learned may be useful for those involved in designing and/or implementing other teacher-delivered school-based health promotion initiatives.
In vitro aerodynamic characteristics of aerosol delivered from different inhalation methods in mechanical ventilation.
ElHansy, Muhammad H E; Boules, Marina E; Farid, Heba; Chrystyn, Henry; El-Maraghi, Sameh Kamal; Al-Kholy, Mohamed Bakry; El-Essawy, Assem Fouad Mohamed; Abdelrahman, Maha M; Said, Amira S A; Hussein, Raghda R S; Rabea, Hoda; Abdelrahim, Mohamed E A
Aerodynamic characteristics of aerosol delivery during invasive mechanical ventilation (IMV) are mostly determined by inserting cascade impactor in the circuit. Impactor might have some effect on airflow within IMV. Hence, the aim of the present study was to develop and evaluate new in vitro aerodynamic characterization methodology without affecting airflow in IMV. Breathing simulator was set in standard adult IMV circuit with inspiratory and expiratory pressures of 20 and 5 cm H 2 O, 1:3 inspiratory-expiratory ratio, 15 breaths min -1 , and tidal volume of 500 ml. Two ml of salbutamol solution containing 10,000 μg was nebulized using three different vibrating mesh nebulizers (VMNs) and Sidestream jet nebulizer (JET). Sixteen-metered doses, containing 100 μg salbutamol each, were delivered using three different spacers. Each device was placed in inspiration limb of Y-piece of ventilator tubing. Aerodynamic characteristics of aerosol delivered were measured using cooled Andersen cascade impactor, with mixing inlet connected to it. VMNs used had significantly more total mass in the impactor (p < .001) and fine particle dose (p < .001) compared to JET. Spacers used had higher total mass in the impactor percent (p < .001) and fine particle fraction compared to nebulizers. The in vitro IMV methodology setting suggested here showed encouraging results in comparison of different aerosol delivery systems in intubated patient.
Vagus nerve stimulation delivered during motor rehabilitation improves recovery in a rat model of stroke.
Khodaparast, Navid; Hays, Seth A; Sloan, Andrew M; Fayyaz, Tabbassum; Hulsey, Daniel R; Rennaker, Robert L; Kilgard, Michael P
Neural plasticity is widely believed to support functional recovery following brain damage. Vagus nerve stimulation paired with different forelimb movements causes long-lasting map plasticity in rat primary motor cortex that is specific to the paired movement. We tested the hypothesis that repeatedly pairing vagus nerve stimulation with upper forelimb movements would improve recovery of motor function in a rat model of stroke. Rats were separated into 3 groups: vagus nerve stimulation during rehabilitation (rehab), vagus nerve stimulation after rehab, and rehab alone. Animals underwent 4 training stages: shaping (motor skill learning), prelesion training, postlesion training, and therapeutic training. Rats were given a unilateral ischemic lesion within motor cortex and implanted with a left vagus nerve cuff. Animals were allowed 1 week of recovery before postlesion baseline training. During the therapeutic training stage, rats received vagus nerve stimulation paired with each successful trial. All 17 trained rats demonstrated significant contralateral forelimb impairment when performing a bradykinesia assessment task. Forelimb function was recovered completely to prelesion levels when vagus nerve stimulation was delivered during rehab training. Alternatively, intensive rehab training alone (without stimulation) failed to restore function to prelesion levels. Delivering the same amount of stimulation after rehab training did not yield improvements compared with rehab alone. These results demonstrate that vagus nerve stimulation repeatedly paired with successful forelimb movements can improve recovery after motor cortex ischemia and may be a viable option for stroke rehabilitation. © The Author(s) 2014.
A randomized comparative effectiveness trial of using cable television to deliver diabetes prevention programming
Ackermann, Ronald T; Sandy, Lewis G; Beauregard, Tom; Coblitz, Mark; Norton, Kristi L; Vojta, Deneen
Objective To evaluate the use and effectiveness of two "in-home" strategies for delivering diabetes prevention programming using cable television. Methods An individually randomized, two-arm intervention trial including adults with diabetes risk factors living in two US cities. Interventions involved a 16-session lifestyle intervention delivered via "video-on-demand" cable television, offered alone versus in combination with web-based lifestyle support tools. Repeated measures longitudinal linear regression with imputation of missing observations was used to compare changes in body weight. Results A total of 306 individuals were randomized and offered the interventions. After 5 months, 265 (87%) participants viewed at least 1, and 110 (36%) viewed ≥9 of the video episodes. A total of 262 (86%) participants completed a 5-month weight measurement. In intention-to-treat analysis with imputation of missing observations, mean weight loss at 5 months for both treatment groups combined was 3.3% (95% CI 0.7-5.0%), regardless of intervention participation (with no differences between randomized groups (P = 0.19)), and was 4.9% (95% CI 2.1-6.5%) for participants who viewed ≥9 episodes. Conclusions In-home delivery of evidence-based diabetes prevention programming in a reality television format, offered with or without online behavioral support tools, can achieve modest weight losses consistent with past implementation studies of face-to-face programs using similar content. PMID:24740868
MOSFET assessment of radiation dose delivered to mice using the Small Animal Radiation Research Platform (SARRP).
Ngwa, Wilfred; Korideck, Houari; Chin, Lee M; Makrigiorgos, G Mike; Berbeco, Ross I
The Small Animal Radiation Research Platform (SARRP) is a novel isocentric irradiation system that enables state-of-the-art image-guided radiotherapy research to be performed with animal models. This paper reports the results obtained from investigations assessing the radiation dose delivered by the SARRP to different anatomical target volumes in mice. Surgically implanted metal oxide semiconductor field effect transistors (MOSFET) dosimeters were employed for the dose assessment. The results reveal differences between the calculated and measured dose of -3.5 to 0.5%, -5.2 to -0.7%, -3.9 to 0.5%, -5.9 to 2.5%, -5.5 to 0.5%, and -4.3 to 0% for the left kidney, liver, pancreas, prostate, left lung, and brain, respectively. Overall, the findings show less than 6% difference between the delivered and calculated dose, without tissue heterogeneity corrections. These results provide a useful assessment of the need for tissue heterogeneity corrections in SARRP dose calculations for clinically relevant tumor model sites.
Comparison of maternal and newborn outcomes of Tibetan and Han Chinese delivering in Lhasa, Tibet
Miller, Suellen; Tudor, Carrie; Thorsten, Vanessa; Nyima; Sonam; Droyoung; Wright, Linda; Varner, Michael
Aim To compare maternal and neonatal outcomes of Tibetan and Han Chinese women delivering vaginally at high altitude (3650 meters) in Lhasa, Tibet Autonomous Region, People's Republic of China. Method Comparative analysis of data from a prospective observational study of Tibetan (n = 938) and Han Chinese (n = 146) women delivering at three hospitals between January 2004 and May 2005. Results Han Chinese women had higher rates of pre-eclampsia/gestational hypertension than Tibetan women, (10.3% vs 5.9%, P = 0.04). There was no difference in rates of postpartum hemorrhage between Tibetan and Han women (12.8% vs 17.1%, P = 0.15). Han newborns weighed significantly less than Tibetan newborns (P < 0.01), and were twice as likely to be small for gestational age, (24.5% vs 11.6%, P < 0.01). Tibetan newborns were less likely to have poor neonatal outcomes than Han newborns (P < 0.01). Conclusion In high altitude deliveries in Tibet, adverse outcomes were significantly more common among Han Chinese. PMID:19012697
Procedure for the delivering of personal short-term visitor dosimeters
Update of the administrative procedure for delivering a personal short-term visitor dosimeter to associated members of CERN's personnel. Associated members of the CERN personnel may request a short term visitor dosimeter if working only in Supervised Radiation Areas and for a period of less than two months in a calendar year. Such a dosimeter is delivered without the need to provide the usual regular documents: radiation passport, certificate from the home institute or medical certificate. Periodic verification will ensure that holders of these personal dosimeters do not exceed the maximum allowed personal dose for this type of dosimeter, which is the same as the limit for members of the public at 1 mSv per year. From now on, the two-month period can be spread over a calendar year, offering greater flexibility to users coming to CERN for multiple short periods. Please return unused dosimeters Persons leaving CERN for a period of more than one month should return their dosimeter to the D...
Exploring the feasibility of delivering standardized genomic care using ophthalmology as an example.
Davison, Niall; Payne, Katherine; Eden, Martin; McAllister, Marion; Roberts, Stephen A; Ingram, Stuart; Black, Graeme C M; Hall, Georgina
Broadening access to genomic testing and counseling will be necessary to realize the benefits of personalized health care. This study aimed to assess the feasibility of delivering a standardized genomic care model for inherited retinal dystrophy (IRD) and of using selected measures to quantify its impact on patients. A pre-/post- prospective cohort study recruited 98 patients affected by IRD to receive standardized multidisciplinary care. A checklist was used to assess the fidelity of the care process. Three patient-reported outcome measures-the Genetic Counselling Outcome Scale (GCOS-24), the ICEpop CAPability measure for Adults (ICECAP-A), and the EuroQol 5-dimension questionnaire (EQ-5D)-and a resource-use questionnaire were administered to investigate rates of missingness, ceiling effects, and changes over time. The care model was delivered consistently. Higher rates of missingness were found for the genetic-specific measure (GCOS-24). Considerable ceiling effects were observed for the generic measure (EQ-5D). The ICECAP-A yielded less missing data without significant ceiling effects. It was feasible to use telephone interviews for follow-up data collection. The study highlighted challenges and solutions associated with efforts to standardize genomic care for IRD. The study identified appropriate methods for a future definitive study to assess the clinical effectiveness and cost-effectiveness of the care model.Genet Med advance online publication 02 March 2017.
Using mobile distributed pyrolysis facilities to deliver a forest residue resource for bio-fuel production
Brown, Duncan
Distributed mobile conversion facilities using either fast pyrolysis or torrefaction processes can be used to convert forest residues to more energy dense substances (bio-oil, bio-slurry or torrefied wood) that can be transported as feedstock for bio-fuel facilities. All feedstock are suited for gasification, which produces syngas that can be used to synthesise petrol or diesel via Fischer-Tropsch reactions, or produce hydrogen via water gas shift reactions. Alternatively, the bio-oil product of fast pyrolysis may be upgraded to produce petrol and diesel, or can undergo steam reformation to produce hydrogen. Implementing a network of mobile facilities reduces the energy content of forest residues delivered to a bio-fuel facility as mobile facilities use a fraction of the biomass energy content to meet thermal or electrical demands. The total energy delivered by bio-oil, bio-slurry and torrefied wood is 45%, 65% and 87% of the initial forest residue energy content, respectively. However, implementing mobile facilities is economically feasible when large transport distances are required. For an annual harvest of 1.717 million m3 (equivalent to 2000 ODTPD), transport costs are reduced to less than 40% of the total levelised delivered feedstock cost when mobile facilities are implemented; transport costs account for up to 80% of feedstock costs for conventional woodchip delivery. Torrefaction provides the lowest cost pathway of delivering a forest residue resource when using mobile facilities. Cost savings occur against woodchip delivery for annual forest residue harvests above 2.25 million m3 or when transport distances greater than 250 km are required. Important parameters that influence levelised delivered costs of feedstock are transport distances (forest residue spatial density), haul cost factors, thermal and electrical demands of mobile facilities, and initial moisture content of forest residues. Relocating mobile facilities can be optimised for lowest cost
A Minimally Invasive, Translational Method to Deliver Hydrogels to the Heart Through the Pericardial Space
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Jose R. Garcia, MS
Full Text Available Biomaterials are a new treatment strategy for cardiovascular diseases but are difficult to deliver to the heart in a safe, precise, and translatable way. We developed a method to deliver hydrogels to the epicardium through the pericardial space. Our device creates a temporary compartment for hydrogel delivery and gelation using anatomic structures. The method minimizes risk to patients from embolization, thrombotic occlusion, and arrhythmia. In pigs there were no clinically relevant acute or subacute adverse effects from pericardial hydrogel delivery, making this a translatable strategy to deliver biomaterials to the heart.
The Usability of Diabetes MAP: A Web-delivered Intervention for Improving Medication Adherence
Nelson, Lyndsay A; Bethune, Magaela C; Lagotte, Andrea E
Background Web-delivered interventions are a feasible approach to health promotion. However, if a website is poorly designed, difficult to navigate, and has technical bugs, it will not be used as intended. Usability testing prior to evaluating a website's benefits can identify barriers to user engagement and maximize future use. Objective We developed a Web-delivered intervention called Diabetes Medication Adherence Promotion (Diabetes MAP) and used a mixed-methods approach to test its usability prior to evaluating its efficacy on medication adherence and glycemic control in a randomized controlled trial. Methods We recruited English-speaking adults with type 2 diabetes mellitus (T2DM) from an academic medical center who were prescribed diabetes medications. A trained research assistant administered a baseline survey, collected medical record information, and instructed participants on how to access Diabetes MAP. Participants were asked to use the site independently for 2 weeks and to provide survey and/or focus group feedback on their experience. We analyzed survey data descriptively and qualitative data thematically to identify participants' favorable and unfavorable experiences, characterize usability concerns, and solicit recommendations for improving Diabetes MAP. Results Enrolled participants (N=32) were an average of 51.7 ± 11.8 years old, 66% (21/32) female, 60% (19/32) non-Hispanic White, 88% (28/32) had more than 12 years of education, half had household incomes over $50,000, and 78% (25/32) were privately insured. Average duration of diagnosed diabetes was 7.8 ± 6.3 years, average A1c was 7.4 ± 2.0, and 38% (12/32) were prescribed insulin. Of enrolled participants, 91% (29/32) provided survey and/or focus group feedback about Diabetes MAP. On the survey, participants agreed website information was clear and easy to understand, but in focus groups they reported navigational challenges and difficulty overcoming user errors (eg, entering data in an
The Most Effective Methods for Delivering Severe Weather Early Warnings to Fishermen on Lake Victoria.
Tushemereirwe, Richard; Tuhebwe, Doreen; Cooper, Mary Ann; D'ujanga, Florence Mutonyi
Introduction : It is estimated that five thousand people die on Lake Victoria every year by drowning which is triggered by severe weather hazards like lightning. Objectives : In order to improve predictability of severe weather conditions on Lake Victoria, there is need to deliver timely and effective Severe Weather Early Warning Systems (SWEWS) to those at risk. On Lake Victoria, previous SWEW service trials ceased with the end of the funding grants. This study therefore assessed the possibility of sustaining the SWEW service by assessing willingness to pay. Methods : An assessment was conducted between March and May 2015 to determine the SWEW service improvements desired by the population. A convenience sample of respondents was gathered and interviewed during impromptu visits to landing sites on Lake Victoria. The respondents were also among community members that had earlier participated in a pilot assessing the feasibility of mobile phones is delivering SWEW alerts. Semi-structured questionnaires were administered to fishermen and fisher folks at the landing site to gather suggestions/strategies for (i) better design and implementation of SWEW service, (ii) use of smart phones, and (iii) their ability and willingness to pay for a SWEW service. Results were presented as frequencies. Results : Two hundred fifteen respondents from fourteen landing sites (communities) were interviewed. Over 50% of the respondents (113/215) were aware about at least one community member who had been injured due to lightening on the lake in the past year. Ninety two percent (198/215) of the respondents reported using mobile phones as their main tool of communication but only 4% had smart phones that could receive early warning weather alerts through internet connectivity. Seventy five percent of respondents said they would welcome a system that could deliver commercial weather alerts and 65% were willing to pay for such a service. Conclusions : A SWEW service is feasible
Developing and Delivering a Geoscience MOOC -- What's Involved, and What Works (Invited)
Marshak, S.; Tomkin, J. H.
Efforts to develop free Massive Open Online Courses (MOOCs) have exploded in the last year, and geoscience education is part of this boom. Developing and delivering a MOOC is a major undertaking, and the proliferation of MOOCs can potentially be disruptive to more traditional forms of education, so it's worth asking: What role can/should/will MOOCs play in future geoscience education? Our experience in developing and delivering two MOOCs--Introduction to Sustainability (the first geoscience-related MOOC ever delivered), and Planet Earth . . . and You--provide insight into the impact that a MOOC can have, and into approaches that can work to yield a pedagogically sound experience. Both of these courses cover content similar to that of lower-division college classes, but MOOCs have very different participants than do equivalent, for-credit (i.e., for-fee) university courses. Examination of statistics that characterize student performance, along with interpretations of exit surveys, indicate that MOOC participants are older, are more likely to be working, are not enrolled in a college, and have different educational backgrounds than do traditional students. Significantly, MOOC participants are international (more than100 different nationalities were represented in our MOOCs) and come from both western and non-western traditions. This situation not only leads to ESL challenges, but also enables cross-cultural discussions and global ("crowd sourcing") data collection, beyond what is possible in traditional classes. Peak participant performance is very high (better than the performance of students in campus courses), but drop-out rates are also very high (typically, less than 20% of participants complete all assignments). Active MOOC participants perform as well in online assessments as do either traditional on-campus or traditional (small class, for-credit) online students. MOOC development can improve on-campus instruction, partly through technology transfer and partly
Direct visualization of Agrobacterium-delivered VirE2 in recipient cells
Li, Xiaoyang; Yang, Qinghua; Tu, Haitao; Lim, Zijie; Pan, Shen Q
Agrobacterium tumefaciens is a natural genetic engineer widely used to deliver DNA into various recipients, including plant, yeast and fungal cells. The bacterium can transfer single-stranded DNA molecules (T–DNAs) and bacterial virulence proteins, including VirE2. However, neither the DNA nor the protein molecules have ever been directly visualized after the delivery. In this report, we adopted a split-GFP approach: the small GFP fragment (GFP11) was inserted into VirE2 at a permissive site to create the VirE2-GFP11 fusion, which was expressed in A. tumefaciens; and the large fragment (GFP1–10) was expressed in recipient cells. Upon delivery of VirE2-GFP11 into the recipient cells, GFP fluorescence signals were visualized. VirE2-GFP11 was functional like VirE2; the GFP fusion movement could indicate the trafficking of Agrobacterium-delivered VirE2. As the natural host, all plant cells seen under a microscope received the VirE2 protein in a leaf-infiltration assay; most of VirE2 moved at a speed of 1.3–3.1 μm sec−1 in a nearly linear direction, suggesting an active trafficking process. Inside plant cells, VirE2-GFP formed filamentous structures of different lengths, even in the absence of T-DNA. As a non-natural host recipient, 51% of yeast cells received VirE2, which did not move inside yeast. All plant cells seen under a microscope transiently expressed the Agrobacterium-delivered transgene, but only 0.2% yeast cells expressed the transgene. This indicates that Agrobacterium is a more efficient vector for protein delivery than T-DNA transformation for a non-natural host recipient: VirE2 trafficking is a limiting factor for the genetic transformation of a non-natural host recipient. The split-GFP approach could enable the real-time visualization of VirE2 trafficking inside recipient cells. PMID:24299048
Directory of Open Access Journals (Sweden)
Nadif Ulfia
Full Text Available Abstract: Solving the Students' Speaking Problem in Delivering English Presentation Through 3-P Technique. The aims of this study were to (1 identify whether and to what extent 3-P Technique can improve the students' speaking competence in delivering presentation;(2 describe the teaching and learning when 3-P technique is implemented in English class. This research was conducted at the eleventh grades of MAN 1 Bojonegoro. The subjects of the research were the teacher and the students in the academic year 2016/2017. This study applied 3 cycle action research. In collecting the data, the researcher used observations through field notes, video recording, questionnaire and interview. To analyze the quantitative data, the researcher applied descriptive statistics. Besides, to analyze qualitative data, the researcher applied constant comparative method as suggested by Garner. The findings shows that: (1 3-P Technique can improve students' speaking competence in delivering presentation in terms of students achievement, fluency, pronunciation, ability to express their opinions, arguments, and ideas using appropriate vocabulary and grammatical form, using appropriate body language, voice control, gesture, and eye contact; and (2 3-P technique can improve classroom situation in terms of increasing students' motivation and participation, creating live teaching atmosphere, and increasing teacher motivation. Key words: Speaking, 3 P technique, Action research Abstrak: Memecahkan Masalah Keterampilan Berbicara Siswa dalam Menyampaikan Presentasi Berbahasa Inggris Melalui Teknik 3-P. Tujuan dari penelitian ini adalah untuk (1 mengidentifikasi dan mengetahui sejauh mana teknik 3-P dapat meningkatkan kemampuan berbicara para siswa dalam menyampaikan sebuah presentasi; (2 mendeskripsikan kegiatan pembelajaran dalam penerapan teknik 3-P dalam pembelajaran Bahasa Inggris. Penelitian ini dilakukan pada kelas sebelas MAN 1 Bojonegoro. Subyek penelitian ini
The role of wild fruits and vegetables in delivering a balanced and healthy diet.
Bvenura, Callistus; Sivakumar, Dharini
Without a doubt, fruits and vegetables are important components of a balanced and healthy diet. However, their consumption is very low in the world, with the lowest figures being reported in sub-Saharan Africa. The low consumption of fruits and vegetables means unbalanced and unhealthy diets, which has been linked to various diseases and conditions associated with increased mortality rates in worst cases. Poverty is the major contributor to the low consumption of fruits and vegetables in the majority of cases. However, the world, including sub-Saharan Africa, is endowed with numerous wild fruit and vegetable species which can be exploited and incorporated into the diets and help solve some nutrition related concerns. Therefore, in this review, we explore literature on wild fruits and vegetables with a special emphasis on some of the poorest regions of the world and where the lowest consumption figures are reported; their nutritional compositions; the status of their consumption and their role in the diet with a view to uncover their possible role in delivering a healthy and balanced diet as well as helping lower food and nutrition insecurity. A total of 396 articles were downloaded and analysed but only 213 were considered for this review. The results of the search indicate that wild fruits and vegetables are nutritionally rich and high in phytochemicals, especially antioxidants and therefore can possibly play a significant and positive role in delivering a healthy and balanced diet. However, the major challenge is the acceptability, accessibility as well as a lack of interest in wild fruits and vegetables and sheer neglect. People need to be educated using various forms of media on the nutritional and health benefits of these wild food plants with a view to bring them from the forest to the plate. Researchers need to channel more efforts towards domesticating them for ease of access, among other reasons. Governments need to incentivise the subsistence or
Twitter-Delivered Behavioral Weight-Loss Interventions: A Pilot Series.
Pagoto, Sherry L; Waring, Molly E; Schneider, Kristin L; Oleski, Jessica L; Olendzki, Effie; Hayes, Rashelle B; Appelhans, Bradley M; Whited, Matthew C; Busch, Andrew M; Lemon, Stephenie C
Lifestyle interventions are efficacious at reducing risk for diabetes and cardiovascular disease but have not had a significant public health impact given high cost and patient and provider burden. Online social networks may reduce the burden of lifestyle interventions to the extent that they displace in-person visits and may enhance opportunities for social support for weight loss. We conducted an iterative series of pilot studies to evaluate the feasibility and acceptability of using online social networks to deliver a lifestyle intervention. In Study 1 (n=10), obese participants with depression received lifestyle counseling via 12 weekly group visits and a private group formed using the online social network, Twitter. Mean weight loss was 2.3 pounds (SD 7.7; range -19.2 to 8.2) or 1.2% (SD 3.6) of baseline weight. A total of 67% (6/9) of participants completing exit interviews found the support of the Twitter group at least somewhat useful. In Study 2 (n=11), participants were not depressed and were required to be regular users of social media. Participants lost, on average, 5.6 pounds (SD 6.3; range -15 to 0) or 3.0% (SD 3.4) of baseline weight, and 100% (9/9) completing exit interviews found the support of the Twitter group at least somewhat useful. To explore the feasibility of eliminating in-person visits, in Study 3 (n=12), we delivered a 12-week lifestyle intervention almost entirely via Twitter by limiting the number of group visits to one, while using the same inclusion criteria as that used in Study 2. Participants lost, on average, 5.4 pounds (SD 6.4; range -14.2 to 3.9) or 3.0% (SD 3.1) of baseline weight, and 90% (9/10) completing exit interviews found the support of the Twitter group at least somewhat useful. Findings revealed that a private Twitter weight-loss group was both feasible and acceptable for many patients, particularly among regular users of social media. Future research should evaluate the efficacy and cost-effectiveness of online
Delivering high quality hip fracture rehabilitation: the perspective of occupational and physical therapy practitioners.
Leland, Natalie E; Lepore, Michael; Wong, Carin; Chang, Sun Hwa; Freeman, Lynn; Crum, Karen; Gillies, Heather; Nash, Paul
The majority of post-acute hip fracture rehabilitation in the US is delivered in skilled nursing facilities (SNFs). Currently, there are limited guidelines that equip occupational and physical therapy practitioners with a summary of what constitutes evidence-based high quality rehabilitation. Thus, this study aimed to identify rehabilitation practitioners' perspectives on the practices that constitute high quality hip fracture rehabilitation. Focus groups were conducted with 99 occupational and physical therapy practitioners working in SNFs in southern California. Purposive sampling of facilities was conducted to capture variation in key characteristics known to impact care delivery for this patient population (e.g., financial resources, staffing, and patient case-mix). Questions aimed to elicit practitioners' perspectives on high quality hip fracture rehabilitation practices. Each session was audio-recorded and transcribed. Data were systematically analyzed using a modified grounded theory approach. Seven themes emerged: objectives of care; first 72 h; positioning, pain, and precautions; use of standardized assessments; episode of care practices; facilitating insight into progress; and interdisciplinary collaboration. Clinical guidelines are critical tools to facilitate clinical decision-making and achieve desired patient outcomes. The findings of this study highlight the practitioners' perspective on what constitutes high quality hip fracture rehabilitation. This work provides critical information to advance the development of stakeholder-driven rehabilitation clinical guidelines. Future research is needed to verify the findings from other stakeholders (e.g., patients), ensure the alignment of our findings with current evidence, and develop measures for evaluating their delivery and relationship to desired outcomes. Implications for Rehabilitation This study highlights occupational and physiotherapy therapy practitioners' perspectives on the cumulative best
Lessons Learned from 10 Years of Delivering Quality Microwave Data to Scientists
Smith, D. K.; Wentz, F. J.; Hilburn, K. A.; Gentemann, C. L.
DISCOVER (Distributed Information Services: Climate/Ocean Products and Visualization for Earth Research) is a NASA MEaSUREs funded project that delivers ocean surface wind, water vapor, cloud, sea surface temperature and rain products to the scientific community. We have delivered these data to users via the Internet for over 10 years thanks to successive funding (Pathfinder, ESIP, REASoN and now MEaSUREs). Since we are a group of scientists who use the data ourselves in research, our approach to providing DISCOVER data to the user community is based on what we would want; that is, we provide simple file formats that are quick to download and easy to transfer between computer systems, with read routines and files to check whether the data are correct after transfer, and helpful, quick and accurate user support. Web and FTP user metrics collected since 1998 show a continual increase in activity and file downloads. Most importantly, the DISCOVER data are now essential building blocks to other value-added products created by scientists for the research community, such as the CCMP winds (another NASA MEaSUREs funded project). An extensive list of publications presenting results obtained through use of the DISCOVER data demonstrates the demand for and long-term use of the DISCOVER ocean data products by scientists. Our products are generated after extensive intercalibration, algorithm refinement, quality control checks, geolocation and satellite attitude adjustments, along-scan bias corrections, hot load or antenna emissivity corrections, sun glitter and RFI removal and independent validation. In this talk, we will summarize our methods and tools used in producing the various DISCOVER data products, describe the means by which we distribute the data to users and support them in their research, list the types of value-added products available, and present some of the ways in which the data are being used to answer important scientific and climate questions. In addition
Cost of delivering health care services at primary health facilities in Ghana.
Dalaba, Maxwell Ayindenaba; Welaga, Paul; Matsubara, Chieko
There is limited knowledge on the cost of delivering health services at primary health care facilities in Ghana which is posing a challenge in resource allocations. This study therefore estimated the cost of providing health care in primary health care facilities such as Health Centres (HCs) and Community-based Health Planning and Services (CHPS) in Ghana. The study was cross-sectional and quantitative data was collected from the health provider perspective. Data was collected between July and August, 2016 at nine primary health facilities (six CHPS and three HCs) from the Upper West region of Ghana. All health related costs for the year 2015 and revenue generated for the period were collected. Data were captured and analysed using Microsoft excel. Costs of delivery health services were estimated. In addition, unit costs such as cost per Outpatient Department (OPD) attendance were estimated. The average annual cost of delivering health services through CHPS and HCs was US$10,923 and US$44,638 respectively. Personnel cost accounted for the largest proportion of cost (61% for CHPS and 59% for HC). The cost per OPD attendance was higher at CHPS (US$8.79) than at HCs (US$5.16). The average Internally Generated Funds (IGF) recorded for the period at CHPS and HCs were US$2327 and US$ 15,795 respectively. At all the facilities, IGFs were greatly lower than costs of running the health facilities. Also, at both the CHPS and HCs, the National Health Insurance Scheme (NHIS) reimbursement was the main source of revenue accounting for over 90% total IGF. The average annual cost of delivering primary health services through CHPS and HCs is US$10,923 and US$44,638 respectively and personnel cost accounts for the major cost. The government should be guided by these findings in their financial planning, decision making and resource allocation in order to improve primary health care in the country. However, more similar studies involving large numbers of primary health facilities in
Do we deliver the pressures we intend to when using a T-piece resuscitator?
Directory of Open Access Journals (Sweden)
Evelien Roegholt
Full Text Available BACKGROUND: A T-piece resuscitator (TPR uses a built-in manometer to set the inflation pressures, but we are not informed what pressures are actually delivered distally. Aim of this study was to measure the proximal and distal pressures under different gas conditions when using a TPR. METHODOLOGY/FINDINGS: A test lung was ventilated using a TPR (PIP 25 cmH₂O, PEEP 5 cmH₂O with a gas flow rate of 8 L/min. A Pressure delivered by six different TPRs was tested. To test variability 20 participants were asked to set PEEP and PIP pressures to 25/5 cmH₂O. B PIP and PEEP were measured proximal and distal of the TPR when using standard tubing or heated tubing with or without a humidifier. In experiment A mean (SD proximal PIP and PEEP of the TPRs were respectively 20.3 (0.3 cmH₂O (19.9-20.6 cmH₂O and 4.9 (0.1 cmH₂O. When 20 participants set pressures; PIP 26.7 (0.5 cm H₂O and PEEP 5.9 (0.44 cmH2O were measured. Experiment B showed that the decrease of PIP between proximal and distal pressures was not clinically significant. However there was a significant decrease of PEEP using the standard tubing (5.1 (0.1 cmH₂O proximally versus 4.8 (0.2 cmH₂O distally; p<0.001 compared to, when using a humidifier with associated tubing and the humidifier turned on, 5.1 (0.1 proximally versus 3.9 (0.2 cmH₂O distally; (p<0.001. CONCLUSION/SIGNIFICANCE: The accuracy of the built-in manometer of a TPR is acceptable. Most pressures set proximally are comparable to the actual pressures delivered distally. However, when using tubing associated with the humidifier PEEP decreases distally by 1.1-1.2 cmH₂O and users should anticipate on this.
Maternal and perinatal outcomes of pregnancies delivered at 23 weeks' gestation.
Crane, Joan M G; Magee, Laura A; Lee, Tang; Synnes, Anne; von Dadelszen, Peter; Dahlgren, Leanne; De Silva, Dane A; Liston, Robert
To evaluate the maternal and perinatal outcomes of pregnancies delivered at 23+0 to 23+6 weeks' gestation. This prospective cohort study included women in the Canadian Perinatal Network who were admitted to one of 16 Canadian tertiary perinatal units between August 1, 2005, and March 31, 2011, and who delivered at 23+0 to 23+6 weeks' gestation. Women were included in the network if they were admitted with spontaneous preterm labour with contractions, a short cervix without contractions, prolapsing membranes with membranes at or beyond the external os or a dilated cervix, preterm premature rupture of membranes, intrauterine growth restriction, gestational hypertension, or antepartum hemorrhage. Maternal outcomes included Caesarean section, placental abruption, and serious complication. Perinatal outcomes were mortality and serious morbidity. A total of 248 women and 287 infants were included in the study. The rate of Caesarean section was 10.5% (26/248) and 40.3% of women (100/248) had a serious complication, the most common being chorioamnionitis (38.6%), followed by blood transfusion (4.5%). Of infants with known outcomes, perinatal mortality was 89.9% (223/248) (stillbirth 23.3% [67/287] and neonatal death 62.9% [156/248]). Of live born neonates with known outcomes (n = 181), 38.1% (69/181) were admitted to NICU. Of those admitted to NICU, neonatal death occurred in 63.8% (44/69). Among survivors at discharge, the rate of severe brain injury was 44.0% (11/25), of retinopathy of prematurity 58.3% (14/24), and of any serious neonatal morbidity 100% (25/25). Two subgroup analyses were performed: in one, antepartum stillbirths were excluded, and in the other only centres that indicated they offered fetal monitoring at 23 weeks' gestation were included and antepartum stillbirths were excluded. In each of these, perinatal outcomes similar to the overall group were found. Pregnant women delivering at 23 weeks' gestation are at risk of morbidity. Their infants have high
Delivering high-resolution landmarks using inkjet micropatterning for spatial monitoring of leaf expansion
Directory of Open Access Journals (Sweden)
Cronk Quentin CB
printed at these scales. Conclusions To apply inkjet micropatterning to plant studies, we have successfully delivered landmarks on ivy leaf surfaces and achieved high-resolution, two-dimensional monitoring of leaf expansion at different growing stages. The measurement is capable of reliably identifying the fine scale changes during plant growth. As well as delivering landmarks, this technology may be used to deliver microscale targeted biological components such as growth hormones, and possibly be used to pattern sensors directly on the leaves.
Current perspectives on Internet delivered cognitive behavioral therapy for adults with anxiety and related disorders
Directory of Open Access Journals (Sweden)
Mewton L
Full Text Available Louise Mewton, Jessica Smith, Pieter Rossouw, Gavin Andrews Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW, Australia Abstract: The aim of the current review is to provide a summary of research into Internet-delivered cognitive behavioral therapy (iCBT for anxiety disorders. We include 37 randomized controlled trials that examined the efficacy of iCBT programs in adults (aged over 18 years, as compared with waiting list or active control. The included studies were identified from Medline searches and from reference lists, and only published data were included. Several trials of iCBT for generalized anxiety disorder, panic disorder, and social phobia were identified. Two trials of iCBT for obsessive-compulsive disorder were identified, whilst one trial each was identified for hypochondriasis, specific phobia (spiders, and post-traumatic stress disorder. Finally, there were five trials that focused on transdiagnostic therapy for either a range of comorbid anxiety disorders or comorbid anxiety and depression. Between-group effect sizes were moderate to large for all disorders, and ranged from 0.30 to 2.53. iCBT was found to be commensurate with face-to-face cognitive behavioral therapy whether delivered individually or in group format. Guidance may not be necessary for iCBT to be effective for immediate gains, but may be more important in longer-term maintenance of symptom improvement and maximizing patient adherence. The clinical experience of the individual providing guidance does not appear to impact treatment outcomes. Future research needs to focus on the optimal level of guidance required to generate maximum patient benefits, whilst balancing the efficient use of clinician time and resources. Evidence-based contraindications to iCBT should also be developed so that the choice of treatment modality accurately reflects patients' needs. Further research should be conducted into the effective elements of
Cost of delivering health care services at primary health facilities in Ghana
Directory of Open Access Journals (Sweden)
Maxwell Ayindenaba Dalaba
Full Text Available Abstract Background There is limited knowledge on the cost of delivering health services at primary health care facilities in Ghana which is posing a challenge in resource allocations. This study therefore estimated the cost of providing health care in primary health care facilities such as Health Centres (HCs and Community-based Health Planning and Services (CHPS in Ghana. Methods The study was cross-sectional and quantitative data was collected from the health provider perspective. Data was collected between July and August, 2016 at nine primary health facilities (six CHPS and three HCs from the Upper West region of Ghana. All health related costs for the year 2015 and revenue generated for the period were collected. Data were captured and analysed using Microsoft excel. Costs of delivery health services were estimated. In addition, unit costs such as cost per Outpatient Department (OPD attendance were estimated. Results The average annual cost of delivering health services through CHPS and HCs was US$10,923 and US$44,638 respectively. Personnel cost accounted for the largest proportion of cost (61% for CHPS and 59% for HC. The cost per OPD attendance was higher at CHPS (US$8.79 than at HCs (US$5.16. The average Internally Generated Funds (IGF recorded for the period at CHPS and HCs were US$2327 and US$ 15,795 respectively. At all the facilities, IGFs were greatly lower than costs of running the health facilities. Also, at both the CHPS and HCs, the National Health Insurance Scheme (NHIS reimbursement was the main source of revenue accounting for over 90% total IGF. Conclusions The average annual cost of delivering primary health services through CHPS and HCs is US$10,923 and US$44,638 respectively and personnel cost accounts for the major cost. The government should be guided by these findings in their financial planning, decision making and resource allocation in order to improve primary health care in the country. However, more similar
Residual plaque burden, delivered dose, and tissue composition predict 6-month outcome after balloon angioplasty and beta-radiation therapy
M. Sabaté (Manel); J.P. Marijnissen (Johannes); S.G. Carlier (Stephan); I.P. Kay (Ian Patrick); V.L.M.A. Coen (Veronique); J.M.R. Ligthart (Jürgen); M.A. Costa (Marco); P.W.J.C. Serruys (Patrick); P.C. Levendag (Peter); W.J. van der Giessen (Wim); H. Boersma (Eric)
textabstractBACKGROUND: Inhomogeneity of dose distribution and anatomic aspects of the atherosclerotic plaque may influence the outcome of irradiated lesions after balloon angioplasty (BA). We evaluated the influence of delivered dose and morphological characteristics of coronary
Predictors and moderators of response to internet-delivered Interpersonal Psychotherapy and Cognitive Behaviour Therapy for depression.
Donker, T.; Batterham, P.J.; Warmerdam, L.; Bennett, K.; Bennett, A.; Cuijpers, P.; Griffiths, K.M.
Background: By identifying which predictors and moderators lead to beneficial outcomes, accurate selection of the best initial treatment will have significant benefits for depressed individuals. Method: An automated, fully self-guided randomized controlled internet-delivered noninferiority trial was
Do weight management programmes delivered at professional football clubs attract and engage high risk men? A mixed-methods study
National Research Council Canada - National Science Library
Hunt, Kate; Gray, Cindy M; Maclean, Alice; Smillie, Susan; Bunn, Christopher; Wyke, Sally
.... Football Fans in Training (FFIT), a men-only weight management programme delivered to groups of men at top professional football clubs, encourages men to lose weight by working with, not against, cultural ideals of masculinity...
Fails-to-Deliver Data under 10,000 Shares between September 16, 2008 and July 1, 2009
Securities and Exchange Commission — This file contains the date, CUSIP numbers, ticker symbols, issuer name, price, and total number of fails-to-deliver (i.e., the balance level outstanding) recorded...
The importance of multidisciplinary teamwork and team climate for relational coordination among teams delivering care to older patients
J.M. Hartgerink (Jacqueline); J.M. Cramm (Jane); T.J.E.M. Bakker (Ton); A.M. van Eijsden (A.); J.P. Mackenbach (Johan); A.P. Nieboer (Anna)
textabstractAim: To identify predictors of relational coordination among professionals delivering care to older patients. Background: Relational coordination is known to enhance quality of care in hospitals. The underlying mechanisms, however, remain poorly understood. Design: This cross-sectional
Physical therapist-delivered cognitive-behavioral therapy: a qualitative study of physical therapists' perceptions and experiences.
Nielsen, Mandy; Keefe, Francis J; Bennell, Kim; Jull, Gwendolen A
The importance of the biopsychosocial model in assessment and management of chronic musculoskeletal conditions is recognized. Physical therapists have been encouraged to develop psychologically informed practice. Little is known about the process of physical therapists' learning and delivering of psychological interventions within the practice context. The aim of this study was to investigate physical therapists' experiences and perspectives of a cognitive-behavioral-informed training and intervention process as part of a randomized controlled trial (RCT) involving adults with painful knee osteoarthritis. A qualitative design was used. Participants were physical therapists trained to deliver pain coping skills training (PCST). Eight physical therapists trained to deliver PCST were interviewed by telephone at 4 time points during the 12-month RCT period. Interviews were audiorecorded, transcribed verbatim into computer-readable files, and analyzed using Framework Analysis. Thematic categories identified were: training, experience delivering PCST, impact on general clinical practice, and perspectives on PCST and physical therapist practice. Physical therapists reported positive experiences with PCST and program delivery. They thought that their participation in the RCT had enhanced their general practice. Although some components of the PCST program were familiar, the therapists found delivering the program was quite different from regular practice. Physical therapists believed the PCST program, a 3- to 4-day workshop followed by formal mentoring and performance feedback from a psychologist for 3 to 6 months and during the RCT, was critical to their ability to effectively deliver the PCST intervention. They identified a number of challenges in delivering PCST in their normal practice. Physical therapists can be trained to confidently deliver a PCST program. The physical therapists in this study believed that training enhanced their clinical practice. Comprehensive
A Pilot Telerehabilitation Program: Delivering Early Intervention Services to Rural Families
Cason, Jana
The enTECH Telerehabilitation Program explored the use of telerehabilitation as an alternative service delivery model for early intervention therapy services. Utilizing the Kentucky Telehealth Network, two families living in rural Kentucky received occupational therapy services over a 12-week period. Following program implementation, qualitative data was collected using participant journals and interviews. Data analysis identified three thematic categories related to the program: benefits/strengths, challenges/weaknesses, and recommendations for program improvement. Results of the program evaluation indicated that telerehabilitation has the potential to cost-effectively meet the therapeutic needs of children living in rural areas where provider shortages exist. The enTECH Telerehabilitation Program serves as a model for how telerehabilitation can be used to deliver early intervention services to ameliorate health disparities and improve access to rehabilitation services. PMID:25945160
A Pilot Telerehabilitation Program: Delivering Early Intervention Services to Rural Families
Directory of Open Access Journals (Sweden)
Jana Cason
Full Text Available The enTECH Telerehabilitation Program explored the use of telerehabilitation as an alternative service delivery model for early intervention therapy services. Utilizing the Kentucky Telehealth Network, two families living in rural Kentucky received occupational therapy services over a 12-week period. Following program implementation, qualitative data was collected using participant journals and interviews. Data analysis identified three thematic categories related to the program: benefits/strengths, challenges/weaknesses, and recommendations for program improvement. Results of the program evaluation indicated that telerehabilitation has the potential to cost-effectively meet the therapeutic needs of children living in rural areas where provider shortages exist. The enTECH Telerehabilitation Program serves as a model for how telerehabilitation can be used to deliver early intervention services to ameliorate health disparities and improve access to rehabilitation services. Keywords: Telerehabilitation, Occupational Therapy, Rural, Early Intervention, Children, Program Evaluation, Cost Analysis
Shigella manipulates host immune responses by delivering effector proteins with specific roles
Directory of Open Access Journals (Sweden)
Hiroshi eAshida
Full Text Available The intestinal epithelium deploys multiple defense systems against microbial infection to sense bacterial components and danger alarms, as well as to induce intracellular signal transduction cascades that trigger both the innate and adaptive immune system, which are pivotal for bacterial elimination. However, many enteric bacterial pathogens, including Shigella, deliver a subset of virulence proteins (effectors via the type III secretion system (T3SS that enable bacterial evasion from host immune systems; consequently, these pathogens are able to efficiently colonize the intestinal epithelium. In this review, we present select recently discovered examples of interactions between Shigella and host immune responses, with particular emphasis on strategies that bacteria use to manipulate inflammatory outputs of host cell responses such as cell death, membrane trafficking, and innate and adaptive immune responses.
Cytosolic iron chaperones: Proteins delivering iron cofactors in the cytosol of mammalian cells.
Philpott, Caroline C; Ryu, Moon-Suhn; Frey, Avery; Patel, Sarju
Eukaryotic cells contain hundreds of metalloproteins that are supported by intracellular systems coordinating the uptake and distribution of metal cofactors. Iron cofactors include heme, iron-sulfur clusters, and simple iron ions. Poly(rC)-binding proteins are multifunctional adaptors that serve as iron ion chaperones in the cytosolic/nuclear compartment, binding iron at import and delivering it to enzymes, for storage (ferritin) and export (ferroportin). Ferritin iron is mobilized by autophagy through the cargo receptor, nuclear co-activator 4. The monothiol glutaredoxin Glrx3 and BolA2 function as a [2Fe-2S] chaperone complex. These proteins form a core system of cytosolic iron cofactor chaperones in mammalian cells. © 2017 by The American Society for Biochemistry and Molecular Biology, Inc.
2016 CSSE L3 Milestone: Deliver In Situ to XTD End Users
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Patchett, John M. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Nouanesengsy, Boonthanome [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Fasel, Patricia Kroll [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Ahrens, James Paul [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)
This report summarizes the activities in FY16 toward satisfying the CSSE 2016 L3 milestone to deliver in situ to XTD end users of EAP codes. The Milestone was accomplished with ongoing work to ensure the capability is maintained and developed. Two XTD end users used the in situ capability in Rage. A production ParaView capability was created in the HPC and Desktop environment. Two new capabilities were added to ParaView in support of an EAP in situ workflow. We also worked with various support groups at the lab to deploy a production ParaView in the LANL environment for both desktop and HPC systems. . In addition, for this milestone, we moved two VTK based filters from research objects into the production ParaView code to support a variety of standard visualization pipelines for our EAP codes.
Paraprofessional-Delivered Video Prompting to Teach Academics to Students with Severe Disabilities in Inclusive Settings.
Knight, Victoria F; Kuntz, Emily M; Brown, Melissa
Video prompting is effective for teaching a variety of skills (e.g., daily living, communication) to students with autism and intellectual disability; yet, little research exists on the efficacy of these strategies on academic skills, in inclusive settings, and with typical intervention agents. Authors collaborated with paraprofessionals to select socially important academic skills (i.e., literacy, social studies, science, and math) aligned with students' IEPs and content taught in their inclusive classes. Results from the multiple probe across participants and skills design indicated a functional relation between the paraprofessional-delivered video prompting and correct responding to academic tasks for all three elementary students with autism and intellectual disability. Implications for practitioners, study limitations, and recommendations for future research are discussed.
Layperson Surf Lifeguards Deliver High-quality Ventilations Compared with Experienced Nurse Anesthetists
DEFF Research Database (Denmark)
Nørkjær, Louise; Stærk, Mathilde; Glerup Lauridsen, Kasper
Introduction: Every year approximately 360,000 people die following asphyxial cardiac arrest due to drowning. Effective ventilation by surf lifeguards should be initiated as soon as possible to improve survival. The use of a supraglottic airway (SGA) may help deliver effective ventilations. SGA...... is widely used by nurse anesthetists as a standard for airway management, but it is unknown whether surf lifeguards, who are often non-healthcare providers, can use SGA effectively. SGA used by nurse anesthetists may be considered as a gold standard. Aim: To compare the use of a SGA by surf lifeguards...... and nurse anesthetists. Methods: In a simulation study, surf lifeguards without healthcare background and nurse anesthetists were asked to insert a SGA (i-gelO2, size 4, Intersurgical) in a resuscitation manikin (AMBU Man ALS, AMBU) and perform ventilations. Tidal volume was analyzed via manikin software...
Delivering interventions to reduce the global burden of stillbirths: improving service supply and community demand
Bhutta, Zulfiqar A; Darmstadt, Gary L; Haws, Rachel A; Yakoob, Mohammad Yawar; Lawn, Joy E
Background Although a number of antenatal and intrapartum interventions have shown some evidence of impact on stillbirth incidence, much confusion surrounds ideal strategies for delivering these interventions within health systems, particularly in low-/middle-income countries where 98% of the world's stillbirths occur. Improving the uptake of quality antenatal and intrapartum care is critical for evidence-based interventions to generate an impact at the population level. This concluding paper of a series of papers reviewing the evidence for stillbirth interventions examines the evidence for community and health systems approaches to improve uptake and quality of antenatal and intrapartum care, and synthesises programme and policy recommendations for how best to deliver evidence-based interventions at community and facility levels, across the continuum of care, to reduce stillbirths. Methods We systematically searched PubMed and the Cochrane Library for abstracts pertaining to community-based and health-systems strategies to increase uptake and quality of antenatal and intrapartum care services. We also sought abstracts which reported impact on stillbirths or perinatal mortality. Searches used multiple combinations of broad and specific search terms and prioritised rigorous randomised controlled trials and meta-analyses where available. Wherever eligible randomised controlled trials were identified after a Cochrane review had been published, we conducted new meta-analyses based on the original Cochrane criteria. Results In low-resource settings, cost, distance and the time needed to access care are major barriers for effective uptake of antenatal and particularly intrapartum services. A number of innovative strategies to surmount cost, distance, and time barriers to accessing care were identified and evaluated; of these, community financial incentives, loan/insurance schemes, and maternity waiting homes seem promising, but few studies have reported or evaluated the
A Designed Framework for Delivering Systems Thinking Skills to Small Business Managers
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Daowei Sun
Full Text Available Many small businesses suffer from inadequate management skills which can lead to poor business performance and unsustainable businesses. Research to date has focused on traditional skills such as communication, time management and people skills, yet critically many business managers have no systems thinking skills. This paper presents a framework targeted at delivering systems thinking skills to managers of small businesses utilizing some key characteristic of small business managers. The design is also based on a systems analysis and guided by both adult learning theory and teaching theory. The quality of a training framework depends on the quality of the content design and the right training delivery methods. The systems thinking skills training framework structured systems thinking knowledge into three modules in order to meet the needs of different levels of managers. The framework advocates blended training delivery methods and it also presents possible pitfalls based on training experiences. Additionally, the framework incorporates a continuous improvement process for ongoing systemic improvement.
Delivering the Goods: Scaling out Results of Natural Resource Management Research
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Larry Harrington
Full Text Available To help integrated natural resource management (INRM research "deliver the goods" for many of the world's poor over a large area and in a timely manner, the authors suggest a problem-solving approach that facilitates the scaling out of relevant agricultural practices. They propose seven ways to foster scaling out: (1 develop more attractive practices and technologies through participatory research (2 balance supply-driven approaches with resource user demands, (3 use feedback to redefine the research agenda, (4 encourage support groups and networks for information sharing, (5 facilitate negotiation among stakeholders, (6 inform policy change and institutional development, and (7 make sensible use of information management tools, including models and geographic information systems (GIS. They also draw on experiences in Mesoamerica, South Asia, and southern Africa to describe useful information management tools, including site similarity analyses, the linking of simulation models with GIS, and the use of farmer and land type categories.
Open source technologies for delivering historical maps online - case studies at the National Library of Scotland
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Christopher Fleet
Full Text Available Over the last four years, the National Library of Scotland has saved money and improved user access to online historical maps through the implementation of new open source technologies. These new tools include a new Viewer for MrSID images using OpenLayers, a collaborative Georeferencer application, new Tile Map Services for delivering georeferenced historical maps online, and a new GeoServer and OpenLayers application for accessing 44,000 series maps as clickable indexes. All of these applications were developed by Petr Pridal / Klokan Technologies, in collaboration with the National Library of Scotland, and all of them are easily extendible to other map libraries. These open source tools also provide an excellent basis for collaboration with other map libraries, sharing technology, experience and advice.
Guided parent-delivered cognitive behavioral therapy for childhood anxiety: Predictors of treatment response.
Thirlwall, Kerstin; Cooper, Peter; Creswell, Cathy
Guided Parent-delivered Cognitive Behaviour Therapy (GPD-CBT) is a brief, effective treatment for childhood anxiety disorders, however not all children respond favourably. To examine predictors of response to GPD-CBT. Parents of 125 children (7-12 years) with an anxiety disorder received GPD-CBT over 2.6 or 5.3h. Recovery was measured post treatment and six months later. Younger children and those with primary Generalised Anxiety Disorder (GAD) improved more post treatment, but older children and those without primary GAD had better outcomes at six month follow up. Fewer children allocated to 2.6h had recovered post treatment compared to those allocated to the 5.2h intervention, but did not differ significantly six months later. The identification of predictors of short and longer-term treatment outcomes can guide treatment decisions following this low-intensity approach. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.
A pilot exploration of speech sound disorder intervention delivered by telehealth to school-age children.
Grogan-Johnson, Susan; Gabel, Rodney M; Taylor, Jacquelyn; Rowan, Lynne E; Alvares, Robin; Schenker, Jason
This article describes a school-based telehealth service delivery model and reports outcomes made by school-age students with speech sound disorders in a rural Ohio school district. Speech therapy using computer-based speech sound intervention materials was provided either by live interactive videoconferencing (telehealth), or conventional side-by-side intervention. Progress was measured using pre- and post-intervention scores on the Goldman Fristoe Test of Articulation-2 (Goldman & Fristoe, 2002). Students in both service delivery models made significant improvements in speech sound production, with students in the telehealth condition demonstrating greater mastery of their Individual Education Plan (IEP) goals. Live interactive videoconferencing thus appears to be a viable method for delivering intervention for speech sound disorders to children in a rural, public school setting.
A Pilot Investigation of Speech Sound Disorder Intervention Delivered by Telehealth to School-Age Children
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Sue Grogan-Johnson
Full Text Available This article describes a school-based telehealth service delivery model and reports outcomes made by school-age students with speech sound disorders in a rural Ohio school district. Speech therapy using computer-based speech sound intervention materials was provided either by live interactive videoconferencing (telehealth, or conventional side-by-side intervention. Progress was measured using pre- and post-intervention scores on the Goldman Fristoe Test of Articulation-2 (Goldman & Fristoe, 2002. Students in both service delivery models made significant improvements in speech sound production, with students in the telehealth condition demonstrating greater mastery of their Individual Education Plan (IEP goals. Live interactive videoconferencing thus appears to be a viable method for delivering intervention for speech sound disorders to children in a rural, public school setting. Keywords: Telehealth, telerehabilitation, videoconferencing, speech sound disorder, speech therapy, speech-language pathology; E-Helper
Multidisciplinary views toward pharmacist-delivered medication therapy management services in dialysis facilities.
Parker, Wendy M; Jang, Soo Min; Muzzy, Julia D; Cardone, Katie E
To determine views of staff of dialysis centers toward pharmacist-delivered medication therapy management (MTM) services. Focus group study. Three private, nonprofit, outpatient dialysis facilities. Multidisciplinary dialysis staff. Two focus group sessions were conducted using a semistructured interview guide. Views of staff toward MTM services at a dialysis center. A total of 13 staff members of dialysis centers participated in the study. Participants included nurses, patient care technicians, a social worker, dietitian, and administrative personnel. Key themes included: the need for access to MTM services in dialysis facilities exists; services should include medication reconciliation and patient education; services should be proactive, consistent, individualized, and covered by insurance; and that pharmacists are uniquely suited to provide MTM services. Dialysis staff support the integration of MTM services in facilities. Further research is needed to identify barriers and opportunities in the implementation process, including patient perspectives.
Dialogue with Citizens - the Missing Link in Delivering e-Government?
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Wendy Olphert
Full Text Available Many governments and political bodies across the globe are exploring the potential benefits of ICT as a means of improving communication with citizens and stimulating participation and engagement in political and civic processes. This paper reviews progress to date in the UK towards delivering e-government at the local level, and concludes that that there is evidence of a lack of 'pull-through' of the ministerial concepts and vision in the current delivery of e-government. In order to achieve the important e-government goals of increasing citizen participation and improved speed and efficiency of the underlying processes, the authors argue that a participative approach to the design and delivery of e-government is required. A co-creation approach to design is proposed. This will enable a dialogue between the citizen and the local authority, and which will embody and support democratic processes which will facilitate the genuine co-creation of decisions.
A pilot telerehabilitation program: delivering early intervention services to rural families.
Cason, Jana
The enTECH Telerehabilitation Program explored the use of telerehabilitation as an alternative service delivery model for early intervention therapy services. Utilizing the Kentucky Telehealth Network, two families living in rural Kentucky received occupational therapy services over a 12-week period. Following program implementation, qualitative data was collected using participant journals and interviews. Data analysis identified three thematic categories related to the program: benefits/strengths, challenges/weaknesses, and recommendations for program improvement. Results of the program evaluation indicated that telerehabilitation has the potential to cost-effectively meet the therapeutic needs of children living in rural areas where provider shortages exist. The enTECH Telerehabilitation Program serves as a model for how telerehabilitation can be used to deliver early intervention services to ameliorate health disparities and improve access to rehabilitation services.
Shigella Manipulates Host Immune Responses by Delivering Effector Proteins with Specific Roles
Ashida, Hiroshi; Mimuro, Hitomi; Sasakawa, Chihiro
The intestinal epithelium deploys multiple defense systems against microbial infection to sense bacterial components and danger alarms, as well as to induce intracellular signal transduction cascades that trigger both the innate and the adaptive immune systems, which are pivotal for bacterial elimination. However, many enteric bacterial pathogens, including Shigella, deliver a subset of virulence proteins (effectors) via the type III secretion system (T3SS) that enable bacterial evasion from host immune systems; consequently, these pathogens are able to efficiently colonize the intestinal epithelium. In this review, we present and select recently discovered examples of interactions between Shigella and host immune responses, with particular emphasis on strategies that bacteria use to manipulate inflammatory outputs of host-cell responses such as cell death, membrane trafficking, and innate and adaptive immune responses. PMID:25999954
Delivering a MOOC for literature searching in health libraries: evaluation of a pilot project.
Young, Gil; McLaren, Lisa; Maden, Michelle
In an era when library budgets are being reduced, Massive Online Open Courses (MOOC's) can offer practical and viable alternatives to the delivery of costly face-to-face training courses. In this study, guest writers Gil Young from Health Care Libraries Unit - North, Lisa McLaren from Brighton and Sussex Medical School and Liverpool University PhD student Michelle Maden describe the outcomes of a funded project they led to develop a MOOC to deliver literature search training for health librarians. Funded by Health Education England, the MOOC was developed by the Library and Information Health Network North West as a pilot project that ran for six weeks. In particular, the MOOC target audience is discussed, how content was developed for the MOOC, promotion and participation, cost-effectiveness, evaluation, the impact of the MOOC and recommendations for future development. H. S. © 2017 Health Libraries Group.
Developing a Typology for Peer Education and Peer Support Delivered by Prisoners.
South, Jane; Bagnall, Anne-Marie; Woodall, James
Peer interventions delivered for prisoners by prisoners offer a means to improve health and reduce risk factors for this population. The variety of peer programs poses challenges for synthesizing evidence. This article presents a typology developed as part of a systematic review of peer interventions in prison settings. Peer interventions are grouped into four modes: peer education, peer support, peer mentoring, and bridging roles, with the addition of a number of specific interventions identified through the review process. The article discusses the different modes of peer delivery with reference to a wider health promotion literature on the value of social influence and support. In conclusion, the typology offers a framework for developing the evidence base across a diverse field of practice in correctional health care.
Using Behavioral Economics to Design Physician Incentives That Deliver High-Value Care.
Emanuel, Ezekiel J; Ubel, Peter A; Kessler, Judd B; Meyer, Gregg; Muller, Ralph W; Navathe, Amol S; Patel, Pankaj; Pearl, Robert; Rosenthal, Meredith B; Sacks, Lee; Sen, Aditi P; Sherman, Paul; Volpp, Kevin G
Behavioral economics provides insights about the development of effective incentives for physicians to deliver high-value care. It suggests that the structure and delivery of incentives can shape behavior, as can thoughtful design of the decision-making environment. This article discusses several principles of behavioral economics, including inertia, loss aversion, choice overload, and relative social ranking. Whereas these principles have been applied to motivate personal health decisions, retirement planning, and savings behavior, they have been largely ignored in the design of physician incentive programs. Applying these principles to physician incentives can improve their effectiveness through better alignment with performance goals. Anecdotal examples of successful incentive programs that apply behavioral economics principles are provided, even as the authors recognize that its application to the design of physician incentives is largely untested, and many outstanding questions exist. Application and rigorous evaluation of infrastructure changes and incentives are needed to design payment systems that incentivize high-quality, cost-conscious care.
Innovative Extension Models and Smallholders: How ICT platforms can Deliver Timely Information to Farmers in India.
Nagothu, U. S.
Agricultural extension services, among others, contribute to improving rural livelihoods and enhancing economic development. Knowledge development and transfer from the cognitive science point of view, is about, how farmers use and apply their experiential knowledge as well as acquired new knowledge to solve new problems. This depends on the models adopted, the way knowledge is generated and delivered. New extension models based on ICT platforms and smart phones are promising. Results from a 5-year project (www.climaadapt.org) in India shows that farmer led-on farm validations of technologies and knowledge exchange through ICT based platforms outperformed state operated linear extension programs. Innovation here depends on the connectivity, net-working between stakeholders that are involved in generating, transferring and using the knowledge. Key words: Smallholders, Knowledge, Extension, Innovation, India
Cervical leverage: A new procedure to deliver deep retrosternal goitres without thoracotomy.
Naraynsingh, Vijay; Ramarine, Ian; Cawich, Shamir O; Maharaj, Ravi; Dan, Dilip
Although most retrosternal goitres can be removed through a standard collar incision, some cases require extra-cervical incisions for complete resection. We report a new technique to remove large retrosternal goitres without extra-cervical incisions. We present two cases in which a US Army-Navy (Parker-Langenback) retractor was used to deliver large retrosternal components into the cervical incisions. This technique is useful in cases where the retrosternal component extends beyond the reach of the exploring finger and a well-developed plane can be developed between the gland and surrounding tissue. The cervical leverage technique allows removal of a large retrosternal component through a cervical incision, thereby avoiding the attendant morbidity of a thoracotomy or median sternotomy. It should not be used if there is suspected neoplastic disease, dense adherence to or invasion of surrounding intra-thoracic structures. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.
Cervical leverage: A new procedure to deliver deep retrosternal goitres without thoracotomy☆
Naraynsingh, Vijay; Ramarine, Ian; Cawich, Shamir O.; Maharaj, Ravi; Dan, Dilip
INTRODUCTION Although most retrosternal goitres can be removed through a standard collar incision, some cases require extra-cervical incisions for complete resection. We report a new technique to remove large retrosternal goitres without extra-cervical incisions. PRESENTATION OF CASE We present two cases in which a US Army-Navy (Parker-Langenback) retractor was used to deliver large retrosternal components into the cervical incisions. DISCUSSION This technique is useful in cases where the retrosternal component extends beyond the reach of the exploring finger and a well-developed plane can be developed between the gland and surrounding tissue. CONCLUSION The cervical leverage technique allows removal of a large retrosternal component through a cervical incision, thereby avoiding the attendant morbidity of a thoracotomy or median sternotomy. It should not be used if there is suspected neoplastic disease, dense adherence to or invasion of surrounding intra-thoracic structures. PMID:24076566
End-of-life communication in veterinary medicine: delivering bad news and euthanasia decision making.
Shaw, Jane R; Lagoni, Laurel
Given the expectations of clients and the resultant impact of end-of-life conversations on pet owners and the veterinary team, compassionate end-of-life communication is considered to be an ethical obligation, a core clinical skill, and integral to the success of a veterinary team. End-of-life communication is related to significant clinical outcomes, including enduring veterinarian-client-patient relationships and veterinarian and client satisfaction. Effective techniques for end-of-life communication can be taught and are a series of learned skills. The purpose of this article is to present best practices for delivering bad news and euthanasia decision-making discussions. In this article, the SPIKES six-step model (setting, perception, invitation, knowledge, empathize, and summarize) currently employed in medical curricula is utilized to structure end-of-life conversations in veterinary medicine.
Genetic testing for inherited ocular disease: delivering on the promise at last?
Gillespie, Rachel L; Hall, Georgina; Black, Graeme C
Genetic testing is of increasing clinical utility for diagnosing inherited eye disease. Clarifying a clinical diagnosis is important for accurate estimation of prognosis, facilitating genetic counselling and management of families, and in the future will direct gene-specific therapeutic strategies. Often, precise diagnosis of genetic ophthalmic conditions is complicated by genetic heterogeneity, a difficulty that the so-called 'next-generation sequencing' technologies promise to overcome. Despite considerable counselling and ethical complexities, next-generation sequencing offers to revolutionize clinical practice. This will necessitate considerable adjustment to standard practice but has the power to deliver a personalized approach to genomic medicine for many more patients and enhance the potential for preventing vision loss. © 2013 Royal Australian and New Zealand College of Ophthalmologists.
A comparison of personalized feedback for college student drinkers delivered with and without a motivational interview.
Murphy, James G; Benson, Trisha A; Vuchinich, Rudy E; Deskins, Mary M; Eakin, David; Flood, Amanda M; McDevitt-Murphy, Meghan E; Torrealday, Ohiana
This study evaluated the relative efficacy of personalized drinking feedback (PDF) delivered with and without a motivational interview (MI) for college student drinkers. Heavy-drinking college students (N = 54; 691% female) were identified from a large screening sample and randomly assigned either to receive PDF during a single MI session or to receive PDF without an MI. Of these participants, 51 (94%) completed a 6-month follow-up assessment that included measures of alcohol consumption and alcohol-related problems. At 6-months postintervention, participants in both groups showed significant, small to moderate reductions in alcohol consumption, but the groups did not differ. Women showed larger reductions than men. Rates of alcohol-related problems remained relatively unchanged. The hypothesis that an MI would enhance the efficacy of PDF was not supported.
Aleppo and Beyond: Options for Delivering Humanitarian Aid in Dangerous Conditions
parachute system for high altitude drops. It uses GPS and active control of a drogue chute to steer the package during decent; JPADS has demonstrated...20,000. Surprisingly, the 10K is not much cheaper per ton than the 2K system. In large quantities, using commercial GPS rather than military GPS , and...floated the idea of using unmanned air vehicles (UAVs, sometimes referred to as " drones ") to deliver aid into Aleppo. There are a wide range of UAVs
Development of Au nanowire injector system to deliver plasmid into mouse embryo
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Kkotchorong Park
Full Text Available In this data article, we developed a Au nanowire injector (Au NWI for directly delivering plasmid into the 1-cell stage of the mouse embryos designed to successfully attach and detach the plasmid on the Au NWI, highly minimizing physical and chemical damage on the embryos. This data presents that a Au NWI system does not induce detrimental damages on development of embryos and efficiently express the green fluorescence protein in vitro. The data provided herein is in association with the research article related to reduce the occurrence of mosaicism by a Au NWI," Suppressing Mosaicism by Au Nanowire Injector-driven Direct Delivery of Plasmids into Mouse Embryos" (Park et al., 2017 [1].
Development and validation of a postpartum depression risk score in delivered women, Iran
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Mohammad R Maracy
Full Text Available Background: Investigators describe a dramatic increase in the incidence of mood disorder after childbirth, with the largest risk in the 90 days after delivery. This study is designed to develop a relatively simple screening tool and validate it from the significant variables associated with postpartum depression (PPD to detect delivered women at high risk of having PPD. Materials and Methods: In the cross-sectional study, 6,627 from a total of 7,300 delivered women, 2-12 months after delivery were recruited and screened for PPD. Split-half validation was used to develop the risk score. The training data set was used to develop the model, and the validation data set was used to validate the developed the risk factors of postpartum depression risk score using multiple logistic regression analysis to compute the β coefficients and odds ratio (OR for the dependent variables associated with possible PPD in this study. Calibration was checked using the Hosmer and Lemeshow test. A score for independent variables contributing to PPD was calculated. Cutoff points using a trade-off between the sensitivity and specificity of risk scores derived from PPD model using the Receiver Operating Characteristic (ROC curve. Results: The predicted and observed PPD were not different (P value = 0.885. The aROC with area under the curve (S.E. of 0.611 (0.008 for predicting PPD using the suggested cut-off point of -0.702, the proportion of participants screening positive for PPD was 70.9% (sensitivity (CI 95%; 69.5, 72.3 while the proportion screening negative was 60.1% (specificity (CI 95%; 58.2, 62.1. Conclusion: Despite of the relatively low sensitivity and specificity in this study, it could be a simple, practical and useful screening tool to identify individual at high risk for PPD in the target population.
Designing and delivering facilitated storytelling interventions for chronic disease self-management: a scoping review.
Gucciardi, Enza; Jean-Pierre, Nicole; Karam, Grace; Sidani, Souraya
Little is known about how to develop and deliver storytelling as an intervention to support those managing chronic illnesses. This scoping review aims to describe the core elements of storytelling interventions in order to help facilitate its implementation. A scoping review was conducted in seven databases for articles published up to May 2014 to identify interventions that describe in detail how storytelling was used to support people in disease self-management interventions. Ten articles met all inclusion criteria. Core elements consistently observed across the storytelling interventions were: reflection and interactive meaning-making of experiences; principles of informality and spontaneity; non-directional and non-hierarchical facilitation; development of group norms and conduct to create a community among participants; and both an individual and collective role for participants. Differences were also observed across interventions, such as: the conceptual frameworks that directed the design of the intervention; the type and training of facilitators; intervention duration; and how session topics were selected and stories delivered. Furthermore, evaluation of the intervention and outcome assessment varied greatly across studies. The use of storytelling can be a novel intervention to enhance chronic disease self-management. The core elements identified in the review inform the development of the intervention to be more patient-centred by guiding participants to take ownership of and lead the intervention, which differs significantly from traditional support groups. Storytelling has the potential to provide patients with a more active role in their health care by identifying their specific needs as well as gaps in knowledge and skills, while allowing them to form strong bonds with peers who share similar disease-related experiences. However, measures of impact differed across interventions given the variation in chronic conditions. Our findings can guide future
Effects of a Guided Internet-Delivered Self-Help Intervention for Adolescents With Chronic Pain.
Voerman, Jessica S; Remerie, Sylvia; Westendorp, Tessa; Timman, Reinier; Busschbach, Jan J V; Passchier, Jan; de Klerk, Cora
Cognitive-behavioral therapy (CBT) is effective in reducing the frequency and intensity of chronic pain in adolescents. However, CBT seems not to be considered acceptable by all adolescents. The main aim of our study was therefore to evaluate the effects of guided Internet-delivered self-help for adolescents with chronic pain. Adolescents (N = 69) were assessed on the outcome measures of pain, coping, disability, catastrophizing, rewarding of pain behavior by parents, and quality of life. Measures were taken 7 weeks before treatment and at pretreatment, posttreatment, and 3-month follow-up. Multilevel modeling was used for longitudinal analysis of the data. Pain intensity, interference caused by pain, rewarding of pain behavior by parents, and sleep problems significantly decreased during the intervention. The quality-of-life scores for pain, general behavior, mental health, family activities, and health changes also significantly improved during the intervention. With regard to coping, only problem-focused avoidance behavior significantly increased. No significant differences were found for pain-related disability and pain catastrophizing. Contrary to expectations, guided Internet-delivered self-help for chronic pain is difficult to use in adolescents, resulting in treatment attrition and loss to follow-up. Dutch Trial Register NTR1926. The results of this trial suggest that Internet-based self-management is effective in decreasing pain intensity in adolescents with chronic pain. Because the intervention is grounded in CBT, we expect the underlying mechanism to be a change in self-management skills and in the ability of challenging dysfunctional thoughts. Copyright © 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.
Self-Etch Adhesive as a Carrier for ACP Nanoprecursors to Deliver Biomimetic Remineralization.
Wu, Zhifang; Wang, Xiaokan; Wang, Zhe; Shao, Changyu; Jin, Xiaoting; Zhang, Leiqing; Pan, Haihua; Tang, Ruikang; Fu, Baiping
Lab biomineralization should be carried out in an actual clinical practice. This study evaluated self-etch adhesive as a carrier for amorphous calcium phosphate (ACP) nanoprecursors to continuously deliver biomimetic remineralization of self-assembly type I collagen and demineralized dentin. Si-containing ACP particles (Si-ACP) stabilized with polyaspartic acid (PAsp) were synthesized and characterized by transmission electron microscopy (TEM), scanning electron microscopy-energy-dispersive X-ray spectroscopy, Fourier transform infrared analysis, X-ray powder diffractometry, and X-ray phototelectron spectroscopy. The biomimetic remineralization of single-layer reconstituted type I collagen fibrils and demineralized dentin was analyzed by using two one-bottle self-etch dentin adhesives (Clearfil S3 Bond (S3), Kurraray-Noritake; Adper Easy One (AEO), 3 M ESPE) as a carrier loaded (or not, in the case of the control) with 25 wt % of Si-ACP particles. In vitro cytotoxicity assessed by the Cell Counting Kit-8 indicated that the Si-ACP particles had no adverse effect on cell viability. The capacity for Ca and P ions release from cured Si-ACP-containing adhesives (S3, AEO) was evaluated by inductively coupled plasma-atomic emission spectrometry, revealing the successively increasing release of Ca and P ions for 28 days. The intra- and extrafibrillar remineralization of type I collagen and demineralized dentin was confirmed by TEM and selected-area electron diffraction when the adhesives were used as a carrier loaded with Si-ACP particles. Therefore, we propose self-etch adhesive as a novel carrier for ACP nanoprecursors to continuously deliver biomimetic remineralization.
The effectiveness of nurse-delivered aromatherapy in an acute care setting.
Johnson, Jill R; Rivard, Rachael L; Griffin, Kristen H; Kolste, Alison K; Joswiak, Denise; Kinney, Mary Ellen; Dusek, Jeffery A
To examine the use and effectiveness of essential oil therapeutic interventions on pain, nausea, and anxiety, when provided by nurses to patients in acute hospital settings across a large health system. This study expands upon the limited body of literature on aromatherapy use among inpatients. Retrospective, effectiveness study using data obtained from electronic health records. Ten Allina Health hospitals located in Minnesota and western Wisconsin. Nurse-delivered aromatherapy. Change in patient-reported pain, anxiety, and nausea, rated before and after receiving aromatherapy using a numeric rating scale (0-10). There were 10,262 hospital admissions during the study time frame in which nurse-delivered aromatherapy was part of patient care. The majority of admissions receiving aromatherapy were females (81.71%) and white (87.32%). Over 75% of all aromatherapy sessions were administered via inhalation. Lavender had the highest absolute frequency (49.5%) of use regardless of mode of administration, followed by ginger (21.2%), sweet marjoram (12.3%), mandarin (9.4%), and combination oils (7.6%). Sweet marjoram resulted in the largest single oil average pain change at -3.31 units (95% CI: -4.28, -2.33), while lavender and sweet marjoram had equivalent average anxiety changes at -2.73 units, and ginger had the largest single oil average change in nausea at -2.02 units (95% CI: -2.55, -1.49). Essential oils generally resulted in significant clinical improvements based on their intended use, although each oil also showed ancillary benefits for other symptoms. Future research should explore use of additional essential oils, modes of administration, and different patient populations. Copyright © 2016. Published by Elsevier Ltd.
Human cardiotoxic drugs delivered by soaking and microinjection induce cardiovascular toxicity in zebrafish.
Zhu, Jun-Jing; Xu, Yi-Qiao; He, Jian-Hui; Yu, Hang-Ping; Huang, Chang-Jiang; Gao, Ji-Min; Dong, Qiao-Xiang; Xuan, Yao-Xian; Li, Chun-Qi
Cardiovascular toxicity is a major challenge for the pharmaceutical industry and predictive screening models to identify and eliminate pharmaceuticals with the potential to cause cardiovascular toxicity in humans are urgently needed. In this study, taking advantage of the transparency of larval zebrafish, Danio rerio, we assessed cardiovascular toxicity of seven known human cardiotoxic drugs (aspirin, clomipramine hydrochloride, cyclophosphamide, nimodipine, quinidine, terfenadine and verapamil hydrochloride) and two non-cardiovascular toxicity drugs (gentamicin sulphate and tetracycline hydrochloride) in zebrafish using six specific phenotypic endpoints: heart rate, heart rhythm, pericardial edema, circulation, hemorrhage and thrombosis. All the tested drugs were delivered into zebrafish by direct soaking and yolk sac microinjection, respectively, and cardiovascular toxicity was quantitatively or qualitatively assessed at 4 and 24 h post drug treatment. The results showed that aspirin accelerated the zebrafish heart rate (tachycardia), whereas clomipramine hydrochloride, cyclophosphamide, nimodipine, quinidine, terfenadine and verapamil hydrochloride induced bradycardia. Quinidine and terfenadine also caused atrioventricular (AV) block. Nimodipine treatment resulted in atrial arrest with much slower but regular ventricular heart beating. All the tested human cardiotoxic drugs also induced pericardial edema and circulatory disturbance in zebrafish. There was no sign of cardiovascular toxicity in zebrafish treated with non-cardiotoxic drugs gentamicin sulphate and tetracycline hydrochloride. The overall prediction success rate for cardiotoxic drugs and non-cardiotoxic drugs in zebrafish were 100% (9/9) as compared with human results, suggesting that zebrafish is an excellent animal model for rapid in vivo cardiovascular toxicity screening. The procedures we developed in this report for assessing cardiovascular toxicity in zebrafish were suitable for drugs delivered
Internet-delivered cognitive therapy for PTSD: a development pilot series
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Jennifer Wild
Full Text Available Background: Randomised controlled trials have established that face-to-face cognitive therapy for posttraumatic stress disorder (CT-PTSD based on Ehlers and Clark's cognitive model of PTSD is highly effective and feasible with low rates of dropout. Access to evidence-based psychological treatments for PTSD is insufficient. Several studies have shown that therapist-assisted treatment delivery over the Internet is a promising way of improving access to cognitive behavioural therapy interventions. Objective: To develop an Internet version of CT-PTSD that significantly reduces therapist contact time without compromising treatment integrity or retention rates. Methods: We describe the development of an Internet version of CT-PTSD. It implements all the key procedures of face-to-face CT-PTSD, including techniques that focus on the trauma memory, such as memory updating, stimulus discrimination and revisiting the trauma site, as well as restructuring individually relevant appraisals relating to overgeneralisation of danger, guilt, shame or anger, behavioural experiments and planning activities to reclaim quality of life. A cohort of 10 patients meeting DSM-IV criteria for PTSD worked through the programme, with remote guidance from a therapist, and they were assessed at pre- and post-treatment on PTSD outcome, mood, work and social adjustment and process measures. Results: No patients dropped out. Therapists facilitated the treatment with 192 min of contact time per patient, plus 57 min for reviewing the patient's progress and messages. Internet-delivered CT-PTSD was associated with very large improvements on all outcome and process measures, with 80% of patients achieving clinically significant change and remission from PTSD. Conclusions: Internet-delivered cognitive therapy for PTSD (iCT-PTSD appears to be an acceptable and efficacious treatment. Therapist time was reduced to less than 25% of time in face-to-face CT-PTSD. Randomised controlled trials
Sedation effects of intranasal dexmedetomidine delivered as sprays versus drops on pediatric response to venous cannulation.
Xie, Zhubin; Shen, Weihua; Lin, Jingyi; Xiao, Liwen; Liao, Minyan; Gan, Xiaoliang
Mucosal atomization device (MAD) was designed to increase the bioavailability of intranasal medications by facilitating absorption, the present study aimed to evaluate and compare the sedation effects of intranasal dexmedetomidine delivered as drops versus sprays on pediatric responses to intravenous cannulation. One hundred and six pediatric patients (aged from 2 to 5years) scheduled for elective ophthalmic surgery were intranasally received a dose of 2μg/kg in 20μl/kg of dexmedetomidine for sedation to reduce response to venous cannulation. The patients were randomized into syringe group and MAD group in which dexmedetomidine was delivered as drops or sprays via syringe or MAD respectively. The primary outcome was the response to peripheral vein cannulation assessed by the FLACC scores (faces, legs, activity, cry and consolability) 30min after intranasal administration of dexmedetomidine. The secondary outcomes included acceptance for intranasal medication, sedation onset time, and needle insertion times and any adverse event at the preoperative holding area. The FLACC scores in MAD group were significantly decreased than that treated by drops (P=0.021). The acceptance for intranasal administration between both groups was comparable (P>0.05), the onset time and the incidences in two and more times of needle insertion did not differ significantly between syringe and MAD groups (all P>0.05). None of patients were required to clinically intervene in heart rates reduction and none suffered respiratory depression after administrations of dexmedetomidine in either group. Intranasal dexmedetomidine by sprays offers better sedation effects to reduce responses to venous cannulation than drops. Copyright © 2017 Elsevier Inc. All rights reserved.
SU-E-T-357: Electronic Compensation Technique to Deliver Total Body Dose
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Lakeman, T [State University of New York at Buffalo, Buffalo, NY (United States); Wang, I; Podgorsak, M [State University of New York at Buffalo, Buffalo, NY (United States); Roswell Park Cancer Institute, Buffalo, NY (United States)
Purpose: Total body irradiation (TBI) uses large parallel-opposed radiation fields to suppress the patient's immune system and eradicate the residual cancer cells in preparation of recipient for bone marrow transplant. The manual placement of lead compensators has conventionally been used to compensate for the varying thickness through the entire body in large-field TBI. The goal of this study is to pursue utilizing the modern electronic compensation technique to more accurately and efficiently deliver dose to patients in need of TBI. Methods: Treatment plans utilizing electronic compensation to deliver a total body dose were created retrospectively for patients for whom CT data had been previously acquired. Each treatment plan includes two, specifically weighted, pair of opposed fields. One pair of open, large fields (collimator=45°), to encompass the patient's entire anatomy, and one pair of smaller fields (collimator=0°) focused only on the thicker midsection of the patient. The optimal fluence for each one of the smaller fields was calculated at a patient specific penetration depth. Irregular surface compensators provide a more uniform dose distribution within the smaller opposed fields. Results: Dose-volume histograms (DVH) were calculated for the evaluating the electronic compensation technique. In one case, the maximum body doses calculated from the DVH were reduced from the non-compensated 195.8% to 165.3% in the electronically compensated plans, indicating a more uniform dose with the region of electronic compensation. The mean body doses calculated from the DVH were also reduced from the non-compensated 120.6% to 112.7% in the electronically compensated plans, indicating a more accurate delivery of the prescription dose. All calculated monitor units were well within clinically acceptable limits. Conclusion: Electronic compensation technique for TBI will not substantially increase the beam on time while it can significantly reduce the compensator
Fidelity scorecard: evaluation of a caregiver-delivered symptom management intervention.
Frambes, Dawn; Lehto, Rebecca; Sikorskii, Alla; Tesnjak, Irena; Given, Barbara; Wyatt, Gwen
To evaluate and quantify the intervention fidelity of a symptom management protocol through implementation of a scorecard, using an exemplar study of caregiver-delivered reflexology for people with breast cancer. Studies on caregiver-delivered symptom management interventions seldom include adequate information on protocol fidelity, contributing to potentially suboptimal provision of the therapeutic intervention, hindering reproducibility and generalizability of the results. Fidelity assessment of a 4-week intervention protocol in a randomized controlled trial (RCT) with data collection between 2012 - 2016. The National Institutes of Health Behaviour Change Consortium (NIH-BCC) conceptual model for intervention fidelity guided the study. The five NIH-BCC fidelity elements are: (1) dose; (2) provider training; (3) intervention delivery; (4) intervention receipt; and (5) enactment. To illustrate the elements, an intervention protocol was deconstructed and each element quantified using a newly developed fidelity scorecard. Mean scores and frequency distributions were derived for the scorecard elements. For dose, the mean number of sessions was 4·4, 96% used the correct intervention duration and 29% had 4 weeks with at least one session. Provider training was achieved at 80% of the maximum score, intervention delivery was 96%, intervention receipt was 99% and enactment indicated moderate adoption at 3·8 sessions per patient. The sample mean score was 15·4 out of 16, indicating the high overall fidelity. Research findings that include description of how fidelity is both addressed and evaluated are necessary for clinical translation. Clinicians can confidently recommend symptom management strategies to patients and caregivers when fidelity standards are explicitly reported and measured. © 2017 John Wiley & Sons Ltd.
Agrobacterium delivers VirE2 protein into host cells via clathrin-mediated endocytosis
Li, Xiaoyang; Pan, Shen Q.
Agrobacterium tumefaciens can cause crown gall tumors on a wide range of host plants. As a natural genetic engineer, the bacterium can transfer both single-stranded DNA (ssDNA) [transferred DNA (T-DNA)] molecules and bacterial virulence proteins into various recipient cells. Among Agrobacterium-delivered proteins, VirE2 is an ssDNA binding protein that is involved in various steps of the transformation process. However, it is not clear how plant cells receive the T-DNA or protein molecules. Using a split–green fluorescent protein approach, we monitored the VirE2 delivery process inside plant cells in real time. We observed that A. tumefaciens delivered VirE2 from the bacterial lateral sides that were in close contact with plant membranes. VirE2 initially accumulated on plant cytoplasmic membranes at the entry points. VirE2-containing membranes were internalized through clathrin-mediated endocytosis to form endomembrane compartments. VirE2 colocalized with the early endosome marker SYP61 but not with the late endosome marker ARA6, suggesting that VirE2 escaped from early endosomes for subsequent trafficking inside the cells. Dual endocytic motifs at the carboxyl-terminal tail of VirE2 were involved in VirE2 internalization and could interact with the μ subunit of the plant clathrin-associated adaptor AP2 complex (AP2M). Both the VirE2 cargo motifs and AP2M were important for the transformation process. Because AP2-mediated endocytosis is well conserved, our data suggest that the A. tumefaciens pathogen hijacks conserved endocytic pathways to facilitate the delivery of virulence factors. This might be important for Agrobacterium to achieve both a wide host range and a high transformation efficiency. PMID:28345032
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Fatma OZUDOGRU
Full Text Available With the increasing number of foreign language courses via e-learning in higher education institutions, it is important to investigate whether the quality of e-learning is up to the standard. This study aimed at finding out the views of freshmen students on foreign language courses delivered via e-learning and revealing whether there were any statistically significant differences between students' views in terms of age, gender, time spent on using e-learning system and the faculty they studied at. This research was designed using the survey model. The sample of the research consisted of 478 freshmen students who were studying at four faculties and one vocational college in a state university in Turkey. The research data were collected through a scale, proposing a sixdimensional assessment of e-learning systems, which was developed by Ozkan and Koseler (2009 and tested for its reliability by the researchers. Data were analyzed using frequencies, mean, standard deviation, independent samples t-test and one-way Anova. The results indicated that the students' views on foreign language courses delivered via e-learning were negative with an 'overall' part mean score of 2,14 (Std=1,17. Also, the students disagreed 'learners' perspective' dimension (x̅=2,24 and partially agreed 'instructor attitudes', 'system quality', 'information content quality', 'service quality' and 'supportive issues' dimensions. Furthermore, it was revealed that there were no significant correlations between students' views and age and the time spent on using elearning. However, statistically significant differences were found between students' views and gender and the faculty students were studying at (p<0.05. The e-learning system should be developed in order for students to have valuable e-learning experiences and benefit from e-learning more.
New ways of working; delivering better care for people with long-term conditions*
Tzortziou Brown, Victoria; Patel, Irem; Thomas, Nicola; Tomlinson, James; Roberts, Rachel; Rayner, Hugh; Ashman, Neil; Hull, Sally
Background The cost-effectiveness of the traditional outpatient model for specialist care provision is increasingly being questioned in view of the changing patient needs, workforce challenges and technological advances. Setting This report summarises two RCGP London events showcasing new ways of delivering care for long-term conditions. Questions What are the alternative approaches to the traditional outpatient model and do they have common themes? What are the challenges and opportunities of these new models of care? Methods Presentation of examples of new ways of long-term condition care delivery and round-table facilitative discussion and reflection on the challenges and solutions around service re-design and implementation, the commissioning and funding of new models of care, the facilitation of system-wide learning and the collection of data for evaluation. Results Different ways of delivering care for people with Chronic Kidney Disease (CKD) and Chronic Obstructive Pulmonary Disease (COPD) were presented. Most of the interventions included virtual clinics (during which patient care was reviewed by a specialist remotely without the need for a face-to-face consultation), improved communication between primary and secondary care clinicians, an element of referral triage/prioritisation, the use of trigger tools to identify people at risk of deterioration, patient education and a multi-disciplinary approach. Discussion-conclusions Different models to the traditional outpatient long-term condition care are feasible and can result in improvements in the quality of care and staff satisfaction. However, such initiatives require careful planning, close collaboration between health care professionals and allocation of appropriate resources and training within primary care. There is also a need for systematic evaluation of such pilots to assess their cost-effectiveness and their acceptability to clinicians and patients. This requires systematic collection of population
New ways of working; delivering better care for people with long-term conditions.
Tzortziou Brown, Victoria; Patel, Irem; Thomas, Nicola; Tomlinson, James; Roberts, Rachel; Rayner, Hugh; Ashman, Neil; Hull, Sally
The cost-effectiveness of the traditional outpatient model for specialist care provision is increasingly being questioned in view of the changing patient needs, workforce challenges and technological advances. This report summarises two RCGP London events showcasing new ways of delivering care for long-term conditions. What are the alternative approaches to the traditional outpatient model and do they have common themes? What are the challenges and opportunities of these new models of care? Presentation of examples of new ways of long-term condition care delivery and round-table facilitative discussion and reflection on the challenges and solutions around service re-design and implementation, the commissioning and funding of new models of care, the facilitation of system-wide learning and the collection of data for evaluation. Different ways of delivering care for people with Chronic Kidney Disease (CKD) and Chronic Obstructive Pulmonary Disease (COPD) were presented. Most of the interventions included virtual clinics (during which patient care was reviewed by a specialist remotely without the need for a face-to-face consultation), improved communication between primary and secondary care clinicians, an element of referral triage/prioritisation, the use of trigger tools to identify people at risk of deterioration, patient education and a multi-disciplinary approach. Different models to the traditional outpatient long-term condition care are feasible and can result in improvements in the quality of care and staff satisfaction. However, such initiatives require careful planning, close collaboration between health care professionals and allocation of appropriate resources and training within primary care. There is also a need for systematic evaluation of such pilots to assess their cost-effectiveness and their acceptability to clinicians and patients. This requires systematic collection of population level data, agreement on the key outcomes for evaluation and a
Using Facebook to deliver a social norm intervention to reduce problem drinking at university.
Ridout, Brad; Campbell, Andrew
University students usually overestimate peer alcohol use, resulting in them 'drinking up' to perceived norms. Social norms theory suggests correcting these inflated perceptions can reduce alcohol consumption. Recent findings by the current authors show portraying oneself as 'a drinker' is considered by many students to be a socially desirable component of their Facebook identity, perpetuating an online culture that normalises binge drinking. However, social networking sites have yet to be utilised in social norms interventions. Actual and perceived descriptive and injunctive drinking norms were collected from 244 university students. Ninety-five students screened positive for hazardous drinking and were randomly allocated to a control group or intervention group that received social norms feedback via personalised Facebook private messages over three sessions. At 1 month post-intervention, the quantity and frequency of alcohol consumed by intervention group during the previous month had significantly reduced compared with baseline and controls. Reductions were maintained 3 months post-intervention. Intervention group perceived drinking norms were significantly more accurate post-intervention. This is the first study to test the feasibility of using Facebook to deliver social norms interventions. Correcting misperceptions of peer drinking norms resulted in clinically significant reductions in alcohol use. Facebook has many advantages over traditional social norms delivery, providing an innovative method for tackling problem drinking at university. These results have implications for the use of Facebook to deliver positive messages about safe alcohol use to students, which may counter the negative messages regarding alcohol normally seen on Facebook. © 2014 Australasian Professional Society on Alcohol and other Drugs.
Delivering the evidence--skill mix and education for elder care.
Wolff, Mark S; Schenkel, Andrew B; Allen, Kenneth L
To review the current status of dental curricula on elder care, and the current curricula regarding elder care, and it's effect on altering practitioner behaviors while addressing the needs of a growing North American elder population. An impending crisis is looming over the oral healthcare of our aging population. At the same moment that life expectancy is being extended through increasingly complex healthcare improvements, the numbers of trained dental providers capable and interested in delivering the needed care is failing to grow at an adequate rate. The skills necessary to manage these increasingly complex patients require an interprofessional approach capable of delivering care to sicker patients, in a variety of living accommodations, while managing a variety of care givers. The dental skills necessary to treat these elderly are modifications of skills students routinely learn in dental school. As a matter of fact, the skills students acquire to treat an adult patient population may be contrary to the basic skills necessary to manage the elderly dependent adult patient. Teaching students the nuance differences needed to properly diagnose and care for this population is a difficult task that must be taught in a contextual environment. Significant changes in the teaching of dental management of the elderly are critical within much of the education community. Just as teaching students to care for the pediatric population as general dentists, the clinical education must involve a sufficient number of quality experiences to address issues of both competency, that of the graduate to perform care independently, and attitudes, the actually willingness to treat the elderly. © 2014 John Wiley & Sons A/S and The Gerodontology Society. Published by John Wiley & Sons Ltd.
"Delivering knowledge and advice": Healthcare providers' experiences of their interaction with patients' management of rheumatoid arthritis.
Bergsten, Ulrika; Bergman, Stefan; Fridlund, Bengt; Arvidsson, Barbro
Rheumatic diseases are often chronic and involve a lifetime of suffering. The focus of rheumatology care is to support patients to manage their lives and master their disease. Healthcare providers and patients have different views on the consequences of living with rheumatic diseases and patients are reporting unmet healthcare needs. There is a need to integrate providers' perspective to develop the quality of rheumatology care. The aim was to explore healthcare providers' experiences of their interaction with patients in their management of RA. Interviews with 18 providers from different clinical settings were analysed in accordance with the grounded theory method. A core category; Delivering knowledge and advice was found to be the most important task and involved providing the patient with information about the disease and appropriate forms of treatment. Healthcare providers' attitudes and patients' responses influenced the outcome of the delivery of knowledge and advice and three dimensions emerged; completed delivery, adjusted delivery and failed delivery. There were differences in the providers' experiences in their interaction with patients as well as in reflections on their role as the delivering part. There could be difficulties in the interaction when patients' expectations and preferences were not taken into account when giving advice. These findings highlight the importance of developing rheumatology care, as no provider or patient benefits if the delivery of knowledge and advice becomes a failed delivery. The healthcare organization must acknowledge the difficulties involved in the interaction with patients in their management of RA and find methods to develop a more person-centred approach to care.
Boosting restraint norms: a community-delivered campaign to promote booster seat use.
Bryant-Stephens, Tyra; Garcia-Espana, J Felipe; Winston, Flaura K
The objective of this study was to evaluate the effectiveness of a theoretically grounded community-delivered marketing campaign to promote belt-positioning booster seat (BPB) use among vulnerable populations when disseminated by community members. A prospective, nonrandomized community intervention trial was conducted to evaluate the "Boosting Restraint Norms" social marketing campaign delivered by community partners in Norristown, Pennsylvania (intervention community), between October 2008 and November 2008. York, Pennsylvania, served as the comparison community. In total, 800 vehicles with 822 children aged 4 to 7 years were observed for BPB use, the primary outcome of interest, at baseline (September 2008) and at 6 months after intervention (April 2009). During the study period, a 28 percent increase in the prevalence of BPB use at 6 months was observed in the intervention community with no change in the prevalence of BPB use in the comparison community. After adjustment for child age and gender, vehicle type, driver gender, and driver level, BPB use increased from 39 to 50 percent in the intervention community. The "Boosting Restraint Norms" social marketing campaign, distributed through community organizations combined with caregiver education and a one-time free distribution of BPBs, was effective in increasing BPB use. This study demonstrates the feasibility of utilizing community organizations with established audiences to spread the "No Regrets" messaging of the campaign in the community. This study also indicates that spreading evidence-based messages in this manner may effectively change behavior in populations that are often hard to reach. Future studies are needed in which this methodology is tested in additional communities and rural settings.
77 FR 16228 - Key Hyundai of Manchester, LLC; Analysis of Proposed Consent Order To Aid Public Comment
... personal information, like anyone's Social Security number, date of birth, driver's license number or other... matter involves their advertising of the purchase, financing, and leasing of their motor vehicles... costs and terms when advertising credit. The complaint also alleges a violation of the Consumer Leasing...
78 FR 38445 - Hyundai-Kia America Technical Center, Inc., Grant of Petition for Decision of Inconsequential...
... assembly plant. Background Requirement: Section Sec. 4.3.3 of FMVSS No. 110 specially states: Sec. 4.3.3... required by Sec. 567.4 or Sec. 567.5 of this chapter. This information shall be in the English language...
Acceptability of Interventions Delivered Online and Through Mobile Phones for People Who Experience Severe Mental Health Problems: A Systematic Review.
Berry, Natalie; Lobban, Fiona; Emsley, Richard; Bucci, Sandra
Psychological interventions are recommended for people with severe mental health problems (SMI). However, barriers exist in the provision of these services and access is limited. Therefore, researchers are beginning to develop and deliver interventions online and via mobile phones. Previous research has indicated that interventions delivered in this format are acceptable for people with SMI. However, a comprehensive systematic review is needed to investigate the acceptability of online and mobile phone-delivered interventions for SMI in depth. This systematic review aimed to 1) identify the hypothetical acceptability (acceptability prior to or without the delivery of an intervention) and actual acceptability (acceptability where an intervention was delivered) of online and mobile phone-delivered interventions for SMI, 2) investigate the impact of factors such as demographic and clinical characteristics on acceptability, and 3) identify common participant views in qualitative studies that pinpoint factors influencing acceptability. We conducted a systematic search of the databases PubMed, Embase, PsycINFO, CINAHL, and Web of Science in April 2015, which yielded a total of 8017 search results, with 49 studies meeting the full inclusion criteria. Studies were included if they measured acceptability through participant views, module completion rates, or intervention use. Studies delivering interventions were included if the delivery method was online or via mobile phones. The hypothetical acceptability of online and mobile phone-delivered interventions for SMI was relatively low, while actual acceptability tended to be high. Hypothetical acceptability was higher for interventions delivered via text messages than by emails. The majority of studies that assessed the impact of demographic characteristics on acceptability reported no significant relationships between the two. Additionally, actual acceptability was higher when participants were provided remote online
Embryonic delivered dose of isotretinoin (13-cis-retinoic acid) and its metabolites in hamsters.
Eckhoff, C; Willhite, C C
All-trans-retinoic acid (all-trans-RA) is required in normal embryogenesis and both deficiency and excess are teratogenic. Isotretinoin (13-cis-RA) is teratogenic in all species examined; based on administered dose, humans appear most sensitive, followed by (in order or decreasing sensitivity) monkey, rabbit, hamster, mouse, and rat. Identification of the teratogenic threshold in these species is difficult because RAs are normal physiologic constituents. The rabbit no-observed-adverse-effect-level (NOAEL) and lowest-observed-adverse-effect-level (LOAEL) administered doses (3 and 15 mg/kg/day, respectively, on gestation Days 8-11) are less than the corresponding values in hamster (7.5 and 37.5 mg/kg/day, respectively, on gestation Days 7 and 8), but drawing conclusions from administered dose alone ignores differences in absorbed, metabolized, and embryonic delivered dose. Therefore, distribution and metabolism studies of 13-cis-RA at the NOAEL and LOAEL in pregnant hamsters were performed and plasma and tissue concentrations of parent compound and metabolites were compared to those found in rabbits. Metabolites of 13-cis-RA common to all species include three RAs (all-trans-RA, all-trans-4-oxoRA, 13-cis-4-oxoRA) and the glucuronide conjugate of 13-cis-RA (13-cis-RAG). As in rabbits, we found 13-cis-4-oxoRA also to be the major metabolite of 13-cis-RA in hamster plasma, peripheral tissues, and embryo. Of maternal tissues, peak 13-cis-RA concentrations were highest in liver. Total concentration of RA (13-cis-RA + 13-cis-4-oxoRA + all-trans-RA + all-trans-4-oxoRA) per gram of wet tissue was greatest in maternal liver, followed by that in lung, adipose tissue, muscle, kidney, and brain. At the NOAEL, total RA plasma Cmax in hamster was 6 times that in rabbit; at the LOAEL, hamster plasma total RA Cmax was 4 times that in rabbit. Hamster absorbed and metabolized dose (as AUC of plasma total RA) at the NOAEL and LOAEL was 2.6 and 2.4 times that in rabbit, respectively. In
Effectiveness of different methods for delivering tailored nutrition education to low income, ethnically diverse adults.
Gans, Kim M; Risica, Patricia M; Strolla, Leslie O; Fournier, Leanne; Kirtania, Usree; Upegui, David; Zhao, Julie; George, Tiffiney; Acharyya, Suddhasatta
Computer-tailored written nutrition interventions have been shown to be more effective than non-tailored materials in changing diet, but continued research is needed. Your Healthy Life/Su Vida Saludable (YHL-SVS) was an intervention study with low income, ethnically diverse, English and Spanish-speaking participants to determine which methods of delivering tailored written nutrition materials were most effective in lowering fat and increasing fruit and vegetable (F&V) intake. YHL-SVS was a randomized controlled trial with four experimental conditions: 1) Nontailored (NT) comparison group; 2) Single Tailored (ST) packet; 3) Multiple Tailored (MT) packet mailed in four installments; 4) Multiple Re-Tailored (MRT) MT packets re-tailored between mailings via brief phone surveys. A baseline telephone survey collected information for tailoring as well as evaluation. Follow-up evaluation surveys were collected 4- and 7-months later. Primary outcomes included F&V intake and fat related behaviors. Descriptive statistics, paired t-test and ANOVA were used to examine the effectiveness of different methods of delivering tailored nutrition information. Both the ST and MT groups reported significantly higher F&V intake at 4-months than the NT and MRT groups. At 7 months, only the MT group still had significantly higher F&V intake compared to the NT group. For changes in fat-related behaviors, both the MT and MRT groups showed more change than NT at 4 months, but at 7 months, while these differences persisted, they were no longer statistically significant. There was a significant interaction of experimental group by education for change in F&V intake (P = .0085) with the lowest educational group demonstrating the most change. In this study, tailored interventions were more effective than non-tailored interventions in improving the short-term dietary behaviors of low income, ethnically diverse participants. Delivery of information in multiple smaller doses over time appeared to
Effectiveness of different methods for delivering tailored nutrition education to low income, ethnically diverse adults
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Zhao Julie
Full Text Available Abstract Background Computer-tailored written nutrition interventions have been shown to be more effective than non-tailored materials in changing diet, but continued research is needed. Your Healthy Life/Su Vida Saludable (YHL-SVS was an intervention study with low income, ethnically diverse, English and Spanish-speaking participants to determine which methods of delivering tailored written nutrition materials were most effective in lowering fat and increasing fruit and vegetable (F&V intake. Methods YHL-SVS was a randomized controlled trial with four experimental conditions: 1 Nontailored (NT comparison group; 2 Single Tailored (ST packet; 3 Multiple Tailored (MT packet mailed in four installments; 4 Multiple Re-Tailored (MRT MT packets re-tailored between mailings via brief phone surveys. A baseline telephone survey collected information for tailoring as well as evaluation. Follow-up evaluation surveys were collected 4- and 7-months later. Primary outcomes included F&V intake and fat related behaviors. Descriptive statistics, paired t-test and ANOVA were used to examine the effectiveness of different methods of delivering tailored nutrition information. Results Both the ST and MT groups reported significantly higher F&V intake at 4-months than the NT and MRT groups. At 7 months, only the MT group still had significantly higher F&V intake compared to the NT group. For changes in fat-related behaviors, both the MT and MRT groups showed more change than NT at 4 months, but at 7 months, while these differences persisted, they were no longer statistically significant. There was a significant interaction of experimental group by education for change in F&V intake (P = .0085 with the lowest educational group demonstrating the most change. Conclusion In this study, tailored interventions were more effective than non-tailored interventions in improving the short-term dietary behaviors of low income, ethnically diverse participants. Delivery of
Delivering evidence-based smoking cessation treatment in primary care practice
Papadakis, Sophia; Gharib, Marie; Hambleton, Josh; Reid, Robert D.; Assi, Roxane; Pipe, Andrew L.
Abstract Objective To report on the delivery of evidence-based smoking cessation treatments (EBSCTs) within a sample of 40 Ontario family health teams (FHTs). Design In each FHT, consecutive patients were screened for smoking status and eligible patients completed a questionnaire immediately following their clinic visits (index visits). Multilevel analysis was used to examine FHT-level, provider-level, and patient-level predictors of EBSCT delivery. Setting Forty FHTs in Ontario. Participants Across the 40 participating FHTs, 24 033 patients were screened and 2501 eligible patients contributed data. Main outcome measures Provider performance in the delivery of EBSCTs during the preceding 12 months and during the index visits was assessed. Results The rate of provider delivery of EBSCT for the previous 12 months was 74.0% for the advise strategy. At the index visit, rates of EBSCT strategy delivery were 56.8% for ask; 46.9% for advise; 38.7% for assist; 11.6% for prescribing pharmacotherapy; and 11.3% for arrange follow-up. Significant intra-FHT and intraprovider variability in the rates of EBSCT delivery was identified. Family health teams with a physician champion (odds ratio [OR] 2.0; 95% CI 1.1 to 3.6; P < .01) and providers who highly ranked the importance of smoking cessation (OR 1.7; 95% CI 1.1 to 2.7; P < .01) were more likely to deliver EBSCTs. Patient readiness to quit (OR 1.6; 95% CI 1.3 to 1.9; P < .001), presence of smoking-related illness (OR 1.6; 95% CI 1.2 to 2.1; P < .01), and presenting for an annual health examination (OR 2.0; 95% CI 1.6 to 2.5; P < .001) were associated with the delivery of EBSCTs. Conclusion Rates of smoking cessation advice were higher than previously reported for Canadian physicians; however, rates of assistance with quitting were lower. Future quality improvement initiatives should specifically target increasing the rates of screening and advising among low-performing FHTs and providers within FHTs, with a particular emphasis
Mobile Phone-Delivered Cognitive Behavioral Therapy for Insomnia: A Randomized Waitlist Controlled Trial.
Horsch, Corine Hg; Lancee, Jaap; Griffioen-Both, Fiemke; Spruit, Sandor; Fitrianie, Siska; Neerincx, Mark A; Beun, Robbert Jan; Brinkman, Willem-Paul
This study is one of the first randomized controlled trials investigating cognitive behavioral therapy for insomnia (CBT-I) delivered by a fully automated mobile phone app. Such an app can potentially increase the accessibility of insomnia treatment for the 10% of people who have insomnia. The objective of our study was to investigate the efficacy of CBT-I delivered via the Sleepcare mobile phone app, compared with a waitlist control group, in a randomized controlled trial. We recruited participants in the Netherlands with relatively mild insomnia disorder. After answering an online pretest questionnaire, they were randomly assigned to the app (n=74) or the waitlist condition (n=77). The app packaged a sleep diary, a relaxation exercise, sleep restriction exercise, and sleep hygiene and education. The app was fully automated and adjusted itself to a participant's progress. Program duration was 6 to 7 weeks, after which participants received posttest measurements and a 3-month follow-up. The participants in the waitlist condition received the app after they completed the posttest questionnaire. The measurements consisted of questionnaires and 7-day online diaries. The questionnaires measured insomnia severity, dysfunctional beliefs about sleep, and anxiety and depression symptoms. The diary measured sleep variables such as sleep efficiency. We performed multilevel analyses to study the interaction effects between time and condition. The results showed significant interaction effects (Psleep efficiency (d=0.71). Overall, these improvements were also retained in a 3-month follow-up. This study demonstrated the efficacy of a fully automated mobile phone app in the treatment of relatively mild insomnia. The effects were in the range of what is found for Web-based treatment in general. This supports the applicability of such technical tools in the treatment of insomnia. Future work should examine the generalizability to a more diverse population. Furthermore, the
A systematic review of randomised control trials of sexual health interventions delivered by mobile technologies
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Kara Burns
reported statistically significant increases in condom use. Finally, one trial showed that collection of sexual health information using mobile technology was acceptable. Conclusions The findings suggest interventions delivered by SMS interventions can increase uptake of sexual health services and STI testing. High quality trials of interventions using standardised objective measures and employing a wider range of behavioural change techniques are needed to assess if interventions delivered by mobile phone can alter safer sex behaviours carried out between couples and reduce STIs.
Heterogeneous access and processing of EO-Data on a Cloud based Infrastructure delivering operational Products
Niggemann, F.; Appel, F.; Bach, H.; de la Mar, J.; Schirpke, B.; Dutting, K.; Rucker, G.; Leimbach, D.
To address the challenges of effective data handling faced by Small and Medium Sized Enterprises (SMEs) a cloud-based infrastructure for accessing and processing of Earth Observation(EO)-data has been developed within the project APPS4GMES(www.apps4gmes.de). To gain homogenous multi mission data access an Input Data Portal (IDP) been implemented on this infrastructure. The IDP consists of an Open Geospatial Consortium (OGC) conformant catalogue, a consolidation module for format conversion and an OGC-conformant ordering framework. Metadata of various EO-sources and with different standards is harvested and transferred to an OGC conformant Earth Observation Product standard and inserted into the catalogue by a Metadata Harvester. The IDP can be accessed for search and ordering of the harvested datasets by the services implemented on the cloud infrastructure. Different land-surface services have been realised by the project partners, using the implemented IDP and cloud infrastructure. Results of these are customer ready products, as well as pre-products (e.g. atmospheric corrected EO data), serving as a basis for other services. Within the IDP an automated access to ESA's Sentinel-1 Scientific Data Hub has been implemented. Searching and downloading of the SAR data can be performed in an automated way. With the implementation of the Sentinel-1 Toolbox and own software, for processing of the datasets for further use, for example for Vista's snow monitoring, delivering input for the flood forecast services, can also be performed in an automated way. For performance tests of the cloud environment a sophisticated model based atmospheric correction and pre-classification service has been implemented. Tests conducted an automated synchronised processing of one entire Landsat 8 (LS-8) coverage for Germany and performance comparisons to standard desktop systems. Results of these tests, showing a performance improvement by the factor of six, proved the high flexibility and
A systematic review of randomised control trials of sexual health interventions delivered by mobile technologies.
Burns, Kara; Keating, Patrick; Free, Caroline
use. Finally, one trial showed that collection of sexual health information using mobile technology was acceptable. The findings suggest interventions delivered by SMS interventions can increase uptake of sexual health services and STI testing. High quality trials of interventions using standardised objective measures and employing a wider range of behavioural change techniques are needed to assess if interventions delivered by mobile phone can alter safer sex behaviours carried out between couples and reduce STIs.
Bringing loyalty to e-Health: theory validation using three internet-delivered interventions.
Crutzen, Rik; Cyr, Dianne; de Vries, Nanne K
Internet-delivered interventions can effectively change health risk behaviors, but the actual use of these interventions by the target group once they access the website is often very low (high attrition, low adherence). Therefore, it is relevant and necessary to focus on factors related to use of an intervention once people arrive at the intervention website. We focused on user perceptions resulting in e-loyalty (ie, intention to visit an intervention again and to recommend it to others). A background theory for e-loyalty, however, is still lacking for Internet-delivered interventions. The objective of our study was to propose and validate a conceptual model regarding user perceptions and e-loyalty within the field of eHealth. We presented at random 3 primary prevention interventions aimed at the general public and, subsequently, participants completed validated measures regarding user perceptions and e-loyalty. Time on each intervention website was assessed by means of server registrations. Of the 592 people who were invited to participate, 397 initiated the study (response rate: 67%) and 351 (48% female, mean age 43 years, varying in educational level) finished the study (retention rate: 88%). Internal consistency of all measures was high (Cronbach alpha > .87). The findings demonstrate that the user perceptions regarding effectiveness (beta(range) .21-.41) and enjoyment (beta(range) .14-.24) both had a positive effect on e-loyalty, which was mediated by active trust (beta(range) .27-.60). User perceptions and e-loyalty had low correlations with time on the website (r(range) .04-.18). The consistent pattern of findings speaks in favor of their robustness and contributes to theory validation regarding e-loyalty. The importance of a theory-driven solution to a practice-based problem (ie, low actual use) needs to be stressed in view of the importance of the Internet in terms of intervention development. Longitudinal studies are needed to investigate whether people
Pilot Randomized Controlled Trial of Internet-Delivered Cognitive-Behavioral Treatment for Pediatric Headache.
Law, Emily F; Beals-Erickson, Sarah E; Noel, Melanie; Claar, Robyn; Palermo, Tonya M
To evaluate the feasibility and preliminary effectiveness of an Internet-delivered cognitive-behavioral therapy (CBT) intervention for adolescents with chronic headache. Headache is among the most common pain complaints of childhood. Cognitive-behavioral interventions are efficacious for improving pain among youth with headache. However, many youth do not receive psychological treatment for headache due to poor access, which has led to consideration of alternative delivery modalities such as the Internet. We used a parallel arm randomized controlled trial design to evaluate the feasibility and preliminary effectiveness of an Internet-delivered family-based CBT intervention, Web-based management of adolescent pain. Adolescents were eligible for the trial if they were a new patient being evaluated in a specialized headache clinic, between 11 and 17 years of age, and had recurrent headache for 3 months or more as diagnosed by a pediatric neurologist. Eighty-three youths were enrolled in the trial. An online random number generator was used to randomly assign participants to receive Internet CBT adjunctive to specialized headache treatment (n = 44) or specialized headache treatment alone (n = 39). The primary treatment outcome was headache days. Youth and parents in the Internet CBT group demonstrated high levels of engagement with the web program and reported satisfaction with the intervention. Multilevel modelling (MLM) was used to conduct hypothesis testing for continuous outcomes. For our primary treatment outcome of headache days, adolescents reported a statistically significant reduction in headache days from baseline to post-treatment and baseline to 3-month follow-up in both treatment conditions (main effect for time F(2, 136) = 19.70, P headache treatment group at post-treatment or follow-up (group × time interaction F(2, 134) = 0.94, P = .395). For our secondary treatment outcomes, findings from MLM showed that adolescents in both
An efficacy trial of brief lifestyle intervention delivered by generalist community nurses (CN SNAP trial
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Fanaian Mahnaz
Full Text Available Abstract Background Lifestyle risk factors, in particular smoking, nutrition, alcohol consumption and physical inactivity (SNAP are the main behavioural risk factors for chronic disease. Primary health care (PHC has been shown to be an effective setting to address lifestyle risk factors at the individual level. However much of the focus of research to date has been in general practice. Relatively little attention has been paid to the role of nurses working in the PHC setting. Community health nurses are well placed to provide lifestyle intervention as they often see clients in their own homes over an extended period of time, providing the opportunity to offer intervention and enhance motivation through repeated contacts. The overall aim of this study is to evaluate the impact of a brief lifestyle intervention delivered by community nurses in routine practice on changes in clients' SNAP risk factors. Methods/Design The trial uses a quasi-experimental design involving four generalist community nursing services in NSW Australia. Services have been randomly allocated to an 'early intervention' group or 'late intervention' (comparison group. 'Early intervention' sites are provided with training and support for nurses in identifying and offering brief lifestyle intervention for clients during routine consultations. 'Late intervention site' provide usual care and will be offered the study intervention following the final data collection point. A total of 720 generalist community nursing clients will be recruited at the time of referral from participating sites. Data collection consists of 1 telephone surveys with clients at baseline, three months and six months to examine change in SNAP risk factors and readiness to change 2 nurse survey at baseline, six and 12 months to examine changes in nurse confidence, attitudes and practices in the assessment and management of SNAP risk factors 3 semi-structured interviews/focus with nurses, managers and clients
Acute and chronic effects of epicardial radiofrequency applications delivered on epicardial coronary arteries.
Viles-Gonzalez, Juan F; de Castro Miranda, Reynaldo; Scanavacca, Mauricio; Sosa, Eduardo; d'Avila, Andre
Epicardial coronary injury is by far the most feared complication of epicardial ablation. Little information is available regarding the chronic effects of delivering radiofrequency in the vicinity of large coronary vessels, and the long-term impact of this approach for mapping and ablation on epicardial vessel integrity is poorly understood. Therefore, the aim of this study was to characterize the acute and chronic histopathologic changes produced by in vivo epicardial pulses of radiofrequency ablation on coronary artery of porcine hearts. Seven pigs underwent a left thoracotomy. The catheter was sutured adjacent to the left anterior descending artery and left circumflex artery, and 20 pulses of radiofrequency energy were applied. Radiofrequency lesions located no more than 1 mm of the vessel were used for this analysis. Three animals were euthanized 20 days (acute phase) after the procedure and 4 animals after 70 days (chronic phase). The following parameters were obtained in each vessel analyzed: (1) internal and external perimeter; (2) vessel wall thickness; (3) tunica media thickness, and (4) tunica intima thickness. The presence of adipose tissue around the coronary arteries, the distance between the artery and the epicardium, and the anatomic relationship of the artery with the coronary vein was also documented for each section. Sixteen of 20 (80%) sections analyzed, showed intimal thickening with a mean of 0.18 ± 0.14 mm compared with 0.13 ± 0.16 mm in the acute phase (P = 0.331). The mean tunica media thickness was 0.25 ± 0.10 mm in the chronic phase animals compared with 0.18 ± 0.03 mm in the acute phase animals (P = 0.021). A clear protective effect of pericardial fat and coronary veins was also present. A positive correlation between depth of radiofrequency lesion and the degree of vessel injury expressed as intimal and media thickening (P = 0.001) was present. A negative correlation was identified (r = -0.83; P = 0.002) between intimal thickening
Mental health workshops delivered by medical students in Cambridge secondary schools: an evaluation of learning.
Bentham, Chloe; Daunt, Anna; Taylor, Stephanie; Simmons, Meinou
For a group of medical students to design and deliver a mental health workshop in Cambridge secondary schools. Subsequently, to evaluate any improvements in pupils' knowledge of mental health issues, including knowledge of common mental illnesses, stigma and where to access help with mental health problems. A group of three medical students undertook a five week Student Selected Component to develop a mental health workshop in Spring 2013. The workshop was designed to include interactive components, such as role play, models and video. It was delivered to eight classes of 12-13 year old pupils across two local secondary schools, a total of 230 students. Questionnaires were completed before and after each workshop to test knowledge acquisition of mental health issues, stigma and where pupils could get help with mental health problems. Comparisons between data from the pre- and post-workshop questionnaires were made to assess learning. The responses from the questionnaires showed a global improvement in knowledge of mental health. This is highlighted by the increase in awareness of the prevalence of mental health problems amongst young people from 47.0% before the workshops to 97.8% after the workshops. The ability to identify symptoms of anxiety rose from 21.7% to 44.8% and the ability to identify depression rose from 29.0% to 53.5% respectively. Whilst only 15.2% pupils disagreed with a stigmatising statement about mental illness before the workshops, 61.3% pupils disagreed afterwards. The students were also better informed about how to access help and identified areas that they found useful to learn about. Comparison of the pre- and post-workshop questionnaires indicate that medical student-led workshops are an effective method for improving knowledge of mental health topics amongst 12-13 year old school pupils, as well as encouraging positive attitudes towards mental health. The project highlights a demand for mental health education in schools and brings to
Nanoparticle-based cancer treatment: can delivered dose and biological dose be reliably modeled and quantified?
Hoopes, P. Jack; Petryk, Alicia A.; Giustini, Andrew J.; Stigliano, Robert V.; D'Angelo, Robert N.; Tate, Jennifer A.; Cassim, Shiraz M.; Foreman, Allan; Bischof, John C.; Pearce, John A.; Ryan, Thomas
Essential developments in the reliable and effective use of heat in medicine include: 1) the ability to model energy deposition and the resulting thermal distribution and tissue damage (Arrhenius models) over time in 3D, 2) the development of non-invasive thermometry and imaging for tissue damage monitoring, and 3) the development of clinically relevant algorithms for accurate prediction of the biological effect resulting from a delivered thermal dose in mammalian cells, tissues, and organs. The accuracy and usefulness of this information varies with the type of thermal treatment, sensitivity and accuracy of tissue assessment, and volume, shape, and heterogeneity of the tumor target and normal tissue. That said, without the development of an algorithm that has allowed the comparison and prediction of the effects of hyperthermia in a wide variety of tumor and normal tissues and settings (cumulative equivalent minutes/ CEM), hyperthermia would never have achieved clinical relevance. A new hyperthermia technology, magnetic nanoparticle-based hyperthermia (mNPH), has distinct advantages over the previous techniques: the ability to target the heat to individual cancer cells (with a nontoxic nanoparticle), and to excite the nanoparticles noninvasively with a noninjurious magnetic field, thus sparing associated normal cells and greatly improving the therapeutic ratio. As such, this modality has great potential as a primary and adjuvant cancer therapy. Although the targeted and safe nature of the noninvasive external activation (hysteretic heating) are a tremendous asset, the large number of therapy based variables and the lack of an accurate and useful method for predicting, assessing and quantifying mNP dose and treatment effect is a major obstacle to moving the technology into routine clinical practice. Among other parameters, mNPH will require the accurate determination of specific nanoparticle heating capability, the total nanoparticle content and biodistribution in
Effect of Body Mass Index on pregnancy outcomes in nulliparous women delivering singleton babies
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Liston William A
Full Text Available Abstract Background The increasing prevalence of obesity in young women is a major public health concern. These trends have a major impact on pregnancy outcomes in these women, which have been documented by several researchers. In a population based cohort study, using routinely collected data, this paper examines the effect of increasing Body Mass Index (BMI on pregnancy outcomes in nulliparous women delivering singleton babies. Methods This was a retrospective cohort study, based on all nulliparous women delivering singleton babies in Aberdeen between 1976 and 2005. Women were categorized into five groups – underweight (BMI 2, normal (BMI 20 – 24.9 Kg/m2 overweight (BMI 25 – 29.9 Kg/m2, obese (BMI 30 – 34.9 Kg/m2 and morbidly obese (BMI > 35 Kg/m2. Obstetric and perinatal outcomes were compared by univariate and multivariate analyses. Results In comparison with women of BMI 20 – 24.9, morbidly obese women faced the highest risk of pre-eclampsia {OR 7.2 (95% CI 4.7, 11.2} and underweight women the lowest {OR 0.6 (95% CI 0.5, 0.7}. Induced labour was highest in the morbidly obese {OR 1.8 (95% CI 1.3, 2.5} and lowest in underweight women {OR 0.8 (95% CI 0.8, 0.9}. Emergency Caesarean section rates were highest in the morbidly obese {OR 2.8 (95% CI 2.0, 3.9}, and comparable in women with normal and low BMI. Obese women were more likely to have postpartum haemorrhage {OR 1.5 (95% CI 1.3, 1.7} and preterm delivery ( 4,000 g was in the morbidly obese {OR 2.1 (95% CI 1.3, 3.2} and the lowest in underweight women {OR 0.5 (95% CI 0.4, 0.6}. Conclusion Increasing BMI is associated with increased incidence of pre-eclampsia, gestational hypertension, macrosomia, induction of labour and caesarean delivery; while underweight women had better pregnancy outcomes than women with normal BMI.
Costs and cost-effectiveness of delivering intermittent preventive treatment through schools in western Kenya
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Jukes Matthew CH
Full Text Available Abstract Background Awareness of the potential impact of malaria among school-age children has stimulated investigation into malaria interventions that can be delivered through schools. However, little evidence is available on the costs and cost-effectiveness of intervention options. This paper evaluates the costs and cost-effectiveness of intermittent preventive treatment (IPT as delivered by teachers in schools in western Kenya. Methods Information on actual drug and non-drug associated costs were collected from expenditure and salary records, government budgets and interviews with key district and national officials. Effectiveness data were derived from a cluster-randomised-controlled trial of IPT where a single dose of sulphadoxine-pyrimethamine and three daily doses of amodiaquine were provided three times in year (once termly. Both financial and economic costs were estimated from a provider perspective, and effectiveness was estimated in terms of anaemia cases averted. A sensitivity analysis was conducted to assess the impact of key assumptions on estimated cost-effectiveness. Results The delivery of IPT by teachers was estimated to cost US$ 1.88 per child treated per year, with drug and teacher training costs constituting the largest cost components. Set-up costs accounted for 13.2% of overall costs (equivalent to US$ 0.25 per child whilst recurrent costs accounted for 86.8% (US$ 1.63 per child per year. The estimated cost per anaemia case averted was US$ 29.84 and the cost per case of Plasmodium falciparum parasitaemia averted was US$ 5.36, respectively. The cost per case of anaemia averted ranged between US$ 24.60 and 40.32 when the prices of antimalarial drugs and delivery costs were varied. Cost-effectiveness was most influenced by effectiveness of IPT and the background prevalence of anaemia. In settings where 30% and 50% of schoolchildren were anaemic, cost-effectiveness ratios were US$ 12.53 and 7.52, respectively. Conclusion This
Effectiveness of mask and helmet interfaces to deliver noninvasive ventilation in a human model of resistive breathing.
Racca, Fabrizio; Appendini, Lorenzo; Gregoretti, Cesare; Stra, Elisa; Patessio, Antonio; Donner, Claudio F; Ranieri, V Marco
The helmet, a transparent latex-free polyvinyl chloride cylinder linked by a metallic ring to a soft collar that seals the helmet around the neck, has been recently proposed as an effective alternative to conventional face mask to deliver pressure support ventilation (PSV) during noninvasive ventilation in patients with acute respiratory failure. We tested the hypothesis that mechanical characteristics of the helmet (large internal volume and high compliance) might impair patient-ventilator interactions compared with standard face mask. Breathing pattern, CO(2) clearance, indexes of inspiratory muscle effort and patient-ventilator asynchrony, and dyspnea were measured at different levels of PSV delivered by face mask and helmet in six healthy volunteers before (load-off) and after (load-on) application of a linear resistor. During load-off, no differences in breathing pattern and inspiratory muscle effort were found. During load-on, the use of helmet to deliver pressure support increased inspiratory muscle effort and patient-ventilator asynchrony, worsened CO(2) clearance, and increased dyspnea compared with standard face mask. Autocycled breaths accounted for 12 and 25% of the total minute ventilation and for 10 and 23% of the total inspiratory muscle effort during mask and helmet PSV, respectively. We conclude that PSV delivered by helmet interface is less effective in unloading inspiratory muscles compared with PSV delivered by standard face mask. Other ventilatory assist modes should be tested to exploit to the most the potential benefits offered by the helmet.
Ventilator-delivered mask ventilation compared with three standard methods of mask ventilation in a manikin model.
Tracy, M B; Klimek, J; Coughtrey, H; Shingde, V; Ponnampalam, G; Hinder, M; Maheshwari, R; Tracy, S K
Little is known regarding the variations in effective ventilation during bag and mask resuscitation with standard methods compared with that delivered by ventilator-delivered mask ventilation (VDMV). To measure the variations in delivered airway pressure, tidal volume (TV), minute ventilation (MV) and inspiratory time during a 3-min period of mask ventilation comparing VDMV with three commonly used hand-delivered methods of bag and mask ventilation: Laerdal self-inflating bag (SIB); anaesthetic bag and T-piece Neopuff. A modified resuscitation manikin was used to measure variation in mechanical ventilation during 3-min periods of mask ventilation. Thirty-six experienced practitioners gave positive pressure mask ventilation targeting acceptable chest wall movement with a rate of 60 inflations/min and when pressures could be targeted or set, a peak inspiratory pressure (PIP) of 18 cm water, positive end-expiratory pressure (PEEP) of 5 cm water, for 3 min with each of the four mask ventilation methods. Each mode was randomly sequenced. A total of 21 136 inflations were recorded and analysed. VDMV achieved PIP and PEEP closest to that targeted and significantly lower variation in all measured parameters (pventilation on a manikin, VDMV produced the least variation in delivered ventilation. SIB produced wide variation and unacceptably high TV and MV in experienced hands.
A Systematic Review of Interventions to Enhance Healthy Lifestyle Behaviors in Adolescents Delivered via Mobile Phone Text Messaging.
Loescher, Lois J; Rains, Stephen A; Kramer, Sandra S; Akers, Chelsie; Moussa, Renee
To systematically review healthy lifestyle interventions targeted to adolescents and delivered using text messaging (TM). PubMed, Embase, CINAHL, PsycINFO, and Web of Science databases. Research articles published during 2011 to 2014; analyses focused on intervention targeting adolescents (10-19 years), with healthy lifestyle behaviors as main variables, delivered via mobile phone-based TM. The authors extracted data from 27 of 281 articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method. Adolescent and setting characteristics, study design and rigor, intervention effectiveness, challenges, and risk of bias. Across studies, 16 (59.3%) of 27 included non-Caucasians. The gender was split for 22 (81.5%) of 27 studies. Thirteen studies were randomized controlled trials. There was heterogeneity among targeted conditions, rigor of methods, and intervention effects. Interventions for monitoring/adherence (n = 8) reported more positive results than those for health behavior change (n = 19). Studies that only included message delivered via TM (n = 14) reported more positive effects than studies integrating multiple intervention components. Interventions delivered using TM presented minimal challenges, but selection and performance bias were observed across studies. Interventions delivered using TM have the potential, under certain conditions, to improve healthy lifestyle behaviors in adolescents. However, the rigor of studies varies, and established theory and validated measures have been inconsistently incorporated. © The Author(s) 2016.
Adding an Internet-delivered treatment to an efficacious treatment package for opioid dependence.
Christensen, Darren R; Landes, Reid D; Jackson, Lisa; Marsch, Lisa A; Mancino, Michael J; Chopra, Mohit P; Bickel, Warren K
To examine the benefit of adding an Internet-delivered behavior therapy to a buprenorphine medication program and voucher-based motivational incentives. A block-randomized, unblinded, parallel, 12-week treatment trial was conducted with 170 opioid-dependent adult patients (mean age = 34.3 years; 54.1% male; 95.3% White). Participants received an Internet-based community reinforcement approach intervention plus contingency management (CRA+) and buprenorphine or contingency management alone (CM-alone) plus buprenorphine. The primary outcomes, measured over the course of treatment, were longest continuous abstinence, total abstinence, and days retained in treatment. Compared to those receiving CM-alone, CRA+ recipients exhibited, on average, 9.7 total days more of abstinence (95% confidence interval [CI = 2.3, 17.2]) and had a reduced hazard of dropping out of treatment (hazard ratio = 0.47; 95% CI [0.26, 0.85]). Prior treatment for opioid dependence significantly moderated the additional improvement of CRA+ for longest continuous days of abstinence. These results provide further evidence that an Internet-based CRA+ treatment is efficacious and adds clinical benefits to a contingency management/medication based program for opioid dependence.
Delivering patient decision aids on the Internet: definitions, theories, current evidence, and emerging research areas.
Hoffman, Aubri S; Volk, Robert J; Saarimaki, Anton; Stirling, Christine; Li, Linda C; Härter, Martin; Kamath, Geetanjali R; Llewellyn-Thomas, Hilary
In 2005, the International Patient Decision Aids Standards Collaboration identified twelve quality dimensions to guide assessment of patient decision aids. One dimension-the delivery of patient decision aids on the Internet-is relevant when the Internet is used to provide some or all components of a patient decision aid. Building on the original background chapter, this paper provides an updated definition for this dimension, outlines a theoretical rationale, describes current evidence, and discusses emerging research areas. An international, multidisciplinary panel of authors examined the relevant theoretical literature and empirical evidence through 2012. The updated definition distinguishes Internet-delivery of patient decision aids from online health information and clinical practice guidelines. Theories in cognitive psychology, decision psychology, communication, and education support the value of Internet features for providing interactive information and deliberative support. Dissemination and implementation theories support Internet-delivery for providing the right information (rapidly updated), to the right person (tailored), at the right time (the appropriate point in the decision making process). Additional efforts are needed to integrate the theoretical rationale and empirical evidence from health technology perspectives, such as consumer health informatics, user experience design, and human-computer interaction. As of 2012, the updated theoretical rationale and emerging evidence suggest potential benefits to delivering patient decision aids on the Internet. However, additional research is needed to identify best practices and quality metrics for Internet-based development, evaluation, and dissemination, particularly in the areas of interactivity, multimedia components, socially-generated information, and implementation strategies.
New Ways of Delivering Marine Scientific Evidence for Policy Needs in the UK
Dorrington, T.
The UK Department for Environment, Food, and Rural Affairs (Defra) is responsible for safeguarding the natural environment, supporting a world-leading food and farming industry, and sustaining a thriving rural economy. This includes the marine environment which makes a significant contribution to the economy of the UK through fisheries, aquaculture, transport, leisure and recreation, energy (including renewable), coastal tourism, and naval defence. The overall vision for the Defra marine programme is to therefore achieve clean, healthy, safe, productive and biologically diverse oceans and seas. In order to attain this it is essential that the decisions that government makes can be justified and that these decisions use the best available evidence and allow for any uncertainty. However, reductions across the budgets of departments such as Defra means that new ways of delivering evidence for policy needs must be sought. To do this we must consider marine monitoring efficiencies including the use of novel technologies, more integrated monitoring programmes, and greater collaboration with the research councils, industry, and academia. We must also seek to leverage other sources of funding from the European Union and other international partners. This presentation will address the main policy drivers (e.g. EU Marine Strategy Framework Directive) and future needs of the marine programme, the Defra Evidence Action Plan (EAP), and how we plan to use new avenues of gaining high quality marine scientific evidence in an era of declining budgets.
High patient satisfaction with nurse practitioner delivered services at two health centres in urban Jamaica.
Jones, Khadene; Hepburn-Brown, Cerese; Anderson-Johnson, Pauline; Lindo, Jascinth L M
Abstract Objective: To explore the level of patient satisfaction with nurse practitioner delivered services at two health centres in urban Jamaica. A cross sectional survey of 120 adult clients (age ≥18 years old) seen by Nurse Practitioner at a Type 3 or Type 5 health centre in Kingston, Jamaica was conducted using a modified self-administered Nurse Practitioner Satisfaction Survey questionnaire. Data were analysed using SPSS® version 18 for Windows®. The study achieved response rate of 91.6% (N = 120). The majority were females (77%) with an average age of 40 ± 16 years. Most (63%) were from the Type 5 health centre and the rest (37%) were from a Type 3 facility. The mean general satisfaction score was 81 out of a possible 90 and 83% of the respondents reported they were very satisfied with another 17% expressing that they were satisfied with the nurse practitioner services at both facilities. No respondent was dissatisfied. The mean satisfaction score was significantly higher among respondents 40 years and older than that of their younger counterparts. Socio demographic and organisation characteristics were not associated with the mean satisfaction score. A high level of satisfaction exists among patients seen by nurse practitioners at two facilities in Kingston, Jamaica. This may represent an opportunity for expanded role of Nurse practitioners in the delivery of primary in Jamaica.
Vertical silicon nanowires as a universal platform for delivering biomolecules into living cells
Shalek, Alex K.; Robinson, Jacob T.; Karp, Ethan S.; Lee, Jin Seok; Ahn, Dae-Ro; Yoon, Myung-Han; Sutton, Amy; Jorgolli, Marsela; Gertner, Rona S.; Gujral, Taranjit S.; MacBeath, Gavin; Yang, Eun Gyeong; Park, Hongkun
A generalized platform for introducing a diverse range of biomolecules into living cells in high-throughput could transform how complex cellular processes are probed and analyzed. Here, we demonstrate spatially localized, efficient, and universal delivery of biomolecules into immortalized and primary mammalian cells using surface-modified vertical silicon nanowires. The method relies on the ability of the silicon nanowires to penetrate a cell's membrane and subsequently release surface-bound molecules directly into the cell's cytosol, thus allowing highly efficient delivery of biomolecules without chemical modification or viral packaging. This modality enables one to assess the phenotypic consequences of introducing a broad range of biological effectors (DNAs, RNAs, peptides, proteins, and small molecules) into almost any cell type. We show that this platform can be used to guide neuronal progenitor growth with small molecules, knock down transcript levels by delivering siRNAs, inhibit apoptosis using peptides, and introduce targeted proteins to specific organelles. We further demonstrate codelivery of siRNAs and proteins on a single substrate in a microarray format, highlighting this technology's potential as a robust, monolithic platform for high-throughput, miniaturized bioassays. PMID:20080678
Creating a spiritual tapestry: nurses' experiences of delivering spiritual care to patients in an Irish hospice.
LENUS (Irish Health Repository)
Bailey, Maria E
This study aims to describe nurses\\' experiences of delivering spiritual support in a palliative care setting in the Republic of Ireland. The authors conducted semi-structured interviews with 22 nurses working in the area of specialist palliative care. A content analysis of the transcriptions revealed five sub-themes: understanding spirituality; the art of nursing in spiritual care; education and learning; the challenge of spiritual caring; and the dimensions of time. The resulting creation of a spiritual tapestry provided an overall theme. Nurses in this study were spiritually self-aware and placed a high value on the spiritual element of their caring role. Nurses described their individual understanding of spirituality and discussed how they recognized and addressed a patient\\'s spiritual needs. Time was described as essential to the provision of spiritual support and appeared to be a significant resource challenge to the provision of spiritual care. The challenges of assessing spiritual needs and measuring outcomes of care were also reported. Participants in this study described the creation of a spiritual tapestry that \\'weaves\\' together care and compassion with skills and knowledge in their nursing practice.
[Modern information and communication technology in medical rehabilitation. Enhanced sustainability through Internet-delivered aftercare].
Kordy, H; Theis, F; Wolf, M
Internet and mobile phones open new avenues for the optimization of health services in medical rehabilitation. Various models of Internet-delivered aftercare after psychosomatic inpatient treatment have shown promising results. The focus of this report is on the experience in translating one of the promising models, the Internet-Bridge ("Internet-Brücke"), to every day health care. Effectiveness was estimated through comparison of 254 patients who were treated in a hospital specialized in psychosomatic medicine and who participated in the Internet-Bridge as well as in the 1-year follow-up in the frame of standard quality assurance between 2003-2010 with 364 patients of the same hospital who also participated in the 1-year follow-up, but did not utilize the aftercare. Sustainable, reliable, and clinically significant improvements were more frequent in participants of the Internet-Bridge, especially with regard to psychological well-being, social problems, and psychosocial competence-at small additional costs. Results are understood as encouragement to start translation to routine care accompanied by research.
F-127-PEI co-delivering docetaxel and TFPI-2 plasmid for nasopharyngeal cancer therapy
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Liu, Tao, E-mail: email@example.com [Department of Otolaryngology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282 (China); Zhang, Xinyu [Department of Otolaryngology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282 (China); Ke, Bo [Jiangxi Key Laboratory of Hematological Oncology and Cell Biology, Jiangxi Provincial People' s Hospital, Nanchang 330006 (China); Wang, Yigang [School of Life Sciences, Zhejiang Sci-Tech University, Hangzhou 310018 (China); Wu, Xidong [Department of Pharmacology, Jiangxi Institute of Materia Medica,Nanchang 330029 (China); Jiang, Gang [Department of Otolaryngology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282 (China); Wu, Ting [Department of Light Chemical Engineering, Guangdong Polytechnic, Foshan 528041 (China); Nie, Guohui, E-mail: email@example.com [Department of Otolaryngological, Peking University Shenzhen Hospital, Shenzhen 518036 (China)
The co-delivery of drug and gene has become the primary strategy in cancer therapy. However, to construct one safe co-delivering system with higher drug loading and gene transfection efficiency for cancer therapy is still challenging. Herein, a novel degradable nanocarriers were synthesized and characterized in this study, which was composed of polyethylenimine (PEI)-linked PEO–PPO–PEO (Pluronic F127), called F127-PEI. Then the nanocarrier was used for hydrophobic docetaxel (DOC) and functional gene (TFPI-2 plasmid) co-delivery to treat nasopharyngeal cancer (NPC). The results indicated that F127-PEI nanocarriers had higher DOC loading amount and possessed good gene delivery effect in vitro. For co-delivery analysis, the obtained F127-PEI/DOC/TFPI-2 complexes could induce a more significant apoptosis than DOC or TFPI-2 alone, and decreased invasive capacity of NPC HNE-1 cells more obviously. Moreover, the F127-PEI copolymer exhibited better blood compatibility and lower cytotoxicity compared to PEI-25k by the hemolysis and MTT assays, which suggests a promising potential for NPC therapy. - Highlights: • F127-PEI was synthesized and used for drug and gene co-delivery. • F127-PEI showed good delivery ability to docetaxel and TFPI-2 plasmid. • The co-loaded complexes showed synergistic effect to nasopharyngeal carcinoma. • F127-PEI showed better blood safety and lower cytotoxicity compared to PEI-25k.
A randomized trial of Internet-delivered treatment for social anxiety disorder in high school students.
Tillfors, Maria; Andersson, Gerhard; Ekselius, Lisa; Furmark, Tomas; Lewenhaupt, Susanne; Karlsson, Anders; Carlbring, Per
Internet-based cognitive behavior therapy (CBT) has been shown effective for university students with social anxiety disorder (SAD) and public speaking fears. The aim of this study was to investigate whether the promising results can be transferred to high school students suffering from this condition. A total of 19 speech-anxious high school students with SAD were randomized either into 9 weeks of Internet-delivered CBT or to a wait-list control group. Significant improvements were found on measures of social anxiety, general anxiety, and depression. Effects were maintained at 1-year follow-up. The average within- and between-group effect sizes (Cohen's d) for the primary social anxiety scales at posttest were 0.98 and 1.38, respectively. However, the average number of completed modules in the CBT program was low. Although compliance can be improved, the results suggest that Internet-based guided self-help is effective in the treatment of high school students with SAD.
Culture, context and therapeutic processes: delivering a parent-child intervention in a remote Aboriginal community.
Mares, Sarah; Robinson, Gary
Little is written about the process of delivering mainstream, evidence-based therapeutic interventions for Aboriginal children and families in remote communities. Patterns of interaction between parents and children and expectations about parenting and professional roles and responsibilities vary across cultural contexts. This can be a challenging experience for professionals accustomed to work in urban settings. Language is only a part of cultural difference, and the outsider in a therapeutic group in an Aboriginal community is outside not only in language but also in access to community relationships and a place within those relationships. This paper uses examples from Let's Start, a therapeutic parent-child intervention to describe the impact of distance, culture and relationships in a remote Aboriginal community, on the therapeutic framework, group processes and relationships. Cultural and contextual factors influence communication, relationships and group processes in a therapeutic group program for children and parents in a remote Aboriginal community. Group leaders from within and from outside the community, are likely to have complementary skills. Cultural and contextual factors influence communication, relationships and group processes in a therapeutic group program for children and parents in a remote Aboriginal community. Group leaders from within and from outside the community, are likely to have complementary skills. Program adaptation, evaluation and staff training and support need to take these factors into account to ensure cultural accessibility without loss of therapeutic fidelity and efficacy.
Collaboration between Professionals: The Use of Videoconferencing for Delivering E-Health
Directory of Open Access Journals (Sweden)
Line Lundvoll Nilsen
Full Text Available This article explores the ways in which collaboration between professionals using videoconferencing affects the e-health delivered to patients. In Norway, general practitioners (GPs and specialists routinely hold videoconferences. Observations of 42 VC meetings, each lasting from 5 to 40 min, were analysed in terms of the interactions. In addition, five semi-structured, face-to-face interviews were conducted, each lasting from 20 to 70 minutes. Statements were selected to illustrate the content of the interactions and how collaborative work affects the delivery of healthcare. Successful collaborative work provides practitioners with a new way of thinking: exchanging information and knowledge between levels of care in order to provide the best treatment for patients locally. The regularity makes the collaborative work a two-way achievement. GPs receive decision support and second opinions, and specialists receive information and opportunities to follow up. How the professionals manage their work (i.e., collaborating may benefit their patients. The regular use of videoconferencing will furnish professionals with enhanced resources for the meeting of patients' demands in the future. Regularly informing one another and exchanging knowledge, benefits the professionals by providing increased certainty with regard to their medical decisions, and it benefits the patients because they will feel satisfied with the competence of the specialists where they live.
Computerized intrapartum electronic fetal monitoring: analysis of the decision to deliver for fetal distress.
Georgieva, Antoniya; Payne, Stephen J; Moulden, Mary; Redman, Christopher W G
We applied computerized methods to assess the Electronic Fetal Monitoring (EFM) in labor. We analyzed retrospectively the last hour of EFM for 1,370 babies, delivered by emergency Cesarean sections before the onset of pushing (data collected at the John Radcliffe Hospital, Oxford, UK). There were two cohorts according to the reason for intervention: (a) fetal distress, n(1) = 524 and (b) failure to progress and/or malpresentation, n(2) = 846. The cohorts were compared in terms of classical EFM features (baseline, decelerations, variability and accelerations), computed by a dedicated Oxford system for automated analysis--OxSys. In addition, OxSys was employed to simulate current clinical guidelines for the classification of fetal monitoring, i.e. providing in real time a three-tier grading system of the EFM (normal, indeterminate, or abnormal). The computerized features and the simulated guidelines corresponded well to the clinical management and to the actual labor outcome (measured by umbilical arterial pH).
Remanufacturing Aided Added-Value Creation, Innovations Meeting to Deliver Sustainable Manufacturing
Tariq Abullah, Ziyad; Guo, Shun Sheng; Yun, Sheng Bu
End-of-life scrap steel such as vehicles bulks and bodies, steel wheel and shells are easily land filled at the end-of-life when treated in a developing country with non-industrial infrastructure. Research idea is about composite shape steel remanufacturing to be sheet steel for construction application through nested recovered pieces of scrap steel within new sheet steel base to meet innovation value creation of remanufactured steel and innovation eco-design of steel products to close supply chain through linkage developed and developing countries of non-industrial infrastructure economy. That can be satisfied through comprehensive business- education-training model conduction firstly at the developing countries to reduce costs and change the intensive labour remanufacturing paradigm collaboratively. Sustainable remanufacturing business model can be applied based on infrastructure of educational institutions such as institutes of technology to adopt environmental, economic, and social developments as triple bottom line sustainability. Such innovation value creation is driven by eco-design and eco-innovation enabling where the meet to deliver human development, employment, and education conscious environment and bench mark recommendations of development directions for upgrading to apply business that allows eco-societies to emerge, through cooperative steel scrap processing.
Improved malignant melanoma prognosis at a consultant-delivered multidisciplinary pigmented lesion clinic in Cork.
LENUS (Irish Health Repository)
Field, S
Early detection and excision is the only effective treatment for malignant melanoma. To assess the effect of a consultant-delivered, rapid-access pigmented lesion clinic (PLC) established at the South Infirmary-Victoria University Hospital (SIVUH), we analyzed melanoma tumour-stage prior to (1998-2002) and after (2003-2007) the advent of the PLC. Patients attending SIVUH had a greater proportion of early-stage tumours (65.3%) compared to the rest of Cork (51.2%), County Cork as a whole (56.7%) and all of Ireland (57.4%). The proportion of SIVUH males with early-stage tumours was statistically significantly higher than the rest of County Cork (chi2 = 11.23, P < 0.05). The proportion of patients > 50y with early-stage tumours was also statistically significantly higher than the rest of County Cork (chi2 = 18.88, P < 0.05), the whole of County Cork (chi2 = 7.84, P < 0.05) and all of Ireland (chi2 = 9.67, P < 0.05). We believe that the early detection and improved prognosis of Cork melanoma patients is at least partly due to the PLC.
Improved malignant melanoma prognosis at a consultant-delivered multidisciplinary pigmented lesion clinic in Cork.
LENUS (Irish Health Repository)
Field, S
Early detection and excision is the only effective treatment for malignant melanoma. To assess the effect of a consultant-delivered, rapid-access pigmented lesion clinic (PLC) established at the South Infirmary-Victoria University Hospital (SIVUH), we analyzed melanoma tumour-stage prior to (1998-2002) and after (2003-2007) the advent of the PLC. Patients attending SIVUH had a greater proportion of early-stage tumours (65.3%) compared to the rest of Cork (51.2%), County Cork as a whole (56.7%) and all of Ireland (57.4%). The proportion of SIVUH males with early-stage tumours was statistically significantly higher than the rest of County Cork (chi2 = 11.23, P < 0.05). The proportion of patients > 50y with early-stage tumours was also statistically significantly higher than the rest of County Cork (chi2 = 18.88, P < 0.05), the whole of County Cork (chi2 = 7.84, P < 0.05) and all of Ireland (chi2 = 9.67, P < 0.05). We believe that the early detection and improved prognosis of Cork melanoma patients is at least partly due to the PLC.
What does it cost to deliver information using position-based beaconless forwarding protocols?
Bader, Ahmed
Beaconless position-based forwarding protocols have recently evolved as a promising solution for packet forwarding in wireless sensor networks. Quite a few variants of this class of forwarding protocols have been proposed over the years. One common observation is that they have all been evaluated from the perspective of a single node. Although useful, but a solid understanding of the end-to-end performance is still necessary. In this paper, we shed light on the end-to-end performance of beaconless position-based protocols along three distinct dimensions: energy, latency, and back-off probability. The latter is used as a direct indicator of the network\\'s transport capacity. Consequently, we are able to provide an elaborate response to the question: what does it really cost to deliver a packet in a wireless sensor network using position-based beaconless forwarding protocols? In responding to this question, we highlighted the different performance tradeoffs inherent to beaconless position-based protocols. Furthermore, some operational recommendations are also provided. © 2012 IEEE.
Three-Dimensional Super-resolution Imaging of Single Nanoparticles Delivered by Pipettes.
Yu, Yun; Sundaresan, Vignesh; Bandyopadhyay, Sabyasachi; Zhang, Yulun; Edwards, Martin A; McKelvey, Kim; White, Henry S; Willets, Katherine A
Controlled three-dimensional positioning of nanoparticles is achieved by delivering single fluorescent nanoparticles from a nanopipette and capturing them at well-defined regions of an electrified substrate. To control the position of single nanoparticles, the force of the pressure-driven flow from the pipette is balanced by the attractive electrostatic force at the substrate, providing a strategy by which nanoparticle trajectories can be manipulated in real time. To visualize nanoparticle motion, a resistive-pulse electrochemical setup is coupled with an optical microscope, and nanoparticle trajectories are tracked in three dimensions using super-resolution fluorescence imaging to obtain positional information with precision in the tens of nanometers. As the particles approach the substrate, the diffusion kinetics are analyzed and reveal either subdiffusive (hindered) or superdiffusive (directed) motion depending on the electric field at the substrate and the pressure-driven flow from the pipette. By balancing the effects of the forces exerted on the particle by the pressure and electric fields, controlled, real-time manipulation of single nanoparticle trajectories is achieved. The developed approach has implications for a variety of applications such as surface patterning and drug delivery using colloidal nanoparticles.
Delivering integrated HAZUS-MH flood loss analyses and flood inundation maps over the Web
Hearn,, Paul P.; Longenecker, Herbert E.; Aguinaldo, John J.; Rahav, Ami N.
Catastrophic flooding is responsible for more loss of life and damages to property than any other natural hazard. Recently developed flood inundation mapping technologies make it possible to view the extent and depth of flooding on the land surface over the Internet; however, by themselves these technologies are unable to provide estimates of losses to property and infrastructure. The Federal Emergency Management Agency's (FEMA's) HAZUS-MH software is extensively used to conduct flood loss analyses in the United States, providing a nationwide database of population and infrastructure at risk. Unfortunately, HAZUS-MH requires a dedicated Geographic Information System (GIS) workstation and a trained operator, and analyses are not adapted for convenient delivery over the Web. This article describes a cooperative effort by the US Geological Survey (USGS) and FEMA to make HAZUS-MH output GIS and Web compatible and to integrate these data with digital flood inundation maps in USGS's newly developed Inundation Mapping Web Portal. By running the computationally intensive HAZUS-MH flood analyses offline and converting the output to a Web-GIS compatible format, detailed estimates of flood losses can now be delivered to anyone with Internet access, thus dramatically increasing the availability of these forecasts to local emergency planners and first responders.
Artificial Virus Delivers CRISPR-Cas9 System for Genome Editing of Cells in Mice.
Li, Ling; Song, Linjiang; Liu, Xiaowei; Yang, Xi; Li, Xia; He, Tao; Wang, Ning; Yang, Suleixin; Yu, Chuan; Yin, Tao; Wen, Yanzhu; He, Zhiyao; Wei, Xiawei; Su, Weijun; Wu, Qinjie; Yao, Shaohua; Gong, Changyang; Wei, Yuquan
CRISPR-Cas9 has emerged as a versatile genome-editing platform. However, due to the large size of the commonly used CRISPR-Cas9 system, its effective delivery has been a challenge and limits its utility for basic research and therapeutic applications. Herein, a multifunctional nucleus-targeting "core-shell" artificial virus (RRPHC) was constructed for the delivery of CRISPR-Cas9 system. The artificial virus could efficiently load with the CRISPR-Cas9 system, accelerate the endosomal escape, and promote the penetration into the nucleus without additional nuclear-localization signal, thus enabling targeted gene disruption. Notably, the artificial virus is more efficient than SuperFect, Lipofectamine 2000, and Lipofectamine 3000. When loaded with a CRISPR-Cas9 plasmid, it induced higher targeted gene disruption efficacy than that of Lipofectamine 3000. Furthermore, the artificial virus effectively targets the ovarian cancer via dual-receptor-mediated endocytosis and had minimum side effects. When loaded with the Cas9-hMTH1 system targeting MTH1 gene, RRPHC showed effective disruption of MTH1 in vivo. This strategy could be adapted for delivering CRISPR-Cas9 plasmid or other functional nucleic acids in vivo.
Direct microneedle array fabrication off a photomask to deliver collagen through skin.
Kochhar, Jaspreet Singh; Anbalagan, Parthiban; Shelar, Sandeep Balu; Neo, Jun Kai; Iliescu, Ciprian; Kang, Lifeng
To fabricate microneedle arrays directly off a photomask using a simple photolithographical approach and evaluate their potential for delivering collagen. A simple photolithographical approach was developed by using photomask consisting of embedded micro-lenses that govern microneedle geometry in a mould free process. Microneedle length was controlled by use of simple glass scaffolds as well as addition of backing layer. The fabricated arrays were tested for their mechanical properties by using a force gauge as well as insertion into human skin with trypan blue staining. Microneedle arrays were then evaluated for the delivery of fluorescent collagen, which was evaluated using a confocal laser scanning microscope. Microneedles with sharp tips ranging between 41.5 ± 8.4 μm and 71.6 ± 13.7 μm as well as of two different lengths of 1336 ± 193 μm and 957 ± 171 μm were fabricated by using the photomasks. The microneedles were robust and resisted fracture forces up to 25 N. They were also shown to penetrate cadaver human skin samples with ease; especially microneedle arrays with shorter length of 957 μm penetrated up to 72% of needles. The needles were shown to enhance permeation of collagen through cadaver rat skin, as compared to passive diffusion of collagen. A simple and mould free approach of fabricating polymeric microneedle array is proposed. The fabricated microneedle arrays enhance collagen permeation through skin.
Electrocardiographic evaluation of defibrillation shocks delivered to out-of-hospital sudden cardiac arrest patients.
Gliner, B E; White, R D
Following out-of-hospital defibrillation attempts, electrocardiographic instability challenges accurate assessment of defibrillation efficacy and post-shock rhythm. Presently, there is no precise definition of defibrillation efficacy in the out-of-hospital setting that is consistently used. The objective of this study was to characterize out-of-hospital cardiac arrest rhythms following low-energy biphasic and high-energy monophasic shocks in order to precisely define defibrillation efficacy and establish uniform criteria for the evaluation of shock performance. Automatic external defibrillators (AEDs) delivering 150 J impedance-compensating biphasic or 200-360 J monophasic damped sine waveform shocks were observed in a combined police and paramedic program. ECGs from 29 biphasic patients and 87 monophasic patients were classified as organized, asystole or VF at post-shock times of 3, 5, 10, 20 and 60 s. Post-shock time (Pcardiac disease. Defibrillation should uniformly be defined as termination of VF for a minimum of 5-s after shock delivery. Rhythms should be reported at 5-s after shock delivery to assess early effects of the defibrillation shock and at 60-s after shock delivery to assess the interaction of the defibrillation therapy and factors such as post-shock myocardial dysfunction and the patient's underlying cardiac disease.
Pull vs. Push: How OmniEarth Delivers Better Earth Observation Information to Subscribers
Fish, C.; Slagowski, S.; Dyrud, L.; Fentzke, J.; Hargis, B.; Steerman, M.
Until very recently, the commercialization of Earth observation systems has largely occurred in two ways: either through the detuning of government satellites or the repurposing of NASA (or other science) data for commercial use. However, the convergence of cloud computing and low-cost satellites is enabling Earth observation companies to tailor observation data to specific markets. Now, underserved constituencies, such as agriculture and energy, can tap into Earth observation data that is provided at a cadence, resolution and cost that can have a real impact to their bottom line. To connect with these markets, OmniEarth fuses data from a variety of sources, synthesizes it into useful and valuable business information, and delivers it to customers via web or mobile interfaces. The "secret sauce" is no longer about having the highest resolution imagery, but rather it is about using that imagery - in conjunction with a number of other sources - to solve complex problems that require timely and contextual information about our dynamic and changing planet. OmniEarth improves subscribers' ability to visualize the world around them by enhancing their ability to see, analyze, and react to change in real time through a solutions-as-a-service platform.
A New Approach for Delivering Customized Security Everywhere: Security Service Chain
Directory of Open Access Journals (Sweden)
Yi Liu
Full Text Available Security functions are usually deployed on proprietary hardware, which makes the delivery of security service inflexible and of high cost. Emerging technologies such as software-defined networking and network function virtualization go in the direction of executing functions as software components in virtual machines or containers provisioned in standard hardware resources. They enable network to provide customized security service by deploying Security Service Chain (SSC, which refers to steering flow through multiple security functions in a particular order specified by individual user or application. However, SSC Deployment Problem (SSC-DP needs to be solved. It is a challenging problem for various reasons, such as the heterogeneity of instances in terms of service capacity and resource demand. In this paper, we propose an SSC-based approach to deliver security service to users without worrying about physical locations of security functions. For SSC-DP, we present a three-phase method to solve it while optimizing network and security resource allocation. The presented method allows network to serve a large number of flows and minimizes the latency seen by flows. Comparative experiments on the fat-tree and Waxman topologies show that our method performs better than other heuristics under a wide range of network conditions.
Trichomonas vaginalis Exosomes Deliver Cargo to Host Cells and Mediate Host∶Parasite Interactions
Twu, Olivia; Lustig, Gila; Stevens, Grant C.; Vashisht, Ajay A.; Wohlschlegel, James A.
Trichomonas vaginalis is a common sexually transmitted parasite that colonizes the human urogential tract where it remains extracellular and adheres to epithelial cells. Infections range from asymptomatic to highly inflammatory, depending on the host and the parasite strain. Here, we use a combination of methodologies including cell fractionation, immunofluorescence and electron microscopy, RNA, proteomic and cytokine analyses and cell adherence assays to examine pathogenic properties of T. vaginalis. We have found that T.vaginalis produces and secretes microvesicles with physical and biochemical properties similar to mammalian exosomes. The parasite-derived exosomes are characterized by the presence of RNA and core, conserved exosomal proteins as well as parasite-specific proteins. We demonstrate that T. vaginalis exosomes fuse with and deliver their contents to host cells and modulate host cell immune responses. Moreover, exosomes from highly adherent parasite strains increase the adherence of poorly adherent parasites to vaginal and prostate epithelial cells. In contrast, exosomes from poorly adherent strains had no measurable effect on parasite adherence. Exosomes from parasite strains that preferentially bind prostate cells increased binding of parasites to these cells relative to vaginal cells. In addition to establishing that parasite exosomes act to modulate host∶parasite interactions, these studies are the first to reveal a potential role for exosomes in promoting parasite∶parasite communication and host cell colonization. PMID:23853596
Hydrogel-delivered brain-derived neurotrophic factor promotes tissue repair and recovery after stroke.
Cook, Douglas J; Nguyen, Cynthia; Chun, Hyun N; L Llorente, Irene; Chiu, Abraham S; Machnicki, Michal; Zarembinski, Thomas I; Carmichael, S Thomas
Stroke is the leading cause of adult disability. Systemic delivery of candidate neural repair therapies is limited by the blood-brain barrier and off-target effects. We tested a bioengineering approach for local depot release of BDNF from the infarct cavity for neural repair in chronic periods after stroke. The brain release levels of a hyaluronic acid hydrogel + BDNF were tested in several stroke models in mouse (strains C57Bl/6, DBA) and non-human primate ( Macaca fascicularis) and tracked with MRI. The behavioral recovery effects of hydrogel + BDNF and the effects on tissue repair outcomes were determined. Hydrogel-delivered BDNF diffuses from the stroke cavity into peri-infarct tissue over 3 weeks in two mouse stroke models, compared with 1 week for direct BDNF injection. Hydrogel delivery of BDNF promotes recovery of motor function. Mapping of motor system connections indicates that hydrogel-BDNF induces axonal sprouting within existing cortical and cortico-striatal systems. Pharmacogenetic studies show that hydrogel-BDNF induces the initial migration of immature neurons into the peri-infarct cortex and their long-term survival. In chronic stroke in the non-human primate, hydrogel-released BDNF can be detected up to 2 cm from the infarct, a distance relevant to human functional recovery in stroke. The hydrogel can be tracked by MRI in mouse and primate.
Evaluation of a Pilot Nutrition Education Program Delivered by Hmong Community Health Workers (CHWs
Directory of Open Access Journals (Sweden)
Jeanette Treiber
Full Text Available Many members of the Hmong population in the United States suffer from comparatively bad health. Moreover, disease prevention messaging that has traditionally been used through various media and healthcare outlets is not as successful with the Hmong as with the general population, due in part to cultural barriers. This paper explores whether community health workers (CHWs may be a potentially successful way to deliver lessons in disease prevention, especially messages on healthy eating, drinking, and exercising. In addition, it explores the potential impact of a CHW program on participation in the Supplemental Nutrition Assistance Program (SNAP. Following a literature review, a pilot project that used CHWs in the Hmong Community of Sacramento, California is described. It used KAP (Knowledge, Attitude, Practice measures in a pre-post test. Statistically significant improvement was achieved in knowledge and attitude, and practice, but not in SNAP participation. The program and CHWs were well received as measured by a satisfaction survey of the 131 participants. Overall the pilot project proved to be successful.
Better Strength, Better Balance! Partnering to deliver a fall prevention program for older adults.
Taing, Darcie; McKay, Kelly
Falls incur significant health and economic costs, particularly among older adults. Physical activity has been found to be the single most important fall prevention behaviour an older adult can do. This manuscript describes Ottawa Public Health's (OPH) experience implementing the Better Strength, Better Balance! (BSBB) program, a fall prevention exercise program for older adults, through an innovative partnership with the local Recreation, Cultural & Facility Services (RCFS) Department. BSBB aims to reach 1300 community-dwelling adults (aged 65 years and older) per year through approximately 86-130 exercise programs. Designed as a universal program, BSBB addresses participation barriers such as transportation, cost and location. BSBB was enabled with funding from the Champlain Local Health Integration Network, and coincided with the implementation of an Older Adult Plan for the City of Ottawa. BSBB is a beginner-level, fall prevention exercise and education program that takes place twice a week, over 12 weeks. Certified RCFS instructors delivered the exercise components of the program and OPH staff incorporated fall prevention messaging and conducted the evaluation. The formative evaluation indicated that participants experienced improved strength and balance, decreased fear of falling and the intent to adopt new fall prevention behaviours following the program. The partnership between OPH and RCFS allowed both partners to leverage their unique and mutual strengths to continually improve the program. Improving access to strength and balance programming is an important public health strategy to reduce falls. The recreation sector is an ideal partner to help public health in this pursuit.
Uptake Pathways of Guandinylated Disulfide Containing Polymers as Nonviral Gene Carrier Delivering DNA to Cells.
Zhang, Jinmin; Yu, Jiankun; Jiang, Jingzheng; Chen, Xiao; Sun, Yanping; Yang, Zhen; Yang, Tianzhi; Cai, Cuifang; Zhao, Xiaoyun; Ding, Pingtian
Polymers of guanidinylated disulfide containing poly(amido amine)s (Gua-SS-PAAs), have shown high transfection efficiency and low cytotoxicity. Previously, we synthesized two Gua-SS-PAA polymers, using guanidino containing monomers (i.e., arginine and agmatine, denoted as ARG and AGM, respectively) and N,N'-cystaminebisacrylamide (CBA). In this study, these two polymers, AGM-CBA and ARG-CBA were complexed with plasmid DNA, and their uptake pathway was investigated. Complexes distribution in MCF-7 cells, and changes on cell endosomes/lysosomes and membrane after the cells were exposed to complexes were tested. In addition, how the transfection efficiency changed with the cell cycle status as well as endocytosis inhibitors were studied. The polymers of AGM-CBA and ARG-CBA can avoid endosomal/lysosomal trap, therefore, greatly delivering plasmid DNA (pDNA) to the cell nucleoli. It is the guanidine groups in the polymers that enhanced complexes' permeation through cell membrane with slight membrane damage, and targeting to the nucleoli. J. Cell. Biochem. 118: 903-913, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.
Adapting the helpful responses questionnaire to assess communication skills involved in delivering contingency management: preliminary psychometrics.
Hartzler, Bryan
A paper/pencil instrument, adapted from Miller and colleagues' (1991) Helpful Responses Questionnaire (HRQ), was developed to assess clinician skill with core communicative aspects involved in delivering contingency management (CM). The instrument presents a single vignette consisting of six points of client dialogue to which respondents write 'what they would say next.' In the context of an implementation/effectiveness hybrid trial, 19 staff clinicians at an opiate treatment program completed serial training outcome assessments before, following, and three months after CM training. Assessments included this adaptation of the HRQ, a multiple-choice CM knowledge test, and a recorded standardized patient encounter scored for CM skillfulness. Study results reveal promising psychometric properties for the instrument, including strong scoring reliability, internal consistency, concurrent and predictive validity, test-retest reliability and sensitivity to training effects. These preliminary findings suggest the instrument is a viable, practical method to assess clinician skill in communicative aspects of CM delivery. Copyright © 2015 Elsevier Inc. All rights reserved.
Development of figurative language skills following central nervous system-directed chemotherapy delivered in early childhood.
Dowling, Emma K; Lewis, Fiona M; Murdoch, Bruce E
Central nervous system (CNS)-directed chemotherapy is delivered for the treatment of childhood acute lymphoblastic leukaemia (ALL). Figurative language deficits have been described in children following CNS-directed chemotherapy; however, comprehensive analysis of figurative interpretation errors, potentially providing clinical utility to assist with intervention planning, has never been performed. The present study aimed to compare the figurative language skills of seven children treated with CNS-directed chemotherapy for ALL before the age of 6 years (mean age at diagnosis 3 years 10 months) and a matched control group of children, using the Test of Language Competence-Expanded Edition (TLC-E) Figurative Language sub-test. It was hypothesised that the children treated with CNS-directed chemotherapy would demonstrate a decreased performance in and an alternative method of interpreting figurative language. The results suggest no negative effects of CNS-directed chemotherapy on figurative language. There were no statistically significant differences between groups for TLC-E Figurative Language sub-test composite scores and picture component errors, nor were there clinically significant differences observed from descriptive comparisons of individual case data and error analysis. As these skills continue to emerge beyond childhood, the need to monitor skill development in ALL survivors beyond childhood is highlighted.
Ethical Considerations When Delivering Behavior Analytic Services for Problem Behavior via Telehealth.
Romani, Patrick W; Schieltz, Kelly M
Delivery of healthcare services via telehealth has been growing in popularity, and work completed by behavior analytic researchers and practitioners have supported this trend. Behavior analysts at the University of Iowa Children's Hospital (UICH) developed a telehealth model of service delivery to build upon their already established in-clinic and in-home services. Results from their telehealth studies showed positive effects. Social functions were identified for most children, and problem behavior decreased by an average of 94.14%. Additionally, parent satisfaction was quite high, suggesting this mode of service delivery was acceptable to caregivers. Given the increasing empirical support for providing behavior analytic services via telehealth, careful consideration needs to be given to the numerous ethical issues involved in telehealth service delivery. The current article describes the telehealth service delivery model developed at UICH as well as the ethical issues considered at different points when delivering these telehealth services. Following these ethical considerations, implications for future research and clinical practice are discussed.
A cyber-physical management system for delivering and monitoring surgical instruments in the OR.
Li, Yu-Ting; Jacob, Mithun; Akingba, George; Wachs, Juan P
The standard practice in the operating room (OR) is having a surgical technician deliver surgical instruments to the surgeon quickly and inexpensively, as required. This human "in the loop" system may result in mistakes (eg, missing information, ambiguity of instructions, and delays). Errors can be reduced or eliminated by integrating information technology (IT) and cybernetics into the OR. Gesture and voice automatic acquisition, processing, and interpretation allow interaction with these new systems without disturbing the normal flow of surgery. This article describes the development of a cyber-physical management system (CPS), including a robotic scrub nurse, to support surgeons by passing surgical instruments during surgery as required and recording counts of surgical instruments into a personal health record (PHR). The robot used responds to hand signals and voice messages detected through sophisticated computer vision and data mining techniques. The CPS was tested during a mock surgery in the OR. The in situ experiment showed that the robot recognized hand gestures reliably (with an accuracy of 97%), it can retrieve instruments as close as 25 mm, and the total delivery time was less than 3 s on average. This online health tool allows the exchange of clinical and surgical information to electronic medical record-based and PHR-based applications among different hospitals, regardless of the style viewer. The CPS has the potential to be adopted in the OR to handle surgical instruments and track them in a safe and accurate manner, releasing the human scrub tech from these tasks.
Newborns' cord blood plasma cotinine concentrations are similar to that of their delivering smoking mothers.
Berlin, Ivan; Heilbronner, Claire; Georgieu, Sabine; Meier, Cathy; Spreux-Varoquaux, Odile
In utero exposure to constituents of tobacco smoke has perinatal and postnatal health consequences. Umbilical cord plasma cotinine levels have been shown to correlate with self-reported daily number of cigarettes at the end of pregnancy, but the exact relationship between maternal and newborn plasma cotinine (and nicotine) is unknown. Concentrations of cotinine, nicotine's main metabolite, were determined in venous blood of delivering mothers and in arterial umbilical cord blood of their newborns at birth. Data from eighteen mother-newborn dyads were analyzed. The mothers smoked 95.1 (SD=96, range 10-420) cigarettes the week preceding delivery. Their mean plasma cotinine concentration at delivery was 106 ng/mL (SD=53, range 17-245) and the newborns' mean umbilical cord plasma cotinine was 88.2 ng/mL (SD=53, range 10-198, pcord blood. Arterial umbilical cord blood plasma cotinine was highly associated with that of the smoking mothers: y=0.79x+0.97, Rsq=0.95, pplasma cotinine concentrations are strongly associated. There is probably no placental barrier for plasma cotinine between pregnant mothers and their newborns. Lack of a placental barrier for cotinine (and probably nicotine) can partially explain smoking related perinatal disorders. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.
Trichomonas vaginalis exosomes deliver cargo to host cells and mediate host∶parasite interactions.
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Olivia Twu
Full Text Available Trichomonas vaginalis is a common sexually transmitted parasite that colonizes the human urogential tract where it remains extracellular and adheres to epithelial cells. Infections range from asymptomatic to highly inflammatory, depending on the host and the parasite strain. Here, we use a combination of methodologies including cell fractionation, immunofluorescence and electron microscopy, RNA, proteomic and cytokine analyses and cell adherence assays to examine pathogenic properties of T. vaginalis. We have found that T.vaginalis produces and secretes microvesicles with physical and biochemical properties similar to mammalian exosomes. The parasite-derived exosomes are characterized by the presence of RNA and core, conserved exosomal proteins as well as parasite-specific proteins. We demonstrate that T. vaginalis exosomes fuse with and deliver their contents to host cells and modulate host cell immune responses. Moreover, exosomes from highly adherent parasite strains increase the adherence of poorly adherent parasites to vaginal and prostate epithelial cells. In contrast, exosomes from poorly adherent strains had no measurable effect on parasite adherence. Exosomes from parasite strains that preferentially bind prostate cells increased binding of parasites to these cells relative to vaginal cells. In addition to establishing that parasite exosomes act to modulate host∶parasite interactions, these studies are the first to reveal a potential role for exosomes in promoting parasite∶parasite communication and host cell colonization.
Comparison of two training programmes on paramedic-delivered CPR performance.
Govender, Kevin; Sliwa, Karen; Wallis, Lee; Pillay, Yugan
To compare CPR performance in two groups of paramedics who received CPR training from two different CPR training programmes. Conducted in June 2014 at the Hamad Medical Corporation Ambulance Service, the national ambulance service of the State of Qatar, the CPR performances of 149 new paramedic recruits were evaluated after they had received training from either a traditional CPR programme or a tailored CPR programme. Both programmes taught the same content but differed in the way in which this content was delivered to learners. Exclusive to the tailored programme was mandatory precourse work, continuous assessments, a locally developed CPR instructional video and pedagogical activities tailored to the background education and learner style preferences of paramedics. At the end of each respective training programme, a single examiner who was blinded to the type of training paramedics had received, rated them as competent or non-competent on basic life support skills, condition specific skills, specific overall skills and non-technical skills during a simulated out-of-hospital cardiac arrest (OHCA) assessment. Paramedics who received CPR training with the tailored programme were rated competent 70.9% of the time, compared with paramedics who attended the traditional programme and who achieved this rating 7.9% of the time (pservices/rights-and-licensing/
Lowering the concentration affects the migration and viability of intracerebroventricular-delivered human mesenchymal stem cells.
Kim, Hyeong Seop; Lee, Na Kyung; Yoo, Dongkyeom; Lee, Jeongmin; Choi, Soo Jin; Oh, Wonil; Chang, Jong Wook; Na, Duk L
Due to their widely known therapeutic benefits, mesenchymal stem cells have been proposed as a novel treatment option for a wide range of diseases including Alzheimer's disease. To maximize these benefits, critical factors such as delivery route, cell viability, and cell migration must be accounted for. Out of the various delivery routes to the brain, the intracerebroventricular (ICV) route stands out due to the widespread distribution that can occur via cerebrospinal fluid flow. The major objective of this present study was to observe how altering cell concentration influences the migration and viability of human umbilical cord blood derived-mesenchymal stem cells (hUCB-MSCs), delivered via ICV injection, in the brains of wild-type (WT) mice. C3H/C57 WT mice were divided into three groups and were injected with 1 × 10(5) hUCB-MSCs suspended in varying volumes: high (3 μl), middle (5 μl), and low (7 μl) concentrations, respectively. Lowering the concentration increased the migratory capabilities and elevated the viability of hUCB-MSCs. These results suggest that cell concentration can affect the physiological state of hUCB-MSCs, and thus the extent of therapeutic efficacy that can be achieved. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.
Delivering a very low birth weight infant and the subsequent risk of divorce or separation.
Swaminathan, Shailender; Alexander, Greg R; Boulet, Sheree
The simultaneous rise over the last two decades in the U.S. in the proportion of VLBW (divorce or separation. The purpose of this paper is to identify the relationship of having a VLBW birth with the probability of divorce or separation in the first two years following delivery. We use data from the 1988 National Maternal and Infant Health Survey (NMIHS). This national stratified, systematic "follow-back" survey augments information from birth records in 1988 by obtaining information on social, demographic, and economic variables from women that delivered a baby in 1988. We estimate a proportional discrete time hazard model of transitions to divorce/separation. Parents of a VLBW infant have 2-fold higher odds of divorce/separation compared with parents of a child with a birth weight greater than 1500 grams. Two years after delivery of a non-VLBW baby 95 percent of the marriages remain stable, while about 90 percent of the marriages remain stable following the birth of a VLBW baby. If the pregnancy was not desired, then only 85 percent of the marriages remain stable 2 years following the delivery of a VLBW infant. There is an evident need to counsel and support families with VLBW infants on mechanisms to cope with the initial stressors that can be anticipated to arise.
A mobile app for delivering in-field soil data for precision agriculture
Isaacs, John P.; Stojanovic, Vladeta; Falconer, Ruth E.
In the last decade precision agriculture has grown from a concept to an emerging technology, largely due to the maturing of GPS and mobile mapping. We investigated methods for reliable delivery and display of appropriate and context aware in-field farm data on mobile devices by developing a prototype android mobile app. The 3D app was developed using OpenGL ES 2.0 and written in Java, using the Android Development Tools (ADT) SDK. The app is able to obtain GPS coordinates and automatically synchronise the view and load relevant data based on the user's location. The intended audience of the mobile app is farmers and agronomists. Apps are becoming an essential tool in an agricultural professional's arsenal however most existing apps are limited to 2D display of data even though the modern chips in mobile devices can support the display of 3D graphics at interactive rates using technologies such as webGL. This project investigated the use of games techniques in the delivery and 3D display of field data, recognising that this may be a departure from the way the field data is currently delivered and displayed to farmers and agronomists. Different interactive 3D visualisation methods presenting spatial and temporal variation in yield values were developed and tested. It is expected that this app can be used by farmers and agronomists to support decision making in the field of precision agriculture and this is a growing market in UK and Europe.
HSV-1 Glycoproteins Are Delivered to Virus Assembly Sites Through Dynamin-Dependent Endocytosis.
Albecka, Anna; Laine, Romain F; Janssen, Anne F J; Kaminski, Clemens F; Crump, Colin M
Herpes simplex virus-1 (HSV-1) is a large enveloped DNA virus that belongs to the family of Herpesviridae. It has been recently shown that the cytoplasmic membranes that wrap the newly assembled capsids are endocytic compartments derived from the plasma membrane. Here, we show that dynamin-dependent endocytosis plays a major role in this process. Dominant-negative dynamin and clathrin adaptor AP180 significantly decrease virus production. Moreover, inhibitors targeting dynamin and clathrin lead to a decreased transport of glycoproteins to cytoplasmic capsids, confirming that glycoproteins are delivered to assembly sites via endocytosis. We also show that certain combinations of glycoproteins colocalize with each other and with the components of clathrin-dependent and -independent endocytosis pathways. Importantly, we demonstrate that the uptake of neutralizing antibodies that bind to glycoproteins when they become exposed on the cell surface during virus particle assembly leads to the production of non-infectious HSV-1. Our results demonstrate that transport of viral glycoproteins to the plasma membrane prior to endocytosis is the major route by which these proteins are localized to the cytoplasmic virus assembly compartments. This highlights the importance of endocytosis as a major protein-sorting event during HSV-1 envelopment. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Evaluation of YadC protein delivered by live attenuated Salmonella as a vaccine against plague.
Sun, Wei; Olinzock, Joseph; Wang, Shifeng; Sanapala, Shilpa; Curtiss, Roy
Yersinia pestis YadB and YadC are two new outer membrane proteins related to its pathogenicity. Here, codon-optimized yadC, yadC810 (aa 32-551), or yadBC antigen genes delivered by live attenuated Salmonella strains are evaluated in mice for induction of protective immune responses against Y. pestis CO92 through subcutaneous or intranasal challenge. Our findings indicate that mice immunized with Salmonella synthesizing YadC, YadC810, or YadBC develop significant serum IgG responses to purified recombinant YadC protein. For subcutaneous challenge (approximately 230 LD50 of Y. pestis CO92), mice immunized with Salmonella synthesizing YadC or YadC810 are afforded 50% protection, but no protection by immunization with the Salmonella strain synthesizing YadBC. None of these antigens provided protection against intranasal challenge (approximately 31 LD50 of Y. pestis CO92). In addition, subcutaneous immunization with purified YadC810 protein emulsified with alum adjuvant does not elicit a protective response against Y. pestis administered by either challenge route. © 2013 Federation of European Microbiological Societies. Published by John Wiley & Sons Ltd. All rights reserved.
Delivering organisational adaptation through legislative mechanisms: Evidence from the Adaptation Reporting Power (Climate Change Act 2008).
Jude, S R; Drew, G H; Pollard, S J T; Rocks, S A; Jenkinson, K; Lamb, R
There is increasing recognition that organisations, particularly in key infrastructure sectors, are potentially vulnerable to climate change and extreme weather events, and require organisational responses to ensure they are resilient and adaptive. However, detailed evidence of how adaptation is facilitated, implemented and reported, particularly through legislative mechanisms is lacking. The United Kingdom Climate Change Act (2008), introduced the Adaptation Reporting Power, enabling the Government to direct so-called reporting authorities to report their climate change risks and adaptation plans. We describe the authors' unique role and experience supporting the Department for Environment, Food and Rural Affairs (Defra) during the Adaptation Reporting Power's first round. An evaluation framework, used to review the adaptation reports, is presented alongside evidence on how the process provides new insights into adaptation activities and triggered organisational change in 78% of reporting authorities, including the embedding of climate risk and adaptation issues. The role of legislative mechanisms and risk-based approaches in driving and delivering adaptation is discussed alongside future research needs, including the development of organisational maturity models to determine resilient and well adapting organisations. The Adaptation Reporting Power process provides a basis for similar initiatives in other countries, although a clear engagement strategy to ensure buy-in to the process and research on its long-term legacy, including the potential merits of voluntary approaches, is required. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.
Challenges in Delivering Green Building Projects: Unearthing the Transaction Costs (TCs
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Queena K. Qian
Full Text Available Delivering green building (GB projects involve some activities that are atypical in comparison with conventional buildings. Such new activities are characterized by uncertainty, and they incur hidden costs that have not been expected nor are they readily appreciated among the stakeholders. This paper develops a typology and chronology to examine the new activities that are associated with transaction costs (TCs in the real estate development process (REDP of green building. Through in-depth interviews with representatives from the major developers in Hong Kong who have experiences in GB practice, this study aims to unearth TCs involved at the critical stages of the REDP. Apart from reconfirming the early project planning stage as the most critical in the consideration of TCs, the study results also identified "extra legal liability risk of the GB product" as the major concern for any GB developer in Hong Kong. The key additional activities that bring significant TCs in developing GB are identified and compared to their traditional counterparts. In turn, project managers not only have to pursue overall cost management whilst winning more business, but they also have to pay particular attention to sustainability in order to minimize hidden societal costs. The study also provides a reference for governments and professionals that will aid in forming policy as well as advance the practice of the GB market by optimizing the societal costs.
Delivering and using 3D models on the web: are we ready?
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Roberto Scopigno
Full Text Available Digital technologies are now mature for producing high quality digital replicas of Cultural Heritage (CH assets. The research results produced in the last decade ignited an impressive evolution and consolidation of the technologies for acquiring high-quality digital three-dimensional (3D models, encompassing both geometry and color. What remains still an open problem is how to deliver those data and related knowledge to our society. The web is nowadays the main channel for the dissemination of knowledge. Emerging commercial solutions for web-publishing of 3D data are consolidating and becoming a de-facto standard for many applications (e-commerce, industrial products, education, etc.. In this framework, CH is a very specific domain, requiring highly flexible solutions. Some recent experiences are presented, aimed at providing a support to the archival of archaeological 3D data, supporting web-based publishing of very high-resolution digitization results and finally enabling the documentation of complex restoration actions. All those examples have been recently implemented on the open-source 3D Heritage Online Presenter (3DHOP platform, developed at CNR-ISTI.
Feasibility and effect of in-home physical exercise training delivered via telehealth before bariatric surgery.
Baillot, Aurélie; Boissy, Patrick; Tousignant, Michel; Langlois, Marie-France
Optimal physical activity (PA) interventions are needed to increase PA in individuals with severe obesity, and optimize the results of bariatric surgery (BS). The aim of this study was to assess the feasibility and effect of Pre-Surgical Exercise Training (PreSET) delivered in-home via telehealth (TelePreSET) in subjects awaiting BS. Six women following the TelePreSET were compared to the women from a previous study (12 performing the PreSET in a gymnasium and 11 receiving usual care). In-home TelePreSET (12-weeks of endurance and strength training) was supervised twice weekly using videoconferencing. Physical fitness, quality of life, exercise beliefs, anthropometric measures and telehealth perception were assessed before and after 12-weeks. Satisfaction was evaluated with questionnaires at the end of the intervention. The TelePreSET participants attended 96% of the exercise sessions, and were very satisfied by the TelePreSET. The baseline telehealth perception score was high, and increased significantly after the intervention. The TelePreSET group significantly increased their physical fitness compared to the usual care group. No significant change was noted in other outcomes. The TelePreSET is feasible and seems effective to improve the physical fitness of women awaiting BS. Further studies are needed to confirm beneficial effects of this innovative mode of delivery.
Enter the Matrix: Building Creative Industry through Delivering Insights in Comics
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Hafiz Ahmad Aziz
Full Text Available Comic is a media which delivers its content through visual sequence. This media has negative preference in Indonesia's community because viewed as mild entertainment for children. Yet in modern society, comics observed and researched as one of media which could penetrate deep within its reader's mind. In re-create cultural insight through comic, the content must encrypt into visual and sequential mode which form a matrix of insight. This matrix will encompasses the effective transformation of cultural content in comic and also other visual media through media linkage strategy. The media linkage strategy is to surround the children's access of information and visual entertainment in order to build certain knowledge and understanding. It's a system that crystallized from global marketing practices of visual media industry over decades. This paper urges to highlight the visual communication design study in creating a matrix of cultural insight in translating cultures of Archipelago and media linkage strategy in order to strengthen cultural understanding among children.
Delivering key signals to the machine: seeking the electric signal that muscles emanate
Bani Hashim, A. Y.; Maslan, M. N.; Izamshah, R.; Mohamad, I. S.
Due to the limitation of electric power generation in the human body, present human-machine interfaces have not been successful because of the nature of standard electronics circuit designs, which do not consider the specifications of signals that resulted from the skin. In general, the outcomes and applications of human-machine interfaces are limited to custom-designed subsystems, such as neuroprosthesis. We seek to model the bio dynamical of sub skin into equivalent mathematical definitions, descriptions, and theorems. Within the human skin, there are networks of nerves that permit the skin to function as a multi dimension transducer. We investigate the nature of structural skin. Apart from multiple networks of nerves, there are other segments within the skin such as minute muscles. We identify the segments that are active when there is an electromyography activity. When the nervous system is firing signals, the muscle is being stimulated. We evaluate the phenomena of biodynamic of the muscles that is concerned with the electromyography activity of the nervous system. In effect, we design a relationship between the human somatosensory and synthetic systems sensory as the union of a complete set of the new domain of the functional system. This classifies electromyogram waveforms linked to intent thought of an operator. The system will become the basis for delivering key signals to machine such that the machine is under operator's intent, hence slavery.
Behavioral economics holds potential to deliver better results for patients, insurers, and employers.
Loewenstein, George; Asch, David A; Volpp, Kevin G
Many programs being implemented by US employers, insurers, and health care providers use incentives to encourage patients to take better care of themselves. We critically review a range of these efforts and show that many programs, although well-meaning, are unlikely to have much impact because they require information, expertise, and self-control that few patients possess. As a result, benefits are likely to accrue disproportionately to patients who already are taking adequate care of their health. We show how these programs could be made more effective through the use of insights from behavioral economics. For example, incentive programs that offer patients small and frequent payments for behavior that would benefit the patients, such as medication adherence, can be more effective than programs with incentives that are far less visible because they are folded into a paycheck or used to reduce a monthly premium. Deploying more-nuanced insights from behavioral economics can lead to policies with the potential to increase patient engagement and deliver dividends for patients and favorable cost-effectiveness ratios for insurers, employers, and other relevant commercial entities.
Application of laser pulse stretching scheme for efficiently delivering laser energy in photoacoustic imaging
Wang, Tianheng; Kumavor, Patrick D.; Zhu, Quing
High-energy and short-duration laser pulses are desirable to improve the photoacoustic image quality when imaging deeply seated lesions. In many clinical applications, the high-energy pulses are coupled to tissue using optical fibers. These pulses can damage fibers if the damage threshold is exceeded. While keeping the total energy under the Food and Drug Administration limit for avoiding tissue damage, it is necessary to reduce the peak intensity and increase the pulse duration for minimizing fiber damage and delivering sufficient light for imaging. We use laser-pulse-stretching to address this problem. An initial 17-ns pulse was stretched to 27 and 37 ns by a ring-cavity laser-pulse-stretching system. The peak power of the 37-ns stretched pulse reduced to 42% of the original, while the fiber damage threshold was increased by 1.5-fold. Three ultrasound transducers centered at 1.3-, 3.5-, and 6-MHz frequencies were simulated, and the results showed that the photoacoustic signal of a 0.5-mm-diameter target obtained with 37-ns pulse was about 98, 91, and 80%, respectively, using the same energy as the 17-ns pulse. Simulations were validated using a broadband hydrophone. Quantitative comparisons of photoacoustic images obtained with three corresponding transducers showed that the image quality was not affected by stretching the pulse.