A cross-sectional study assessing the association between online ratings and structural and quality of care measures : results from two German physician rating websites

BACKGROUND: Even though physician rating websites (PRWs) have been gaining in importance in both practice and research, little evidence is available on the association of patients' online ratings with the quality of care of physicians. It thus remains unclear whether patients should rely on these ratings when selecting a physician. The objective of this study was to measure the association between online ratings and structural and quality of care measures for 65 physician practices from the German Integrated Health Care Network "Quality and Efficiency" (QuE). METHODS: Online reviews from two German PRWs were included which covered a three-year period (2011 to 2013) and included 1179 and 991 ratings, respectively. Information for 65 QuE practices was obtained for the year 2012 and included 21 measures related to structural information (N = 6), process quality (N = 10), intermediate outcomes (N = 2), patient satisfaction (N = 1), and costs (N = 2). The Spearman rank coefficient of correlation was applied to measure the association between ratings and practice-related information. RESULTS: Patient satisfaction results from offline surveys and the patients per doctor ratio in a practice were shown to be significantly associated with online ratings on both PRWs. For one PRW, additional significant associations could be shown between online ratings and cost-related measures for medication, preventative examinations, and one diabetes type 2-related intermediate outcome measure. There again, results from the second PRW showed significant associations with the age of the physicians and the number of patients per practice, four process-related quality measures for diabetes type 2 and asthma, and one cost-related measure for medication. CONCLUSIONS: Several significant associations were found which varied between the PRWs. Patients interested in the satisfaction of other patients with a physician might select a physician on the basis of online ratings. Even though our results indicate associations with some diabetes and asthma measures, but not with coronary heart disease measures, there is still insufficient evidence to draw strong conclusions. The limited number of practices in our study may have weakened our findings.

Disentangling Discrimination: The Impact of Political and Societal Discrimination on Democratic (Dis)Engagement

Thesis (Ph.D.)--University of Washington, 2016-08

Papel do PCT na diferenciação pedagógica e curricular de alunos com DEA/Dislexia

O presente estudo partiu de preocupações da prática relacionadas com o papel do PCT no desenvolvimento pedagógico e curricular sobretudo de alunos com dislexia. No sentido de se responder à pergunta de partida: “de que forma a diferenciação pedagógica e curricular dos alunos com DEA/Dislexia, é contemplada no PCT?” elaborou-se um quadro teórico onde se começou por discutir o papel da escola recorrendo inclusivamente à sua perspectivação histórica. Esta permitiu perceber a escola actual nomeadamente nas tensões entre os processos de massificação escolar conducentes a uma hegemonia do currículo e os processos de flexibilização curricular. O nosso interesse principal situou-se nestes últimos pela sua importância para a diferenciação curricular e pedagógica na sala de aula necessária para os alunos com dislexia. A formação dos professores desempenha neste contexto uma grande relevância, pelo que lhe atribuímos elevada importância. Utilizando como instrumentos de recolha inquéritos por questionário articulados com a análise dos PCTs inquirimos uma amostra de vinte e oito professores de um agrupamento de escolas do distrito de Santarém sobre a sua percepção face à dislexia e à importância dada à utilização do PCT. Os dados recolhidos e tratados permitiram verificar que nem os PCT são encarados como um instrumento de diferenciação curricular e pedagógica, resultando em algumas contradições entre o que se diz fazer e o que se faz efectivamente, nem a DEA/Dislexia é encarada como um problema, que apesar de real não se vê contemplada, de forma explícita nos PCT. Desta forma, consideramos que o estudo realizado (embora limitado no tempo e espaço) permite desvendar algumas das suas representações mostrando uma forte relação entre a ausência de formação e o impacto que esta lacuna tem nas práticas docentes.

Re-viewing history: antiquaries, the graphic arts and Scotland's lost geographies, c.1660-1820

This thesis examines topographical art depicting Scotland’s natural scenery and built environments, architecture, antiquities and signs of modern improvement, made during the period 1660 to 1820. It sets out to demonstrate that topography and topographical art was not exclusively antiquarian in nature, but ranged across various fields of learning and practice. It included the work of artists, geographers, cartographers, travel writers, poets, landscape gardeners, military surveyors, naturalists and historians who were concerned with representing the country’s varied, and often contentious, histories within an increasingly modernising present. The visual images that are considered here were forms of knowledge that found expression in drawings, paintings and engravings, elevations, views and plans. They were made on military surveys and picturesque tours, and were often intended to be included alongside written texts, both published and unpublished, frequently connecting with travels, tours, memoirs, essays and correspondence. It will also be argued that topography was a social practice, involving networks of artists, collectors, publishers and writers, who exchanged information in drawings and letters in a nationwide, and often increasingly commercial enterprise. This thesis will explore some of the strands of such a vast network of picture-making that existed in Scotland, and Britain, between 1660 and 1820, as visual images were circulated, copied, recycled and adapted, and topographical and antiquarian visual culture emerges as a complex, synoptic form of inquiry.

Aplicação do software EdiLim na sala de atividades em educação pré-escolar

Relatório de Estágio apresentado à Escola Superior de Educação do Instituto Politécnico de Castelo Branco para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Educação Pré-Escolar e Ensino do 1º Ciclo Básico.

A communication partner training program: Assessing conversational behaviors and attitudes towards communication in Persons with Aphasia and their Communication Partners

This study examined the conversational behaviors of eleven dyads consisting of a person with aphasia (PWA) and their familiar communication partner (CP), and investigated changes in behaviors as a result of attending a communication partner-training program CPT). Attitudes about communication were examined and related to conversational behaviors observed pre- and post- training. Results indicated that CPs and PWA used significantly more facilitating behaviors than barrier behaviors, although most dyads experienced some barriers. A comparison of pre-and post-CPT conversations revealed a significant interaction between time and type of behavior, with the increase in the number of facilitators approaching significance. Overall, persons with aphasia and their conversational partners expressed positive attitudes about communication. There were no significant correlations between scores on attitude surveys and behaviors pre or post-training. This study demonstrated that these dyads employed facilitative conversational behaviors even before CPT, and that facilitative behaviors can increase after a one-day training workshop.

A review on systematic and taxonomic of the Persian Gulf fish species, based on geographical distribution pattern and habitat diversity, using by GIS

During the period from 2011 - 2015 with the aim of this study was to systematically review and in particular the revised classification of the Persian Gulf (and the Strait of Hormuz) and to obtain new information about the final confirmed list of fish species of Iranian waters of the Persian Gulf (and Hormuz Strait), samples of museums, surveys and sampling, and comparative study of all available sources and documentation was done. Classification systematic of sharks and batoids and bony fishes. Based on the results, the final list of approved fish of the Persian Gulf (including the Strait of Hormuz and Gulf of Oman border region) are 907 species in 157 families, of which 93 species of fish with 28 cartilaginous families (including 18 families with 60 species and 10 families with 34 species of shark and batoids); and 129 families with 814 species of bony fishes are. The presence of 11 new family with only one representative species in the area include Veliferidae, Zeidae, Sebastidae, Stomiidae, Dalatiidae, Zanclidae, Pempheridae, Lophiidae Kuhliidae, Etmoptridae and Chlorophthalmidae also recently introduced and approved. The two families based Creediidae Clinidae and their larvae samples for newly identified area. 62 families with mono-species and 25 families with more than 10 species are present including Gobiidae (53), Carangide (48), Labride (41), Blenniidae (34), Apogonidae (32) and Lutjanidae (31) of bony fishes, Carcharhinidae (26) of sharks and Dasyatidae (12) in terms of number of species of batoids most families to have their data partitioning. Also, 13 species as well as endemic species introduced the Persian Gulf and have been approved in terms of geographical expansion of the Persian Gulf are unique to the area.Two species of the family Poeciliidae and Cyprinodontidae have species of fresh water to the brackish coastal habitats have found a way;in addition to 11 types of families Carcharhinidae, Clupeidae, Chanidae, Gobidae, Mugilidae, Sparidae also as a species, with a focus on freshwater river basins in the south of the country have been found. In this study, it was found that out of 907 species have been reported from the study area, 294 species (32.4 %) to benthic habitats (Benthic habitats) and 613 species (67.6 %) in pelagic habitats (Pelagic habitats) belong. Coral reefs and rocky habitats in the range of benthic fish (129 species - 14.3 %) and reef associated fishes in the range of pelagic fishes (432 species – 47.8 %), the highest number and percentage of habitat diversity (Species habitats) have been allocated. As well as fish habitats with sea grass and algae beds in benthic habitat (17 species- 1.9 %) and pelagic - Oceanic (Open sea) in the whole pelagic fish (30 species – 3.3 %), the lowest number and percentage of habitat diversity into account. From the perspective of animal geography (Zoogeography) and habitat overlaps and similarities (Habitat overlapping) fish fauna of the Persian Gulf compared with other similar seas (tropical and subtropical, and warm temperate) in the Indian Ocean area - calm on the surface, based on the presence of certain species that the fish fauna of the Persian Gulf to the Red Sea and the Bay of Bengal (East Arabian Sea) compared to other regions in the Indian Ocean (Pacific) is closer (about 50%), and the Mediterranean (East area) and The Hawaiian Islands have the lowest overlap and similarity of habitat and species (about 10%).

Biopsy case mix and diagnostic yield at a Malawian central hospital

Cancer is a major disease burden worldwide resulting in high morbidity and mortality. It is the leading cause of mortality in developed countries and is one of the three leading causes of death for adults in developing countries. Pathological examination of tissue biopsies with histological confirmation of a correct cancer diagnosis is central to cancer care. Without an accurate and specific pathologic diagnosis, effective treatment cannot be planned or delivered. In addition, there are marked geographical variations in incidence of cancer overall, and of the specific cancers seen. Much of the published literature on cancer incidence in developing countries reflects gross estimates and may not reflect reality. Performing baseline studies to understand these distributions lays the groundwork for further research in this area of cancer epidemiology. Our current study surveys and ranks cancer diagnoses by individual anatomical site at Queen Elizabeth Central Hospital (QECH) which is the largest teaching and referral hospital in Malawi. A retrospective study was conducted reviewing available pathology reports over a period of one full year from January 2010 to December 2010 for biopsies from patients suspected clinically of having cancer. There were 544 biopsies of suspected cancer, taken from 96 anatomical sites. The oesophagus was the most common biopsied site followed by breast, bladder, bone, prostate, bowel, and cervical lymph node. Malignancies were found in biopsies of the oesophagus biopsies (squamous cell carcinoma, 65.1%; adenocarcinoma, 11.6%), breast (57.5%), bladder (squamous cell carcinoma, 53.1%) and stomach (37.6%). Our study demonstrates that the yield of biopsy for clinically suspected malignancy was greater than 50% for the 11 most common sites and provides a current survey of cancer types by site present in the population reporting to our hospital.

The TOMO-ETNA experiment: an imaging active campaign at Mt. Etna volcano. Context, main objectives, working-plans and involved research projects

The TOMO-ETNA experiment was devised to image of the crust underlying the volcanic edifice and, possibly, its plumbing system by using passive and active refraction/reflection seismic methods. This experiment included activities both on-land and offshore with the main objective of obtaining a new high-resolution seismic tomography to improve the knowledge of the crustal structures existing beneath the Etna volcano and northeast Sicily up to Aeolian Islands. The TOMO ETNA experiment was divided in two phases. The first phase started on June 15, 2014 and finalized on July 24, 2014, with the withdrawal of two removable seismic networks (a Short Period Network and a Broadband network composed by 80 and 20 stations respectively) deployed at Etna volcano and surrounding areas. During this first phase the oceanographic research vessel “Sarmiento de Gamboa” and the hydro-oceanographic vessel “Galatea” performed the offshore activities, which includes the deployment of ocean bottom seismometers (OBS), air-gun shooting for Wide Angle Seismic refraction (WAS), Multi-Channel Seismic (MCS) reflection surveys, magnetic surveys and ROV (Remotely Operated Vehicle) dives. This phase finished with the recovery of the short period seismic network. In the second phase the Broadband seismic network remained operative until October 28, 2014, and the R/V “Aegaeo” performed additional MCS surveys during November 19-27, 2014. Overall, the information deriving from TOMO-ETNA experiment could provide the answer to many uncertainties that have arisen while exploiting the large amount of data provided by the cutting-edge monitoring systems of Etna volcano and seismogenic area of eastern Sicily.

The Catuspatha pattern in Balinese palace: architectural conservation and challenges

Balinese architecture was established prior to European colonization and significantly enhances traditional Balinese values that are woven into the predominant Hindu religion. Palaces are integral to the architectural heritage of Bali and were dated back to the Majapahit Empire. Balinese palaceswere constructed for non-ritualistic activities in this historical cultural landscape. Palaces were often located on road corners called catuspatha1andthey possess sacred values embodied in the concept of pempatanagung.Although Bali Province is today governed as one governance unit, these palaces still reflect their own multiple regal associations which arestill respected by Balinese society. The representations and architecture of these palaces andthe communicative symbols of a heyday era of Bali are raising questions as to how they can be accommodated within the over-arching tourism development and globalization of culture that Bali is experiencing. Therefore, this paper reviews pre-colonial Balinese palaces, their architecture, the catuspatha concept, and considers the traditional values of these ancient monuments as to conservation of palaces and their associated cultural heritage. An extensive literature review, surveys and observational inventories were undertaken at several palaces to obtain results that raise new questions about how these complexes can withstand globalization challenges whilst respecting traditional Balinese culture and society.

Changes in the rates of weight and waist circumference gain in Australian adults over time: a longitudinal cohort study

OBJECTIVE: To assess in a single cohort whether annual weight and waist circumference (WC) change has varied over time.

DESIGN: Longitudinal cohort study with three surveys (1) 1999/2000; (2) 2004/2005 and (3) 2011/2012. Generalised linear mixed models with random effects were used to compare annualised weight and WC change between surveys 1 and 2 (period 1) with that between surveys 2 and 3 (period 2). Models were adjusted for age to analyse changes with time rather than age. Models were additionally adjusted for sex, education status, area-level socioeconomic disadvantage, ethnicity, body mass index, diabetes status and smoking status.

SETTING: The Australian Diabetes, Obesity and Lifestyle study (AusDiab)-a population-based, stratified-cluster survey of 11247 adults aged ≥25 years. PARTICIPANTS: 3351 Australian adults who attended each of three surveys and had complete measures of weight, WC and covariates.

PRIMARY OUTCOME MEASURES: Weight and WC were measured at each survey. Change in weight and WC was annualised for comparison between the two periods.

RESULTS: Mean weight and WC increased in both periods (0.34 kg/year, 0.43 cm/year period 1; 0.13 kg/year, 0.46 cm/year period 2). Annualised weight gain in period 2 was 0.11 kg/year (95% CI 0.06 to 0.15) less than period 1. Lesser annual weight gain between the two periods was not seen for those with greatest area-level socioeconomic disadvantage, or in men over the age of 55. In contrast, the annualised WC increase in period 2 was greater than period 1 (0.07 cm/year, 95% CI 0.01 to 0.12). The increase was greatest in men aged 55+ years and those with a greater area-level socioeconomic disadvantage.

CONCLUSIONS: Between 2004/2005 and 2011/2012, Australian adults in a national study continued to gain weight, but more slowly than 1999/2000-2004/2005. While weight gain may be slowing, this was not observed for older men or those in more disadvantaged groups, and the same cannot be said for WC.

Successional specialization in a reptile community cautions against widespread planned burning and complete fire suppression

Summary: Conservation of biodiversity in fire-prone regions depends on understanding responses to fire in animal communities and the mechanisms governing these responses. We collated data from an Australian semi-arid woodland reptile community (4796 individuals captured over 6 years) to: (i) determine the ability of commonly used shorter-term (2 years) surveys to detect reptile responses to time since fire (TSF) and (ii) investigate whether ecological traits of species reliably predicted their responses to fire. Of 16 reptile species analysed, four had responses to TSF consistent with shorter-term surveys and three showed no response to TSF. Nine species had responses to TSF not detected in previous studies using smaller but substantial subsets of the same data. Among the 13 affected species, times of peak abundance ranged from 1 to 50 years after fire. Nocturnal, burrowing species tended to be early successional and leaf-litter dwellers to be late successional, but these were only weak trends. Synthesis and applications. We found only limited support for a generalizable, trait-based model of succession in reptiles. However, our study revealed that the majority of common reptile species in our study region specialize on a post-fire successional stage and may therefore become threatened if homogeneous fire regimes predominate. Our study highlights the importance of interpreting results from time- or sample-limited fire studies of reptiles with the knowledge that many ecological responses may not have been detected. In such cases, an adaptive or precautionary approach to fire management may be necessary. We found only limited support for a generalizable, trait-based model of succession in reptiles. However, our study revealed that the majority of common reptile species in our study region specialize on a post-fire successional stage and may therefore become threatened if homogeneous fire regimes predominate. Our study highlights the importance of interpreting results from time- or sample-limited fire studies of reptiles with the knowledge that many ecological responses may not have been detected. In such cases, an adaptive or precautionary approach to fire management may be necessary.

Transition to specialty practice program characteristics and professional development outcomes

BACKGROUND: Transition to Specialty Practice Programs was introduced to facilitate the transition of nurses to specialty practice, and is recognised as preparatory for emergency nurses. Emergency nursing Transition to Specialty Practice Programs and their characteristics have developed locally in response to unit needs. OBJECTIVE: The aim of this study was to examine the characteristics of emergency nursing Transition to Specialty Practice Programs in Australia, and identify which characteristics were associated with improved professional development outcomes. METHODS: An explanatory sequential design was used. Data were collected via online surveys and interviews of emergency Nurse Managers and Nurse Educators. Transition to Specialty Practice Program characteristics were compared using Mann Whitney U and Chi-Square tests. Content analysis was used to analyse qualitative data. RESULTS: Survey data were collected from 118 emergency departments, and 13 interviews were conducted. Transition to Specialty Practice Programs were offered in most emergency departments (n=80, 72.1%), with one or two intakes per year. Transition to Specialty Practice Program characteristics varied; duration ranged from 5-12months, clinical preparation time ranged from 7-22days, and the number of study days provided ranged from 2-6. When Transition to Specialty Practice Programs of 6 and 12months duration were compared, there was no difference in the content covered. Emergency departments with 12month Transition to Specialty Practice Programs had lower percentages of Clinical Specialists (9% vs 18%, p=0.03) and postgraduate qualified nurses (30.5% vs 43.8%, p=0.09). CONCLUSION: The target participants, duration and clinical preparation of Transition to Specialty Practice Programs participants varied, impeding workforce mobility and articulation to postgraduate study and there were no professional development advantages from longer programs. There is an urgent need for a nationally consistent, evidence-based and fiscally responsible approach to Transition to Specialty Practice Programs.

Relationship between executive functioning and symptoms of attention-deficit/hyperactivity disorder and autism spectrum disorder in 6-8 year old children

This study examined relationships between executive functioning (EF) and ADHD/ASD symptoms in 339 6-8 year-old children to characterise EF profiles associated with ADHD and ADHD + ASD. ADHD status was assessed using screening surveys and diagnostic interviews. ASD symptoms were measured using the Social Communication Questionnaire, and children completed assessments of EF. We found the EF profile of children with ADHD + ASD did not differ from ADHD-alone and that lower-order cognitive skills contributed significantly to EF. Dimensionally, ASD and inattention symptoms were differentially associated with EF, whereas hyperactivity symptoms were unrelated to EF. Differences between categorical and dimensional findings suggest it is important to use both diagnostic and symptom based approaches in clinical settings when assessing these children's functional abilities.

Beyond construction…..A cross-disciplinary approach to improved learning and teaching in built environment degrees

More than 3.4 million people die each year from water, sanitation and hygiene-related causes. Lack of access to clean water and sanitation kills those most vulnerable in the third world. Leadership in managing cross-disciplinary teams is required to present economical, viable community-based solutions. This project utilised the skills of undergraduates across different disciplines of construction, project management, engineering, design, and communication, to work alongside industry mentors in a team to design, build and present an innovative, sustainable water sanitation solution for a Bangladesh community. The semester-long project enabled undergraduate students to develop skills in client relationships, teamwork, and communication as well as discipline skills of project management and construction. The real-world problem necessitated a paradigm shift away from discipline-based knowledge transference towards skills for the future. The project utilised approaches such as negotiated curriculum and assessment; self-directed, flexible participation in learning; use of social media as a learning tool and cross-disciplinary teamwork. Results from student surveys and interviews indicate that this project directly enhanced students’ work-readiness skills and recognition of the importance of problem solving using cross-disciplinary understandings. Students reported greater self-confidence for tackling future workplace challenges. The results also illustrate strong levels of student satisfaction with the cross-disciplinary approach and the importance of skills in client relationships. The project and its outcomes have implications for how learning and teaching occurs in built environment disciplines and has the potential to create significant impact on the calibre of future built environment graduates.