Use of the DACUM process in the identification and verification of competencies for the medical administrative assistant

Medicine has changed in recent years. Medicare will all of its rules and regulations, worker's compensation laws, managed care and the trend toward more and larger group practices all contributed to the creation of an extremely structured regulatory environment which in turn demanded highly trained medical administrative assistants.^ The researcher noted three primary problems in the identification of competencies for the medical administrative assistant position: A lack of curricula, diverse roles, and a complex environment which has undergone radical change in recent years and will continue to evolve. Therefore, the purposes of the study were to use the DACUM process to develop a relevant list of competencies required by the medical administrative assistant practicing in physicians' offices in South Florida; determine the rank order of importance of each competency using a scale of one to five; cross-validate the DACUM group scores with a second population who did not participate in the DACUM process; and establish a basis for a curriculum framework for an occupational program.^ The DACUM process of curriculum development was selected because it seemed best suited to the need to develop a list of competencies for an occupation for which no programs existed. A panel of expert medical office administrative staff was selected to attend a 2-day workshop to describe their jobs in great detail. The panel, led by a trained facilitator, listed major duties and the respective tasks of their job. Brainstorming techniques were used to develop a consensus.^ Based upon the DACUM workshop, a survey was developed listing the 8 major duties and 71 tasks identified by the panel. The survey was mailed to the DACUM group and a second, larger population who did not participate in the DACUM. The survey results from the two groups were then compared. The non-DACUM group validated all but 3 of the 71 tasks listed by the DACUM panel. Because the three tasks were rated by the second group as at least "somewhat important" and rated "very important" by the DACUM group, the researcher recommended the inclusion of all 71 tasks in program development for this occupation. ^

The use of close-range photogrammetry in zooarchaeology : Creating accurate 3D models of wolf crania to study dog domestication

Acknowledgements We thank the Muséum National d'Histoire Naturelle, Paris, that provided access to the specimens, and access to the morphometric platform where the surface scans were performed. We also thank Raphael Cornette and Julien Claude for the fruitful discussions we had when writing the manuscript. This work was supported by NERC (grant number NE/K003259/1) and the European Research Council (ERC-2013-StG 337574-UNDEAD). This is publication ISEM 2016-127. We thank the two anonymous reviewers who greatly helped to improve the manuscript.

The application of aryne chemistry and use of α-diazo carbonyl derivatives in indazole synthesis with biological evaluation

This thesis outlines the synthetic chemistry involved in the preparation of a range of novel indazole compounds and details the subsequent investigation into their potential as biologically active agents. The synthetic route utilised in this research to form the indazole structure was the [3+2] dipolar cycloaddition of diazo carbonyl compounds with reactive aryne intermediates generated in situ. The preparation of further novel indazole derivatives containing different functional groups and substituents was performed by synthesising alternative 1,3- dipole and dipolarophile analogues and provided additionally diverse compounds. Further derivatisation of the indazole product was made possible by deacylation and alkylation methods. Transformation reactions were performed on alkenecontaining ester side chains to provide novel epoxide, aldehyde and tertiary amine derivatives. The first chapter is a review of the literature beginning with a short overview on the structure, reactivity and common synthetic routes to diazo carbonyl derivatives. More attention is given to the use of diazo compounds as 1,3-dipoles in cycloaddition reactions or where the diazo group is incorporated into the final product. A review of the interesting background, structure and reactivity of aryne intermediates is also presented. In addition, some common syntheses of indazole compounds are presented as well as a brief discussion on the importance of indazole compounds as therapeutic agents. The second chapter discusses the synthetic routes employed towards the synthesis of the range of indazoles. Initially, the syntheses of the diazo carbonyl and aryne precursors are described. Next, the synthetic methods to prepare the indazole compounds are provided followed by discussion on derivatisation of the indazole compounds including N-deacylation, N-benzylation and ester side-chain transformation of some alkene-containing indazoles. A series of novel indazole derivatives were submitted for anti-cancer screening at the U.S National Cancer Institute (NCI). A number of these derivatives were identified as hit compounds, with excellent growth inhibition. The results obtained from biological evaluation from the NCI are provided with further results pending from the Community for Open Antimicrobial Drug Discovery. The third chapter details the full experimental procedures, including spectroscopic and analytical data for all the compounds prepared during this research.

A Validation Study for the Use of ROS1 Immunohistochemical Staining in Screening for ROS1 Translocations in Lung Cancer

INTRODUCTION: The presence of ROS proto-oncogene 1, receptor tyrosine kinase gene (ROS1) rearrangements in lung cancers confers sensitivity to ROS kinase inhibitors, including crizotinib. However, they are rare abnormalities (in ∼1% of non-small cell lung carcinomas) that are typically identified by fluorescence in situ hybridization (FISH), and so screening using immunohistochemical (IHC) staining would be both cost- and time-efficient.

METHODS: A cohort of lung tumors negative for other common mutations related to targeted therapies were screened to assess the sensitivity and specificity of IHC staining in detecting ROS1 gene rearrangements, enriched by four other cases first identified by FISH. A review of published data was also undertaken.

RESULTS: IHC staining was 100% sensitive (95% confidence interval: 48-100) and 83% specific (95% confidence interval: 86-100) overall when an h-score higher than 100 was used. Patients with ROS1 gene rearrangements were younger and typically never-smokers, with the tumors all being adenocarcinomas with higher-grade architectural features and focal signet ring morphologic features (two of five). Four patients treated with crizotinib showed a partial response, with three also showing a partial response to pemetrexed. Three of four patients remain alive at 13, 27, and 31 months, respectively.

CONCLUSION: IHC staining can be used to screen for ROS1 gene rearrangements, with patients herein showing a response to crizotinib. Patients with tumors that test positive according to IHC staining but negative according to FISH were also identified, which may have implications for treatment selection.

The Use of Conceptual Business Model in Managing Information Technology Projects

The business model of an organization is an important strategic tool for its success, and should therefore be understood by business professionals and information technology professionals. By this context and considering the importance of information technology in contemporary business models, this article aims to verify the use of the business model components in the information technology (IT) projects management process in enterprises. To achieve this goal, this exploratory research has investigated the use of the Business Model concept in the information technology projects management, by a survey applied to 327 professionals from February to April 2012. It was observed that the business model concept, as well as its practices or its blocks, are not so well explored in its whole potential, possibly because it is relatively new. One of the benefits of this conceptual tool is to provide an understanding in terms of the core business for different areas, enabling a higher level of knowledge in terms of the essential activities of the enterprise IT professionals and the business area.

Induction of apoptosis by UV in the flat oyster, Ostrea edulis

Apoptosis is a fundamental feature in the development of many organisms and tissue systems. It is also a mechanism of host defense against environmental stress factors or pathogens by contributing to the elimination of infected cells. Hemocytes play a key role in defense mechanisms in invertebrates and previous studies have shown that physical or chemical stress can increase apoptosis in hemocytes in mollusks. However this phenomenon has rarely been investigated in bivalves especially in the flat oyster Ostrea edulis. The apoptotic response of hemocytes from flat oysters, O. edulis, was investigated after exposure to UV and dexamethasone, two agents known to induce apoptosis in vertebrates. Flow cytometry and microscopy were combined to demonstrate that apoptosis occurs in flat oyster hemocytes. Investigated parameters like intracytoplasmic calcium activity, mitochondrial membrane potential and phosphatidyl-serine externalization were significantly modulated in cells exposed to UV whereas dexamethasone only induced an increase of DNA fragmentation. Morphological changes were also observed on UV-treated cells using fluorescence microscopy and transmission electron microscopy. Our results confirm the apoptotic effect of UV on hemocytes of O. edulis and suggest that apoptosis is an important mechanism developed by the flat oyster against stress factors.

Use of GLP-1 mimetic in type 2 diabetes mellitus: is it the end of fragility fractures?

International audience

Use of oral rehydration therapy in the treatment of childhood diarrhoea in Douala, Cameroon

Introduction The use of oral rehydration solutions in our context remains limited. This study was conducted to analyze the rate of this use in Douala, Cameroon and thereby determine the factors associated with it. Method A cross-sectional survey was administered to parents of children aged five years and younger during a six-month study period. The studied variables focused on the socio-demographic data of the population, data on diarrhoea and its severity, data on oral rehydration salts (ORS), and data related to other interventions for diarrhoea. The chi-square test was used to qualify associations between variables, with the significance level being set at 5%. Results Overall, 672 people agreed to participate in the study. Among them, 418 (62.2%) correctly defined diarrhoea. When their children develop diarrhoea, the majority of the parents (348, 51.8%) reported seeking hospital assistance before any intervention, while 225 parents (33.5%) preferred the use of ORS first. Four hundred seventy-five parents (70.7%) had heard of ORS and among them 313 (65.9%) had actually given ORS to their children as treatment during these children’s most recent episodes of diarrhoea. Of the parents who had given their children ORS, 217 (69.3%) knew how to prepare it, and 122 (39.0%) knew how to administer it. One hundred thirty-five parents (20.1%) had administered metronidazole to treat their children’s diarrhoea. The age of the children, the parents’ level of education, and the number of children in the household significantly influenced the use or non-use of ORS (respectively, p < 0.001, p = 0.003 and p < 0.0001). Rehydration was correctly identified by 234 parents (34.8%) as the purpose of administering ORS. Conclusion The knowledge and the use of ORS in diarrhoea by the study sample was insufficient. The role of ORS was poorly known. Awareness campaigns can be carried out in order to improve the use of this effective intervention for diarrhoea.

FERTILISER CREDIT AND AGROECOLOGICAL USE OF ORGANIC SOIL AMENDMENTS IN NORTHERN GHANA

Contemporary African agricultural policy embodies the African Green Revolution’s drive towards modernisation and commercialisation. Agroecologists have criticised this movement on ecological, social and political grounds. Northern Ghanaian fertiliser credit schemes provide a good example through which these critiques can be examined in a context where agricultural policy reflects the African Green Revolution’s ideals. This study aimed to determine the relationship of such credit schemes to farmers’ use of organic amendments, elucidate other factors related to organic amendment use, and comment on the relevance of this modernisation policy and its relationship to agroecology. A first research phase employed semi-structured key informant interviews. Qualitative data from these informed construction of a semi-structured questionnaire that was used in a survey of 205 farmers. Multistage sampling purposively identified five villages and selected farmers within who had joined government and donor-funded fertiliser credit schemes. The use of organic and inorganic amendments was compared to that of peers who had not taken part in such schemes. Quantitative data were used in binomial logistic regression, inferential and descriptive statistics. Qualitative data were content analysed. Credit group membership was associated with higher fertiliser application and yield, but had little influence on the extent of commercialisation. Farmers who applied organic amendments were 40% less likely to belong to a fertiliser credit scheme than not, indicating substitution between organic and inorganic fertilisers. Organic amendments were 40% more likely to be applied to compound farms than outfields and six times more likely to be applied by household heads than other household members. However, household heads also preferentially joined credit groups. This was part of an agroecological soil fertility management strategy. Household heads appreciated the soil moisture retention properties of organic amendments, and applied them to compound farms to reduce risk to their household food supply in a semi-arid environment. They simultaneously accessed fertiliser to enhance this household provisioning strategy. They appreciated the increased yields this achieved, yet complained that the repayment terms of credit schemes were unfair, fertiliser did not enhance yields in dry conditions and fertilisers were supplied late. Farmers’ use of credited fertiliser alongside their existing agroecological strategy is helpful to the extent that it raises yields, yet is problematic in that it conflicts with risk-reduction strategies based on organics. There is some potential for modernised and agroecological management paradigms to coexist. For fertiliser credit to play a role in this, schemes must use fairer repayment terms and involve a focus on simultaneous use of organic amendments.

Experimental Project on the Safety and the Optimization of the Use of Glyphosate-Based Herbicides in the Grain Sector.

INTRODUCTION: Glyphosate is the most widely applied pesticide worldwide and it is an active ingredient of all glyphosate-based herbicides (GBHs), including in the formulation “Roundup” . It is unclear if the glyphosate present in ground water can be absorbed and translocated in different parts of the pants, particularly wheat plants. This indeed represents an important aspect for productivity (being this a powerful herbicide) and organic certification of the products (the use of glyphosate is not admitted in organic farming and the ubiquitous contamination of glyphosate in water might in theory affect the level of glyphosate in the plants). Overall, epidemiological, in vivo and in vitro studies available in literature present conflicting findings on the safety of glyphosate. METHODS: The work performed for this PhD thesis aimed to experimentally test the root absorption and the eventual translocation of the glyphosate herbicide in the different parts of the wheat plant (Triticum durum) starting from ground water. Furthermore we aimed to experimentally test the effects of the exposure to GBHs at doses of glyphosate considered to be “safe”, the US ADI of 1.75 mg/kg bw/day, defined as the chronic Reference Dose (cRfD) determined by the US EPA, in in vivo models (Sprague-Dawley rats) and in vitro models (Caco2 and L929). RESULTS: All the experimental absorption studies on wheat plants performed have given negative results in terms of the presence of glyphosate or AMPA in the grain of durum wheat. On the other hand the experimental safety studies on in vitro and in vivo models highlighted different effects at doses currently considered safe for humans and with no effects in animals. CONCLUSION: Overall the integration of the findings from absorption in plants and safety studies will serve as solid evidence-base for risk assessment and productive strategies for agriculture.

Adoption and use of precision agriculture technologies in the sugarcane industry of So Paulo state, Brazil

Precision agriculture (PA) technologies are being applied to crops in Brazil, which are important to ensure Brazil`s position in agricultural production. However, there are no studies available at present to indicate the extent to which PA technologies are being used in the country. Therefore, the main objective of this research was to investigate how the sugar-ethanol industry in So Paulo state, which produces 60% of the domestic sugarcane, is adopting and using these techniques. For this purpose, primary data were used, which were obtained from a questionnaire sent to all companies operating in the sugar-ethanol industry in the region. The aim was to determine to what extent these companies are adopting and using PA technologies, and also to promote a more in-depth discussion of the topic within the sugar-ethanol industry. Information was obtained on the features of the companies, on sources of information that they use for adopting these technologies, on their impacts on these companies and on obstacles hindering their adoption. The main conclusions of this research suggest that companies that adopt and use PA practices reap benefits, such as managerial improvements, higher yields, lower costs, minimization of environmental impacts and improvements in sugarcane quality.

The use of glucan as immunostimulant in the treatment of a severe case of chromoblastomycosis

We report the case of an alternative treatment for a patient with a severe form of chromoblastomycosis that responded poorly to the traditional antifungal therapy. We hereby show, in this study, the improvement of lesions after treatment with itraconazole associated with an intramuscular administration of glucan. We observed that the regression of lesions was associated with an improvement of the cellular immune response. This favourable response that we observed suggests that the therapeutic regimen we used might be an option for the treatment of patients with a severe form of chromoblastomycosis.

The Use of Smell Identification Tests in the Diagnosis of Parkinson`s Disease in Brazil

Smell identification tests may be of routine clinical value in the differential diagnosis of PD but are subject to cultural variation and have not been systematically evaluated in the Brazilian population. We have applied culturally adapted translations of the University of Pennsylvania 40-item smell identification test (UPSIT-40) and the 16-item identification test from Sniffin` Sticks (SS-16) to nondemented Brazilian PD patients and controls. Pearson`s correlation coefficient between the test scores was 0.76 (95% CI 0.70-0.81, n = 204, P < 0.001). To calculate reliability measures for each test we used the diagnosis (either PD or control) as outcome variable for separate logistic regression analyses using the score in the UPSIT-40 or the SS-16 as a covariate. The SS-16 specificity was 89.0% with a sensitivity of 81.1% (106 PD and 118 controls). The UPSIT-40 specificity was 83.5% and its sensitivity 82.1% (95 PD and 109 controls). Regression curves were used to associate an individual`s smell test score with the probability of belonging to the PD, as opposed to the control group. Our data provide support for the use of the UPSIT-40 and SS-16 to help distinguish early PD from controls. (c) 2008 Movement Disorder Society

Preferential use of nonreversed vein grafts in above-knee femoropopliteal bypasses for critical ischemia: Midterm outcome

We evaluated nonreversed vein grafts in above-knee bypasses for chronic critical limb ischemia in a retrospective study with intention-to-treat analysis in patients who underwent above-knee bypass grafting. During a 4-year period, 51 patients (men, 32; women, 19; mean age 66 years) with 53 critically ischemic lower extremities underwent above-knee femoropopliteal bypass grafting. The follow-up evaluation consisted of clinical examination, assessment of the ankle- brachial systolic blood pressure index, and, whenever necessary, duplex scanning. Three ( 5.7%) deaths occurred within 30 days, two from myocardial infarction and one from an undetermined cause. The 2-year cumulative success rate was 82.5 +/- 9.6% for primary patency, 84.6 +/- 8.9% for secondary patency, 90.1 +/- 7.3% for tertiary patency, 86.9 +/- 7.6% for limb salvage, 77.7 +/- 8.4% for survival, 68.0 +/- 11.1% for composite patency, and 68.4 +/- 9.3% for amputation- free survival; the corresponding estimates for vein grafts alone were 86.6 +/- 9.2%, 88.9 +/- 8.6%, 89.0 +/- 8.5%, 88.1 +/- 8.1%, 81.1 +/- 9.1, 76.8 +/- 11.1%, and 72.6 +/- 10.2%. Three prosthetic grafts failed and were replaced with an arm vein graft. Nonreversed vein bypass grafts in above- knee revascularization of critically ischemic limbs are justified.