Widespread Adoption (widespread + adoption)

Distribution by Scientific Domains

Selected Abstracts

Near patient testing for glycated haemoglobin in people with Type 2 diabetes mellitus managed in primary care: acceptability and satisfaction

M. A. Stone
Abstract Aims To assess the acceptability of and satisfaction with near patient testing for glycated haemoglobin in primary care in patients and health professionals. Methods A questionnaire survey and qualitative study were nested within a randomized controlled trial conducted in eight general practices in Leicester-shire, UK. Satisfaction with diabetes care was compared in the intervention group (near patient test) and in the control subjects (usual laboratory test), using the Diabetes Clinic Satisfaction Questionnaire. Semistructured interviews were conducted with a purposive sample of patients and healthcare professionals and analysed using thematic coding and framework charting. Results Questionnaire data for 344 patients were analysed and interviews were conducted with 15 patients and 11 health professionals. Interviews indicated that the near patient test was highly acceptable to patients and staff and confirmed that there may be potential benefits such as time saving, reduced anxiety and impact on patient management and job satisfaction. However, both the survey and the interviews identified high pre-existing levels of satisfaction with diabetes care in both intervention and control group patients and survey results failed to confirm increased patient satisfaction as a result of rapid testing. Limited patient understanding of glycated haemoglobin testing was noted. Conclusions We were unable to confirm actual rather than potential advantages of the near patient test. Widespread adoption in primary care cannot be recommended without further evidence of benefit. [source]

Acceptance of Rapid HIV Screening in a Southeastern Emergency Department

Arin E. Freeman MPH
Abstract Objectives:, The objective was to assess the acceptance of an emergency department (ED) human immunodeficiency virus (HIV) screening program based on the Centers for Disease Control and Prevention (CDC) recommendations for routine HIV screening in health care settings. Methods:, Rapid HIV screening was offered on an opt-out basis to patients aged 13 to 64 years presenting to the ED by trained HIV counselors. Patients were excluded if they had a history of HIV, were physically or mentally incapacitated, did not understand their right to opt-out, or did not speak English or Spanish. Statistical analyses, including logistic regression, were performed to assess the associations between the demographics of patients offered testing and their test acceptance or refusal. Results:, From March 2008 to January 2009, a total of 5,080 (91%) of the 5,585 patients offered the HIV test accepted, and 506 (9%) refused. White and married patients were less likely to accept testing than those who were African American and unmarried (p < 0.001). Adult patients were almost twice as likely to accept testing as pediatric patients (odds ratio [OR] = 1.95; 95% confidence interval [CI] = 1.50 to 2.53). As age increased among pediatric patients, testing refusal decreased (OR = 0.71; 95% CI = 0.59 to 0.85), and as age increased among adult patients, testing refusal increased (OR = 1.17; 95% CI = 1.12 to 1.22). Two percent of persons accepting the test were considered high risk. Males were more likely to report high-risk behavior than females (OR = 1.83; 95% CI = 1.23 to 2.72). Conclusions:, The opt-out approach results in high acceptance of routine HIV screening. Widespread adoption of the CDC's recommendations, although feasible, will require significant increases in resources. [source]

Effectiveness of the Triple P Positive Parenting Program on Parenting: A Meta-Analysis

Ireen De Graaf
Abstract: Triple P is a parenting program intended to prevent and to provide treatment for severe behavioral, emotional, and developmental problems in children. The aim of this meta-analysis was to assess the effectiveness of Triple P Level 4 interventions on parenting styles and parental competency. Level 4 is an intensive training program of 8 , 10 sessions for parents of children with more severe behavioral difficulties. The results indicated that the Triple P Level 4 interventions reduced dysfunctional parenting styles in parents and also improved parental competency. These effects were maintained well through time and appear to support the widespread adoption and implementation of Triple P Level 4 interventions that is taking place in an increasing number of countries around the world. [source]

Venous thromboembolism in the medically ill patient: a call to action

J.-F. Bergmann
Summary The risk of venous thromboembolism (VTE) in medical patients is generally underestimated. However, recent studies including two large double-blind placebo-controlled trials, the Prospective Evaluation of Dalteparin Efficacy for Prevention of VTE in Immobilised Patients trial (PREVENT) and prophylaxis in MEDical patients with ENOXaparin, study show that low-molecular-weight heparins (LMWHs) provide effective thromboprophylaxis for medical patients at risk from VTE without increasing the risk of bleeding. In PREVENT the significant 45%, reduction in VTE among patients receiving dalteparin 5000 IU once daily for 14 days was attributed entirely to a reduction in clinically relevant VTE. The recently published guidelines for the prevention and treatment of VTE, issued by the American College of Chest Physicians, recommend prophylaxis with LMWHs (or low-dose unfractionated heparin) in acutely ill medical patients with risk factors for VTE (grade 1A). Current evidence should encourage the more widespread adoption of thromboprophylaxis in at-risk medical patients, and thus reduce the number of preventable deaths and complications due to VTE. [source]

The Causes and Consequences of Immigrant Labour in the Construction Sector in Malaysia

Suresh Narayanan
ABSTRACT Malaysian construction is highly dependant on immigrant labour; immigrants account for nearly 70 per cent of its workforce. Although they have aided the sector's rapid expansion, it has not been without costs. This paper examines the impact of immigrant labour on construction. The main finding is that immigrants, being largely unskilled, did not contribute to skill formation. Instead, they accumulated skills on-the-job, which were lost when they returned home. There was no evidence that immigrants displaced domestic workers since they were concentrated in jobs rejected by Malaysians. Furthermore, unlike in earlier periods, legal immigrants were no longer a cheap option, given the regulations governing their employment. They were not used to cut costs per se, but were used because domestic workers were not available in sufficient numbers. Despite the large immigrant presence, the general wage level increased, though admittedly not as rapidly as it might have in their absence. The reliance on immigrant workers has increased the need for supervision and quality control, thereby reducing the savings in cost; nonetheless, immigrants have helped keep costs in check. Surprisingly, rising wages and the continued shortage of labour have not led to a widespread adoption of labour-saving methods. This is partly because productivity increases have managed to outpace wage increases, though this advantage is petering out. Also, immigrant presence has kept wages, as a proportion of total costs, manageable. The over reliance of the sector on immigrant labour is not desirable, especially since the majority is drawn from one source - Indonesia. Any disruption of supply from this source can undermine the Malaysian economy. To avoid this, Malaysia must vary its source of immigrant labour and intensify efforts to attract domestic workers by improving conditions in construction. [source]

Appropriate dosing of antiarrhythmic drugs in Japan requires therapeutic drug monitoring,

M. Takada PhD
Summary Objective:, In general, drugs are used in accordance with an approved dosage regimen in expectation of an appropriate balance between efficacy and toxicity. However, dose control of drugs with a narrow therapeutic range and marked intersubject variability in pharmacokinetics should be established through individualization of dosing based on therapeutic drug monitoring (TDM). The purpose of this study was to examine differences between the approved dosage regimen and the doses of antiarrhythmic drugs and digoxin used in clinical practice and to examine the influence of TDM on dosing. Methods:, Prescription research of antiarrhythmic drugs was performed at five national hospitals in Japan. Prescriptions for antiarrhythmic drugs (cibenzoline, disopyramide, pirmenol, mexiletine, aprindine, flecainide, pilsicainide, amiodarone and digoxin) were counted for the study period. The mean dose and dose distribution of the drugs were determined in each hospital. Comparisons were made of mean dose obtained in the study with the dosage approved by the authority. In addition, the percentage of patients that received TDM was determined. Results:, A difference was seen between the approved dosage and the actual dose. For all drugs except flecainide, the mean dose was smaller than the approved dosage. For all drugs except digoxin, remarkable variations were seen in the dose distribution among the hospitals. Digoxin showed a similar dose distribution among the five hospitals. Overall, the percentage of patients that received TDM was low except for Hospital A. However, TDM of digoxin was relatively common at four of the hospitals. Conclusions:, It is concluded that, with the exception of digoxin, the appropriate dosing regimen for antiarrhythmic drugs is not yet established. The establishment of appropriate dosing regimens for antiarrhythmic drugs requires the more widespread adoption of TDM. [source]

Moody and Sankey Down Under: A Case Study in "Trans-Atlantic" Revivalism in Nineteenth-Century New Zealand,

This article examines the reception of revivalism inspired by the work of Dwight Moody and Ira Sankey in the Wanganui-Manawatu region of New Zealand in the 1870s and 1880s. The success of Moody and Sankey's 1873,75 British campaign inspired interest in revivalism, and led to rapid and widespread adoption of their distinctive methods. Though it aroused opposition in some quarters, Moody and Sankey style revivalism became established as a significant feature of New Zealand religiosity at that time. Some aspects continued to appeal well into the twentieth century. This article traces the rise and growth in influence of this form of revivalism, and considers reasons for its appeal in late nineteenth-century New Zealand. [source]

Google book search: Citation analysis for social science and the humanities

Kayvan Kousha
In both the social sciences and the humanities, books and monographs play significant roles in research communication. The absence of citations from most books and monographs from the Thomson Reuters/Institute for Scientific Information databases (ISI) has been criticized, but attempts to include citations from or to books in the research evaluation of the social sciences and humanities have not led to widespread adoption. This article assesses whether Google Book Search (GBS) can partially fill this gap by comparing citations from books with citations from journal articles to journal articles in 10 science, social science, and humanities disciplines. Book citations were 31% to 212% of ISI citations and, hence, numerous enough to supplement ISI citations in the social sciences and humanities covered, but not in the sciences (3%,5%), except for computing (46%), due to numerous published conference proceedings. A case study was also made of all 1,923 articles in the 51 information science and library science ISI-indexed journals published in 2003. Within this set, highly book-cited articles tended to receive many ISI citations, indicating a significant relationship between the two types of citation data, but with important exceptions that point to the additional information provided by book citations. In summary, GBS is clearly a valuable new source of citation data for the social sciences and humanities. One practical implication is that book-oriented scholars should consult it for additional citations to their work when applying for promotion and tenure. [source]

Professional knowledge and the epistemology of reflective practice

Elizabeth Anne Kinsella PhD
Abstract Reflective practice is one of the most popular theories of professional knowledge in the last 20 years and has been widely adopted by nursing, health, and social care professions. The term was coined by Donald Schön in his influential books The Reflective Practitioner, and Educating the Reflective Practitioner, and has garnered the unprecedented attention of theorists and practitioners of professional education and practice. Reflective practice has been integrated into professional preparatory programmes, continuing education programmes, and by the regulatory bodies of a wide range of health and social care professions. Yet, despite its popularity and widespread adoption, a problem frequently raised in the literature concerns the lack of conceptual clarity surrounding the term reflective practice. This paper seeks to respond to this problem by offering an analysis of the epistemology of reflective practice as revealed through a critical examination of philosophical influences within the theory. The aim is to discern philosophical underpinnings of reflective practice in order to advance increasingly coherent interpretations, and to consider the implications for conceptions of professional knowledge in professional life. The paper briefly examines major philosophical underpinnings in reflective practice to explicate central themes that inform the epistemological assumptions of the theory. The study draws on the work of Donald Schön, and on texts from four philosophers: John Dewey, Nelson Goodman, Michael Polanyi, and Gilbert Ryle. Five central epistemological themes in reflective practice are illuminated: (1) a broad critique of technical rationality; (2) professional practice knowledge as artistry; (3) constructivist assumptions in the theory; (4) the significance of tacit knowledge for professional practice knowledge; and (5) overcoming mind body dualism to recognize the knowledge revealed in intelligent action. The paper reveals that the theory of reflective practice is concerned with deep epistemological questions of significance to conceptions of knowledge in health and social care professions. [source]

Optometric glaucoma referrals , measures of effectiveness and implications for screening strategy

Jim Gilchrist
Summary The effectiveness of disease screening is conventionally evaluated using the epidemiological indices of sensitivity and specificity, which measure the association between screening test results and final diagnoses of all the patients screened. The effectiveness of optometric glaucoma referrals cannot be measured using such indices because diagnoses are obtained only on patients who are referred, while the true disease status of those not referred remains unknown. Instead, glaucoma referral effectiveness has been evaluated using measures of ,detection rate', the proportion of those screened who are correctly referred, and ,referral accuracy', the proportion of those referred who are correctly referred occurrence. Examination of these operational measures shows that their obtainable values and, hence, their interpretation are influenced by the total proportions of diseased and referred patients, one or both of which will generally be unavailable in evaluating samples of referrals. On the other hand, if valid estimates of these proportions can be obtained from other sources, it is possible to rescale detection rate and referral accuracy to take account of them. This rescaling produces a pair of weighted kappa coefficients, chance-corrected measures of association between referral and diagnosis, which provide a better indication of true referral effectiveness than other measures. An important consequence of this approach is that it provides a clear quantitative illustration of the need for a dual strategy to improve the overall quality of optometric glaucoma screening; widespread adoption of more comprehensive modes of screening to improve accuracy, together with a significant increase in the total numbers of patients screened to improve detection. In order for detection rates to reach desirable levels, the total number of referrals in any sub-population of patients must match or exceed the number of patients with disease. This analysis confirms quantitatively that which is intuitively obvious; not only that glaucoma awareness and uptake of screening opportunities must be encouraged in all patients over 40 years of age, but also that the older and/or more at risk patients are, the greater is their need to take advantage of glaucoma screening. [source]

Use of models to assess the reduction in contamination of water bodies by agricultural pesticides through the implementation of policy instruments: a case study of the Voluntary Initiative in the UK

James Garratt
Abstract Through normal agricultural use, pesticides may reach environmental water bodies via several routes of entry. Various policies and initiatives exist to reduce the effects of pesticides in the environment. One such initiative in place in the UK is the Voluntary Initiative (VI). The VI is a voluntary scheme put forward by the Crop Protection Association with other crop protection and farming organisations to reduce the environmental impacts of pesticides. Mathematical models of pesticide fate can usefully be applied to examine the impact of factors influencing the contamination of water bodies by pesticides. The work reported here used water quality models to examine how changes in farmer behaviour could potentially impact pesticide contamination of environmental water bodies. As far as possible, uncalibrated, standard regulatory models were used. Where suitable models were not available, simple models were defined for the purposes of the study and calibrated using literature data. Scenarios were developed to represent different standards of practice with respect to pesticide user behaviour. The development of these scenarios was guided by the Crop Protection Management Plan (CPMP) aspect of the VI. A framework for the use of modelling in the evaluation of the VI is proposed. The results of the modelling study suggest that, in several areas, widespread adoption of the measures proposed in the VI could lead to reductions in pesticide contamination of environmental water bodies. These areas include pesticide contamination from farmyards, spray drift and field runoff. In other areas (including pesticide leaching to groundwater and contamination of surface water from field drains) the benefits that may potentially be gained from the VI are less clear. A framework to evaluate the VI should take into consideration the following aspects: (1) groundwater is more at risk when there is a combination of leachable compounds, vulnerable soils, shallow groundwater and high product usage; (2) surface water contamination from drains is most likely when heavy rain falls soon after application, the soils are vulnerable and product usage is high; (3) surface water contamination from drift is most likely when the distance between the spray boom and water body is small and product usage is high; (4) surface water contamination from farmyards is dependent on the nature of the farmyard surface, the competence of the spray operator and the level of product usage. Any policy or initiative to reduce pesticide contamination should be measured against farmer behaviour in these areas. © Crown copyright 2006. Reproduced with the permission of Her Majesty's Stationery Office. Published by John Wiley & Sons, Ltd. [source]

Presidential Coattails and Legislative Fragmentation

Matt Golder
Considerable evidence suggests that legislative fragmentation can negatively affect the survival of democratic presidential regimes. While there is a vast literature examining the determinants of legislative fragmentation, one factor that has traditionally been overlooked is the impact of presidential elections. Do presidential elections increase or decrease legislative fragmentation? Does it matter if presidents are elected by plurality rule or by runoff? Using a new dataset that covers all democratic legislative and presidential elections between 1946 and 2000, I find that presidential coattails can reduce, increase, or have no effect on legislative fragmentation depending on the number of presidential candidates. I also find strong evidence that social heterogeneity increases the number of presidential candidates when runoff systems are employed. Taken together, these results suggest that the widespread adoption of runoffs by newly democratic presidential regimes will likely increase legislative fragmentation, thereby putting their democratic survival at increased risk. [source]

Coronary Flow Reserve by Contrast-Enhanced Echocardiography: A New Noninvasive Diagnostic Tool for Cardiac Allograft Vasculopathy

F. Tona
Noninvasive tests have proven unsatisfactory in cardiac allograft vasculopathy (CAV) diagnosis. We assessed coronary flow reserve (CFR) by contrast-enhanced transthoracic echocardiography (CE-TTE) in heart transplantation (HT). CFR was assessed in the left anterior descending coronary artery in 73 HT recipients (59 male, aged 50 ± 12 years at HT), at 8 ± 4.5 years post-HT. CFR measurements were taken blindly from coronary angiographies. CFR cut points were the standard value of ,2 and those defined by receiver operating characteristics (ROC) curve analysis. CFR was lower in patients with CAV (2.3 ± 0.7 vs. 3.2 ± 0.5, p < 0.0001). The ,2 cut point was 100% specific and 38% sensitive. The ,2.7 cut point, optimal by ROC analysis, was 87% specific and 82% sensitive. Accuracy rose from 71% with the standard ,2 cut point to 85% with the optimal cut point of ,2.7. CFR by CE-TTE may offer promise as a novel, easily repeatable and accurate noninvasive tool in CAV detection. However, further longitudinal studies in larger patient cohorts are warranted before widespread adoption can be advocated. [source]

Extended Thresholds II: The Articulated Envelope

Michael Hensel
Abstract Previous to the widespread adoption of air conditioning in the 20th century, which introduced a distinct differentiation between controlled interior space and the external environment, ,a wealth of strategies' were developed in Turkey to moderate the transition between inside and outside. There is much to learn from these no-energy and low-energy solutions to climate control. Here, Michael Hensel and Defne Sunguro,lu Hensel describe the original research and special study they undertook of external vertical thresholds in an extended envelope when they gained special access to the 17th-century Yerevan Kiosk and Baghdad Kiosk in the Topkapi Palace in Istanbul. Copyright © 2010 John Wiley & Sons, Ltd. [source]

Designing for Low-Carbon Lifestyles

Mukti Mitchell
Abstract Carpenter, shipbuilder and pioneer of sustainable living Mukti Mitchell collaborates with Ken Yeang on an article espousing the widespread adoption of low-carbon lifestyles. As well as discussing the adoption of CO2 reductions at the individual and global levels, they look at the extent to which architectural design can facilitate lifestyle carbon reductions. Copyright © 2010 John Wiley & Sons, Ltd. [source]

Pattern Deposition: From Scripts to Applications

Mike Silver
Abstract Is the widespread adoption of existing design software appropriated from other disciplines limiting architects' potential for pattern-making? Could the development of complex code applied to equally complex pattern problems open up alternative avenues of expression? Mike Silver illustrates work by himself and other architects and artists that suggest that new kinds of software-driven pattern recognition and simulation computer models are opening up the field. Copyright © 2009 John Wiley & Sons, Ltd. [source]

Single-port laparoscopic surgery, the new evolution of endoscopic surgery

H. Rivas
Abstract Introduction: Laparoscopic surgery through a single port is gaining great interest throughout the world. Our group has pioneered and been a leader on these novel techniques. Here we describe our experience based on a model of single-port laparoscopic cholecystectomy. Materials and Methods: From January 2008 until August 2009, over 200 patients have undergone single-port laparoscopic surgery at our institution. Here, we analyze a cohort of the initial 100 cholecystectomies in order to evaluate a proposed technique, common challenges, the learning curve and potential solutions. Results: Single-port laparoscopic surgery was feasible in all patients from this cohort. Patients were strictly selected. Operating times similar to those of conventional laparoscopy were only achieved after completing 50 cases. Common technical challenges included clashing instruments, deflection of laparoscope due to conflict with light source, and organ retraction. Acceptance by surgeons and lack of patience and time may become significant obstacles that prevent the procedure's widespread adoption. The excellent aesthetic results are superior to laparoscopy. Other benefits of laparoscopy are preserved and may prove to be superior on clinical trials. Discussion: Single-port laparoscopic surgery is becoming popular worldwide. Safe and successful adoption requires learning the basic concepts of this method, identifying challenges, and implementing solutions. Once these essentials are mastered, the learning curve may be shortened, especially for experienced laparoscopic surgeons, and this technique may then be used to replicate many abdominal operations. Transparency with patients and team building are essential requirements for a successful adoption. Clinical trials are ideal before universal adoption. [source]

Allergic contact dermatitis in dentistry

Diana M Rubel
SUMMARY Allergic contact dermatitis (ACD) in dentistry may affect dentists and orthodontists, technicians, nurses and patients. Changes to dental practice in recent years have altered the reported frequencies of allergens causing ACD in both dental personnel and patients. Allergic contact dermatitis to medicaments, metals and glutaraldehyde were previously common allergens in dentistry; however, widespread adoption of rubber gloves by staff has resulted in a significant increase in ACD to glove allergens in both dental staff and their patients, while affording protection against the traditional allergens. Both public concerns about potential toxicity of metals in oral restorations and a greater demand for cosmetic dentistry, have resulted in greater use of acrylics and resins by dental personnel, exposing them to highly allergenic materials. Dermatologists need to be aware of the newer allergenic materials used in dentistry in order to correctly manage skin diseases in this high-risk group. [source]

A review of criticisms of phylogenetic nomenclature: is taxonomic freedom the fundamental issue?

ABSTRACT The proposal to implement a phylogenetic nomenclatural system (governed by the PhyloCode), in which taxon names are defined by explicit reference to common descent, has met with strong criticism from some proponents of phylogenetic taxonomy (taxonomy based on the principle of common descent in which only clades and species are recognized). We examine these criticisms and find that some of the perceived problems with phylogenetic nomenclature are based on misconceptions, some are equally true of the current rank-based nomenclatural system, and some will be eliminated by implementation of the PhyloCode. Most of the criticisms are related to an overriding concern that, because the meanings of names are associated with phylogenetic pattern which is subject to change, the adoption of phylogenetic nomenclature will lead to increased instability in the content of taxa. This concern is associated with the fact that, despite the widespread adoption of the view that taxa are historical entities that are conceptualized based on ancestry, many taxonomists also conceptualize taxa based on their content. As a result, critics of phylogenetic nomenclature have argued that taxonomists should be free to emend the content of taxa without constraints imposed by nomenclatural decisions. However, in phylogenetic nomenclature the contents of taxa are determined, not by the taxonomist, but by the combination of the phylogenetic definition of the name and a phylogenetic hypothesis. Because the contents of taxa, once their names are defined, can no longer be freely modified by taxonomists, phylogenetic nomenclature is perceived as limiting taxonomic freedom. We argue that the form of taxonomic freedom inherent to phylogenetic nomenclature is appropriate to phylogenetic taxonomy, in which taxa are considered historical entities that are discovered through phylogenetic analysis and are not human constructs. [source]

Highly efficient deletion of FUT8 in CHO cell lines using zinc-finger nucleases yields cells that produce completely nonfucosylated antibodies

Laetitia Malphettes
Abstract IgG1 antibodies produced in Chinese hamster ovary (CHO) cells are heavily ,1,6-fucosylated, a modification that reduces antibody-dependent cellular cytotoxicity (ADCC) and can inhibit therapeutic antibody function in vivo. Addition of fucose is catalyzed by Fut8, a ,1,6-fucosyltransferase. FUT8,/, CHO cell lines produce completely nonfucosylated antibodies, but the difficulty of recapitulating the knockout in protein-production cell lines has prevented the widespread adoption of FUT8,/, cells as hosts for antibody production. We have created zinc-finger nucleases (ZFNs) that cleave the FUT8 gene in a region encoding the catalytic core of the enzyme, allowing the functional disruption of FUT8 in any CHO cell line. These reagents produce FUT8,/, CHO cells in 3 weeks at a frequency of 5% in the absence of any selection. Alternately, populations of ZFN-treated cells can be directly selected to give FUT8,/, cell pools in as few as 3 days. To demonstrate the utility of this method in bioprocess, FUT8 was disrupted in a CHO cell line used for stable protein production. ZFN-derived FUT8,/, cell lines were as transfectable as wild-type, had similar or better growth profiles, and produced equivalent amounts of antibody during transient transfection. Antibodies made in these lines completely lacked core fucosylation but had an otherwise normal glycosylation pattern. Cell lines stably expressing a model antibody were made from wild-type and ZFN-generated FUT8,/, cells. Clones from both lines had equivalent titer, specific productivity distributions, and integrated viable cell counts. Antibody titer in the best ZFN-generated FUT8,/, cell lines was fourfold higher than in the best-producing clones of FUT8,/, cells made by standard homologous recombination in a different CHO subtype. These data demonstrate the straightforward, ZFN-mediated transfer of the Fut8, phenotype to a production CHO cell line without adverse phenotypic effects. This process will speed the production of highly active, completely nonfucosylated therapeutic antibodies. Biotechnol. Bioeng. 2010;106: 774,783. © 2010 Wiley Periodicals, Inc. [source]

Can the Emergency Department Algorithm Detect Changes in Access to Care?

Robert A. Lowe MD
Abstract Objectives:, The "emergency department algorithm" (EDA) uses emergency department (ED) diagnoses to assign probabilities that a visit falls into each of four categories: nonemergency, primary care,treatable emergency, preventable emergency needing ED care, and nonpreventable emergency. The EDA's developers report that it can evaluate the medical safety net because patients with worse access to care will use EDs for less urgent conditions. After the Oregon Health Plan (OHP, Oregon's expanded Medicaid program) underwent cutbacks affecting access to care in 2003, the authors tested the ability of the EDA to detect changes in ED use. Methods:, All visits to 22 Oregon EDs during 2002 were compared with visits during 2004. For each payer category, mean probabilities that ED visits fell into each of the four categories were compared before versus after the OHP cutbacks. Results:, The largest change in mean probabilities after the cutbacks was 2%. Attempts to enhance the sensitivity of the EDA through other analytic strategies were unsuccessful. By contrast, ED visits by the uninsured increased from 6,682/month in 2002 to 9,058/month in 2004, and the proportion of uninsured visits leading to hospital admission increased by 51%. Conclusions:, The EDA was less useful in demonstrating changes in access to care than were other, simpler measures. Methodologic concerns with the EDA that may account for this limitation are discussed. Given the widespread adoption of the EDA among health policy researchers, the authors conclude that further refinement of the methodology is needed. [source]

Analysing the factors influencing clean technology adoption: a study of the Spanish pulp and paper industry

Pablo del Río González
Technological change has a relevant role to play in the transition towards a sustainable industry. However, slow diffusion of clean technologies can be observed in OECD countries. The analysis of the determinants and barriers to clean technology adoption should be a main goal of economists and social scientists. This paper shows that three sets of interrelated factors prevent but also stimulate the widespread adoption and diffusion of clean technology: these are factors external and internal to the firm, conditions of the potential adopters and characteristics of the environmental technology. These factors are included in the so-called ,triangular model', which is further applied to the analysis of clean technology adoption in the pulp and paper industry in Spain. The empirical study shows that clean technology adoption decisions are the result of an interaction between these factors, often involving contradictory signals for the potential adopter. The paper closes with some public policy recommendations for the effective and efficient promotion of clean technology diffusion. Copyright © 2005 John Wiley & Sons, Ltd and ERP Environment. [source]

Recent trends and racial/ethnic differences in the incidence and treatment of ductal carcinoma in situ of the breast in California women ,

CANCER, Issue 4 2003
Kaire Innos M.D., Ph.D.
Abstract BACKGROUND The rapid increase in the incidence of ductal carcinoma in situ (DCIS) of the breast in the U.S. has been associated with the widespread adoption of screening mammography. Little is known regarding the incidence and treatment of DCIS in women of racial/ethnic groups other than white and black. The current investigation examined recent trends and racial/ethnic differences in the incidence and treatment of DCIS in California. METHODS All cases of DCIS diagnosed in women age , 40 years in California between 1988,1999 were included. Age-adjusted incidence rates for white, black, Hispanic, and Asian-Pacific Islander women were calculated using the 2000 U.S. female population as the standard. The estimated annual percent change (EAPC) in the rates was calculated using least squares regression. RESULTS The average annual age-adjusted incidence of DCIS (1988,1999) was 45.3 per 100,000 in white women, 35.0 in black women, 30.9 in Asian-Pacific Islander women, and 21.8 in Hispanic women. Although a steady increase in the incidence of DCIS was noted in all racial/ethnic groups over the study period, Asian-Pacific Islander women were found to have experienced the steepest increase (EAPC = 9.1%), particularly in the age group 50,64 years (EAPC = 12.0%). The DCIS incidence was reported to increase with age in white, black, and Hispanic women, but remained fairly constant after the age of 50 years in Asian-Pacific Islanders. The proportion of women with DCIS treated with mastectomy decreased from 53% in 1988 to 32% in 1999. Younger women and Asian-Pacific Islander women reportedly were more likely to undergo mastectomy. CONCLUSIONS Considerable differences by race/ethnicity and age were observed in DCIS incidence and the change in the incidence in California between 1988 and 1999. Further information is needed to determine whether these differences are because of differential utilization of screening mammography or biologic characteristics of DCIS lesions. Cancer 2003;97:1099,106. © 2003 American Cancer Society. DOI 10.1002/cncr.11104 [source]