Referral patterns in optometry: Use of secondary consultation/comanagement centers by optometrists

Privately practicing health care practitioners, such as physicians, dentists, and optometrists are facing increasing competitive pressures as the health care industry undergoes significant structural change. The eye care field has been affected by this change and one result has been the establishment of consultation/comanagement centers for optometrists. These centers, staffed primarily by an ophthalmologist, serve community optometrists as a secondary ophthalmic care center and are altering the traditional optometric - ophthalmologic referral system.^ This study was designed to examine the response of optometrists to the formation of a center by measuring the amount and type of optometric participation in a center and identifying factors affecting participation. A predictive model was specified to determine the probability of center use by practitioners.^ The results showed that the establishment of a center in a community did not result in its usage by all practitioners though there were specific practice (organizational) and practitioners (decision-maker) variables that could be used to predict use. Three practice variables and four practitioner variables were found to be important in influencing center use. ^

Democracy in the healthcare workplace: A critical perspective

A review of existing literature revealed at least two distinct theoretical perspectives or schools of thought which are troubled by problems of the lack of participation in the workplace: Jurgen Habermas' ideal of communicative rationality (1984; 1987); and the field of workplace democracy. Whereas Habermas' ideal of communicative rationality establishes communication as necessary to attain a democratic workplace, the ideal of workplace democracy focuses on a participatory ideal in which conditions of open participation must be fulfilled in order to attain a democratic workplace. This study compared the strengths and weaknesses of the conditions proposed by Habermas with the strengths and weaknesses of the conditions selected to represent the workplace democracy ideal. Two incidents were selected for analysis which occurred within a period of one year within one large healthcare organization. The author was present as a participant-observer to assess these incidents. Each of the conditions for the ideal of communicative rationality and for the workplace democracy ideal was systematically applied to both incidents selected for analysis. The results of the analysis suggested that application of Habermas' theory provided more insight into potential distortions in communication than did the conditions selected to represent workplace democracy. Although the conditions of both models were frequently complementary and even overlapping at times, application of each theory to the same incident produced distinctly different results. ^

Sea ice cover, and bottom water and sediment characteristics at stations in the Amundsen Gulf, Canada

Seasonal dynamics in the activity of Arctic shelf benthos have been the subject of few local studies, and the pronounced among-site variability characterizing their results makes it difficult to upscale and generalize their conclusions. In a regional study encompassing five sites at 100-595 m water depth in the southeastern Beaufort Sea, we found that total pigment concentrations in surficial sediments, used as proxies of general food supply to the benthos, rose significantly after the transition from ice-covered conditions in spring (March-June 2008) to open-water conditions in summer (June-August 2008), whereas sediment Chl a concentrations, typical markers of fresh food input, did not. Macrobenthic biomass (including agglutinated foraminifera >500 µm) varied significantly among sites (1.2-6.4 g C/m**2 in spring, 1.1-12.6 g C/m**2 in summer), whereas a general spring-to-summer increase was not detected. Benthic carbon remineralisation also ranged significantly among sites (11.9-33.2 mg C/m**2/day in spring, 11.6-44.4 mg C/m**2/day in summer) and did in addition exhibit a general significant increase from spring-to-summer. Multiple regression analysis suggests that in both spring and summer, sediment Chl a concentration is the prime determinant of benthic carbon remineralisation, but other factors have a significant secondary influence, such as foraminiferan biomass (negative in both seasons), water depth (in spring) and infaunal biomass (in summer). Our findings indicate the importance of the combined and dynamic effects of food supply and benthic community patterns on the carbon remineralisation of the polar shelf benthos in seasonally ice-covered seas.

Radiochemical analyses and contents of organic carbon and CaCO3 in equatorial Pacific Ocean sediments

Uranium series nuclide concentrations have been measured on sediments from five box cores from an equatorial Pacific transect. 230Thexcess activities show discontinuities at the Holocene-glacial boundary as dated by 14C. The glacial sedimentation rates determined by 230Th and 14C are 2.5-3.0 cm/kyr. The Holocene rates from 230Th are much lower than those dated by 14C (1.9-2.3 cm/kyr) because of carbonate dissolution. 230Th sedimentation fluxes exceed water column supply by factors of 1.2-1.8 in the Holocene and 1.8-3.0 in the glacial sections. A number of models have been applied to calculate carbonate dissolution rates. The results show that carbonate dissolution rates in the Holocene (in g/cm**2 kyr) equal 1.5 * 10**-3 exp (1.4D) where D is water depth in kilometers. A point-by- point estimation of sediment fluxes through time show that clay accumulation rates in the area have been near constant at 0.1-0.2 g/cm**2 kyr over the past 20 kyr whereas carbonate accumulation rates have decreased dramatically from 0.6-1.0 g/cm**2 kyr in the glacial sections of the cores to 0.2-0.6 g/cm**2 kyr in the Holocene. The errors caused by the uncertainties in the age of the termination of the last glacial period have been investigated and results show that a range of 11-14 kyr leads to an error upper limit of about 30% in the estimation of CaCO3 dissolution rates. The response time of CaCO3 and 230Thex concentrations in the mixed layer of sediments due to an impulse of change in CaCO3 dissolution rate has also been discussed, showing that the observed changes in carbonate dissolution may be explained in terms of a single or a continuous change, depending upon the thickness of the mixed layer.

Spores, pollen and dinoflagellates in Cretaceous sediments of ODP Hole 129-802A

Lower Cretaceous and Jurassic sediments from Ocean Drilling Program Leg 129 (Sites 800, 801, and 802) and Deep Sea Drilling Project Sites 167, 195, 196, and 463 were analyzed for palynomorphs. In contrast to Atlantic occurrences, all Cretaceous pelagic sediments at these sites in the Pacific are barren of preserved palynomorphs. This absence of palynomorphs appears to be independent of facies, sedimentation rate, paleodepth, and paleolatitude. Except for one sample, the dinocyst-bearing sediments also contain spores and pollen grains. The only palynomorphs observed were in redeposited material having sources near former emergent seamounts. Among the dinoflagellate cysts at Site 802, Dingodinium cerviculum, Odontochitina operculata, Canninginopsis colliveri, and Oligosphaeridium complex are the most important species. Based on the presence of these species and their known biostratigraphic ranges, this basal interval of Site 802 is considered to be Aptian/earliest Albian in age. The lack of dinocysts within the Pacific pelagic sediments may be the result of ubiquitous oxygenated bottom waters throughout the Cretaceous or may indicate that open-marine dinoflagellate populations in this ocean did not produce cysts.

Artificial oxygen fluxes measured by the eddy correlation method using stirring-sensitive oxygen microsensor and oxygen optodes in a flume experiment

In the last decade, the aquatic eddy correlation (EC) technique has proven to be a powerful approach for non-invasive measurements of oxygen fluxes across the sediment water interface. Fundamental to the EC approach is the correlation of turbulent velocity and oxygen concentration fluctuations measured with high frequencies in the same sampling volume. Oxygen concentrations are commonly measured with fast responding electrochemical microsensors. However, due to their own oxygen consumption, electrochemical microsensors are sensitive to changes of the diffusive boundary layer surrounding the probe and thus to changes in the ambient flow velocity. The so-called stirring sensitivity of microsensors constitutes an inherent correlation of flow velocity and oxygen sensing and thus an artificial flux which can confound the benthic flux determination. To assess the artificial flux we measured the correlation between the turbulent flow velocity and the signal of oxygen microsensors in a sealed annular flume without any oxygen sinks and sources. Experiments revealed significant correlations, even for sensors designed to have low stirring sensitivities of ~0.7%. The artificial fluxes depended on ambient flow conditions and, counter intuitively, increased at higher velocities because of the nonlinear contribution of turbulent velocity fluctuations. The measured artificial fluxes ranged from 2 - 70 mmol m**-2 d**-1 for weak and very strong turbulent flow, respectively. Further, the stirring sensitivity depended on the sensor orientation towards the flow. Optical microsensors (optodes) that should not exhibit a stirring sensitivity were tested in parallel and did not show any significant correlation between O2 signals and turbulent flow. In conclusion, EC data obtained with electrochemical sensors can be affected by artificial flux and we recommend using optical microsensors in future EC-studies. Flume experiments were conducted in February 2013 at the Institute for Environmental Sciences, University of Koblenz-Landau Landau. Experiments were performed in a closed oval-shaped acrylic glass flume with cross-sectional width of 4 cm and height of 10 cm and total length of 54 cm. The fluid flow was induced by a propeller driven by a motor and mean flow velocities of up to 20 cm s-1 were generated by applying voltages between 0 V and 4 V DC. The flume was completely sealed with an acrylic glass cover. Oxygen sensors were inserted through rubber seal fittings and allowed positioning the sensors with inclinations to the main flow direction of ~60°, ~95° and ~135°. A Clark type electrochemical O2 microsensor with a low stirring sensitivity (0.7%) was tested and a fast-responding needle-type O2 optode (PyroScience GmbH, Germany) was used as reference as optodes should not be stirring sensitive. Instantaneous three-dimensional flow velocities were measured at 7.4 Hz using stereoscopic particle image velocimetry (PIV). The velocity at the sensor tip was extracted. The correlation of the fluctuating O2 sensor signals and the fluctuating velocities was quantified with a cross-correlation analysis. A significant cross-correlation is equivalent to a significant artificial flux. For a total of 18 experiments the flow velocity was adjusted between 1.7 and 19.2 cm s**-1, and 3 different orientations of the electrochemical sensor were tested with inclination angles of ~60°, ~95° and ~135° with respect to the main flow direction. In experiments 16-18, wavelike flow was induced, whereas in all other experiments the motor was driven by constant voltages. In 7 experiments, O2 was additionally measured by optodes. Although performed simultaneously with the electrochemical sensor, optode measurements are listed as separate experiments (denoted by the attached 'op' in the filename), because the velocity time series was extracted at the optode tip, located at a different position in the flume.

Sampling data, experimental data and fecal pellet characteristics of water pump samples in the strait of Øresund between Denmark and Sweden during 2004/2005

Copepod fecal pellets are often degraded at high rates within the upper part of the water column. However, the identity of the degraders and the processes governing the degradation remain unresolved. To identify the pellet degraders we collected water from Øresund (Denmark) approximately every second month from July 2004 to July 2005. These water samples were divided into 5 fractions (<0.2, <2, <20, <100, <200 µm) and total (unfractionated). We determined fecal pellet degradation rate and species composition of the plankton from triplicate incubations of each fraction and a known, added amount of fecal pellets. The total degradation rate of pellets by the natural plankton community of Øresund followed the phytoplankton biomass, with maximum degradation rate during the spring bloom (2.5 ± 0.49 d**-1) and minimum (0.52 ± 0.14 d**-1) during late winter. Total pellet removal rate ranged from 22% d**-1 (July 2005) to 87% d**-1 (May). Protozooplankton (dinoflagellates and ciliates) in the size range of 20 to 100 µm were the key degraders of the fecal pellets, contributing from 15 to 53% of the total degradation rate. Free-living in situ bacteria did not affect pellet degradation rate significantly; however, culture-originating bacteria introduced in association with the pellets contributed up to 59% of the total degradation rate. An effect of late-stage copepod nauplii (>200 µm) was indicated, but this was not a dominating degradation process. Mesozooplankton did not contribute significantly to the degradation. However, grazing of mesozooplankton on the pellet degraders impacts pellet degradation rate indirectly. In conclusion, protozooplankton seems to include the key organisms for the recycling of copepod fecal pellets in the water column, both through the microbial loop and, especially, by functioning as an effective 'protozoan filter' for fecal pellets.

Crustaceans and fish abundances and species at and around artificially introduced tetrapod fields in the southern North Sea, 2009

The micro-scale spatial distribution patterns of a demersal fish and decapod crustacean assemblage were assessed in a hard-bottom kelp environment in the southern North Sea. Using quadrats along line transects, we assessed the in situ fish and crustacean abundance in relation to substratum types (rock, cobbles and large pebbles) and the density of algae. Six fish and four crustacean species were abundant, with Ctenolabrus rupestris clearly dominating the fish community and Galathea squamifera dominating the crustacean community. Differences in the substratum types had an even stronger effect on the micro-scale distribution than the density of the dominating algae species. Kelp had a negative effect on the fish abundances, with significantly lower average densities in kelp beds compared with adjacent open areas. Averaged over all of the substrata, the most attractive substratum for the fish was large pebbles. In contrast, crustaceans did not show a specific substratum affinity. The results clearly indicate that, similar to other complex systems, significant micro-scale species-habitat associations occur in northern hard-bottom environments. However, because of the frequently harsh environmental conditions, these habitats are mainly sampled from ships with sampling gear, and the resulting data cannot be used to resolve small-scale species-habitat associations. A detailed substratum classification and community assessment, often only possible using SCUBA diving, is therefore important to reach a better understanding of the functional relationships between species and their environment in northern temperate waters, knowledge that is very important with respect to the increasing environmental pressure caused by global climate change.

At surface behaviour at location on spot of southern elephant seals from Marion Island in 2004 with links to datasets

A novel classification system was applied to the sea level anomaly (SLA) environment around Marion Island. We classified the SLA seascape into habitat types and calculated percentage of habitat use of ten juvenile southern elephant seals (SES). Movements were compared to SLA and SLA slope values indicative of ocean eddy features. This classification provides a measure of habitat change due to seasonal fluctuations in SLA. Some of the seals made two migrations in different seasons, each of similar duration and proportions of potential foraging behaviour. The seals in this study did not use any intense eddy features, but their behaviours varied with SLA class. Potential foraging behaviour was positively influenced by negative SLA values (i.e. areas of below average sea surface height). Searching behaviour during the winter was more likely at eddy edges where high SLA slope values correlated with low SLA values. Though the seals did not forage within newly spawned eddies, they did forage near the sub-Antarctic front. Plankton and other biological resources transported by eddies formed at the subtropical convergence zone are evidently concentrated in this region and enhance the food chain there, forming a foraging ground for juvenile SES from Marion Island.

Partition, independence, and population geography in Bengal

This study quantitatively explores the changing population geography in Bengal, with a particular focus on Partition in India in 1947 and Independence of Bangladesh in 1971. Based on decadal census data from 1901 to 2001 at the district level, this paper explores how trends in regional population growth evolved with such historical events. Following Redding and Sturm (2008), Differences-in-Differences estimation is also employed. Estimation results show that there were different shocks on both sides and from both events. In West Bengal, the change in the regional population trends occurred in 1947 and remained similar thereafter. On the other hand, in East Bengal, the population growth became statistically significant after 1971. Further robustness checks show that the impacts were not uniform with respect to the distance from the border. Overall analyses show that the emergence of the international border in Bengal had asymmetric impacts on both sides.

Impacts of tertiary canal irrigation -- impact evaluation of an infrastructure project

We estimate the economic impacts of irrigation using the panel data set from rural Thailand. We employed difference-in-differences estimation and showed that tertiary irrigation has unexpected impacts. Contrary to the local experts predicitions that it should have substantial productivity impacts as it allows better water controls for farmers, we found largely zero profitability impacts. Another unexpected finding is that, while profitability is not affected, we see an increase in cultivation probability with the construction of tertiary canals. This is observed in both wet and dry seasons. This finding suggests that Thai farmers are willing to expand operation scale once they get water.

Soil water availability modulation over estimated relative yield losses in wheat (Triticum aestivum L.) due to ozone exposure

The approach developed by Fuhrer in 1995 to estimate wheat yield losses induced by ozone and modulated by the soil water content (SWC) was applied to the data on Catalonian wheat yields. The aim of our work was to apply this approach and adjust it to Mediterranean environmental conditions by means of the necessary corrections. The main objective pursued was to prove the importance of soil water availability in the estimation of relative wheat yield losses as a factor that modifies the effects of tropospheric ozone on wheat, and to develop the algorithms required for the estimation of relative yield losses, adapted to the Mediterranean environmental conditions. The results show that this is an easy way to estimate relative yield losses just using meteorological data, without using ozone fluxes, which are much more difficult to calculate. Soil water availability is very important as a modulating factor of the effects of ozone on wheat; when soil water availability decreases, almost twice the amount of accumulated exposure to ozone is required to induce the same percentage of yield loss as in years when soil water availability is high.

On-board and Ground Visual Pose Estimation Techniques for UAV Control

In this paper, two techniques to control UAVs (Unmanned Aerial Vehicles), based on visual information are presented. The first one is based on the detection and tracking of planar structures from an on-board camera, while the second one is based on the detection and 3D reconstruction of the position of the UAV based on an external camera system. Both strategies are tested with a VTOL (Vertical take-off and landing) UAV, and results show good behavior of the visual systems (precision in the estimation and frame rate) when estimating the helicopter¿s position and using the extracted information to control the UAV.

Simulation of academic performance rates, estimation of indicators of subjects and of a complete degree

The purpose of this paper is to present a program written in Matlab-Octave for the simulation of the time evolution of student curricula, i.e, how students pass their subjects along time until graduation. The program computes, from the simulations, the academic performance rates for the subjects of the study plan for each semester as well as the overall rates, which are a) the efficiency rate defined as the ratio of the number of students passing the exam to the number of students who registered for it and b) the success rate, defined as the ratio of the number of students passing the exam to the number of students who not only registered for it but also actually took it. Additionally, we compute the rates for the bachelor academic degree which are established for Spain by the National Quality Evaluation and Accreditation Agency (ANECA) and which are the graduation rate (measured as the percentage of students who finish as scheduled in the plan or taking an extra year) and the efficiency rate (measured as the percentage of credits which a student who graduated has really taken). The simulation is done in terms of the probabilities of passing all the subjects in their study plan. The application of the simulator to Polytech students in Madrid, where requirements for passing are specially stiff in first and second year subjects, is particularly relevant to analyze student cohorts and the probabilities of students finishing in the minimum of four years, or taking and extra year or two extra years, and so forth. It is a very useful tool when designing new study plans. The calculation of the probability distribution of the random variable "number of semesters a student has taken to complete the curricula and graduate" is difficult or even unfeasible to obtain analytically, and this is even truer when we incorporate uncertainty in parameter estimation. This is why we apply Monte Carlo simulation which not only provides illustration of the stochastic process but also a method for computation. The stochastic simulator is proving to be a useful tool for identification of the subjects most critical in the distribution of the number of semesters for curriculum vitae (CV) completion and subsequently for a decision making process in terms of CV planning and passing standards in the University. Simulations are performed through a graphical interface where also the results are presented in appropriate figures. The Project has been funded by the Call for Innovation in Education Projects of Universidad Politécnica de Madrid (UPM) through a Project of its school Escuela Técnica Superior de Ingenieros Industriales ETSII during the period September 2010-September 2011.

Development of a 3-Dimensional Mathematical Collision Risk Model Based on Recorded Aircraft Trajectories to Estimate the Safety Level in High Density En-Route Airspaces

Como en todos los medios de transporte, la seguridad en los viajes en avión es de primordial importancia. Con los aumentos de tráfico aéreo previstos en Europa para la próxima década, es evidente que el riesgo de accidentes necesita ser evaluado y monitorizado cuidadosamente de forma continúa. La Tesis presente tiene como objetivo el desarrollo de un modelo de riesgo de colisión exhaustivo como método para evaluar el nivel de seguridad en ruta del espacio aéreo europeo, considerando todos los factores de influencia. La mayor limitación en el desarrollo de metodologías y herramientas de monitorización adecuadas para evaluar el nivel de seguridad en espacios de ruta europeos, donde los controladores aéreos monitorizan el tráfico aéreo mediante la vigilancia radar y proporcionan instrucciones tácticas a las aeronaves, reside en la estimación del riesgo operacional. Hoy en día, la estimación del riesgo operacional está basada normalmente en reportes de incidentes proporcionados por el proveedor de servicios de navegación aérea (ANSP). Esta Tesis propone un nuevo e innovador enfoque para evaluar el nivel de seguridad basado exclusivamente en el procesamiento y análisis trazas radar. La metodología propuesta ha sido diseñada para complementar la información recogida en las bases de datos de accidentes e incidentes, mediante la provisión de información robusta de los factores de tráfico aéreo y métricas de seguridad inferidas del análisis automático en profundidad de todos los eventos de proximidad. La metodología 3-D CRM se ha implementado en un prototipo desarrollado en MATLAB © para analizar automáticamente las trazas radar y planes de vuelo registrados por los Sistemas de Procesamiento de Datos Radar (RDP) e identificar y analizar todos los eventos de proximidad (conflictos, conflictos potenciales y colisiones potenciales) en un periodo de tiempo y volumen del espacio aéreo. Actualmente, el prototipo 3-D CRM está siendo adaptado e integrado en la herramienta de monitorización de prestaciones de Aena (PERSEO) para complementar las bases de accidentes e incidentes ATM y mejorar la monitorización y proporcionar evidencias de los niveles de seguridad. ABSTRACT As with all forms of transport, the safety of air travel is of paramount importance. With the projected increases in European air traffic in the next decade and beyond, it is clear that the risk of accidents needs to be assessed and carefully monitored on a continuing basis. The present thesis is aimed at the development of a comprehensive collision risk model as a method of assessing the European en-route risk, due to all causes and across all dimensions within the airspace. The major constraint in developing appropriate monitoring methodologies and tools to assess the level of safety in en-route airspaces where controllers monitor air traffic by means of radar surveillance and provide aircraft with tactical instructions lies in the estimation of the operational risk. The operational risk estimate normally relies on incident reports provided by the air navigation service providers (ANSPs). This thesis proposes a new and innovative approach to assessing aircraft safety level based exclusively upon the process and analysis of radar tracks. The proposed methodology has been designed to complement the information collected in the accident and incident databases, thereby providing robust information on air traffic factors and safety metrics inferred from the in depth assessment of proximate events. The 3-D CRM methodology is implemented in a prototype tool in MATLAB © in order to automatically analyze recorded aircraft tracks and flight plan data from the Radar Data Processing systems (RDP) and identify and analyze all proximate events (conflicts, potential conflicts and potential collisions) within a time span and a given volume of airspace. Currently, the 3D-CRM prototype is been adapted and integrated in AENA’S Performance Monitoring Tool (PERSEO) to complement the information provided by the ATM accident and incident databases and to enhance monitoring and providing evidence of levels of safety.