Characteristics of primary care office visits to nurse practitioners, physician assistants and physicians in United States Veterans Health Administration facilities, 2005 to 2010: a retrospective cross-sectional analysis.

UNLABELLED: BACKGROUND: Primary care, an essential determinant of health system equity, efficiency, and effectiveness, is threatened by inadequate supply and distribution of the provider workforce. The Veterans Health Administration (VHA) has been a frontrunner in the use of nurse practitioners (NPs) and physician assistants (PAs). Evaluation of the roles and impact of NPs and PAs in the VHA is critical to ensuring optimal care for veterans and may inform best practices for use of PAs and NPs in other settings around the world. The purpose of this study was to characterize the use of NPs and PAs in VHA primary care and to examine whether their patients and patient care activities were, on average, less medically complex than those of physicians. METHODS: This is a retrospective cross-sectional analysis of administrative data from VHA primary care encounters between 2005 and 2010. Patient and patient encounter characteristics were compared across provider types (PA, NP, and physician). RESULTS: NPs and PAs attend about 30% of all VHA primary care encounters. NPs, PAs, and physicians fill similar roles in VHA primary care, but patients of PAs and NPs are slightly less complex than those of physicians, and PAs attend a higher proportion of visits for the purpose of determining eligibility for benefits. CONCLUSIONS: This study demonstrates that a highly successful nationwide primary care system relies on NPs and PAs to provide over one quarter of primary care visits, and that these visits are similar to those of physicians with regard to patient and encounter characteristics. These findings can inform health workforce solutions to physician shortages in the USA and around the world. Future research should compare the quality and costs associated with various combinations of providers and allocations of patient care work, and should elucidate the approaches that maximize quality and efficiency.

The reminiscence bump in the temporal distribution of the best football players of all time: Pel��, Cruijff or Maradona?

The reminiscence bump is the tendency to recall more autobiographical memories from adolescence and early adulthood than from adjacent lifetime periods. In this online study, the robustness of the reminiscence bump was examined by looking at participants' judgements about the quality of football players. Dutch participants (N = 619) were asked who they thought the five best players of all time were. The participants could select the names from a list or enter the names when their favourite players were not on the list. Johan Cruijff, Pel��, and Diego Maradona were the three most often mentioned players. Participants frequently named football players who reached the midpoint of their career when the participants were adolescents (mode = 17). The results indicate that the reminiscence bump can also be identified outside the autobiographical memory domain.

Differential Scanning Calorimetry Study and Computer Modeling of b a Phase Transformation in Ti-6Al-4V Alloy

The relationship between heat-treatment parameters and microstructure in titanium alloys has so far been mainly studied empirically, using characterization techniques such as microscopy. Calculation and modeling of the kinetics of phase transformation have not yet been widely used for these alloys. Differential scanning calorimetry (DSC) has been widely used for the study of a variety of phase transformations. There has been much work done on the calculation and modeling of the kinetics of phase transformations for different systems based on the results from DSC study. In the present work, the kinetics of the transformation in a Ti-6Al-4V titanium alloy were studied using DSC, at continuous cooling conditions with constant cooling rates of 5 ��C, 10 ��C, 20 ��C, 30 ��C, 40 ��C, and 50 ��C/min. The results from calorimetry were then used to trace and model the transformation kinetics in continuous cooling conditions. Based on suitably interpreted DSC results, continuous cooling���transformation (CCT) diagrams were calculated with lines of isotransformed fraction. The kinetics of transformation were modeled using the Johnson���Mehl���Avrami (JMA) theory and by applying the "concept of additivity." The JMA kinetic parameters were derived. Good agreement between the calculated and experimental transformed fractions is demonstrated. Using the derived kinetic parameters, the transformation in a Ti-6Al-4V alloy can be described for any cooling path and condition. An interpretation of the results from the point of view of activation energy for nucleation is also presented.

The ���re-socialization��� of Gypsy women in the literacy courses aimed to the recipients of the Social Integration Revenue Policy of the Region of Madrid

This article studies the gender values that are promoted both in the literacy courses for gypsy women beneficiaries of the Social Integration Revenue Policy of the Region of Madrid and in the events that are organized for this group by public institutions and NGOs. The process of ���socialization��� that occurs in the educative groups for Gypsy women is focused on constructing an image of what it is to be a ���Gypsy modern woman���. Through multiple mechanisms and discursive techniques a specific conception of gender equality is transmitted in these educative spaces. In addition to this, Gypsy women are continually urged to assume certain values and social practices (of gender identity, of "citizenship", of parenting, etc..), while an archetype of "Gypsy Woman" which condenses powerful stereotypes and prejudices about the "Gypsy culture" and the gender relations characteristics of this group is constructed.

The Rhetorical Construction of Corporate Logos

This research is set in the context of today���s societies, in which the corporate visual symbology of a business, corporation or institution constitutes an essential way to transmit its corporate image. Traditional discursive procedures can be discovered in the development of these signs. The rhetorical strategies developed by the great classical authors appear in the logo-symbols expressing the corporate values of today���s companies. Thus, rhetoric is emerging once again in the sense it had many centuries ago: A repertory of rules that, paradoxically, standardizes the deviations of language and whose control is synonymous with power. The main objective of this study is to substantiate the rhetorical construction of logos using as a model of analysis the classical process of creating discourse. This involves understanding logos as persuasive discourses addressed to a modern audience. Our findings show that the rhetorical paradigm can be considered as a creative model for the con��struction of an original logo consistent with a company���s image.

From Counter-terrorism to Criminal Justice: Transformation or Business as Usual?

The article explores the extent to which criminal justice in Northern Ireland has been reconstructed over the past fifteen years. The focus is on the framework provided in the Good Friday Agreement (1998) and the range of transition processes that followed. Post-Agreement Inquiries are reviewed and the findings demonstrate the institutional rigidities facing the transformation of criminal justice. While the ideologies and practices of counter-terrorism no longer dominate the business of criminal justice, the extent of change in terms of social representativeness, scale and expenditure is variable, with the prison service proving the least changed.

Construction Dispute Resolution in Ireland during Recession: Best Practice for Small-to-Medium Enterprises

The purpose of this paper is to identify best practice construction dispute resolution in small-to-medium enterprises (SMEs) within Ireland during the recent economic recession. A sequential mixed methodology encompassing a detailed literature review, case studies, and questionnaire survey is adopted, with results analyzed using both exploratory (data reduction) and confirmatory (structural equation modelling) factor analysis. The results show that four core aspects should be adopted by SMEs to achieve best practice construction dispute resolution in recession: third-party intervention, adoption of a streamlined process, proactive party characteristics, and the use of legal professionals. Numerous studies of this subject have been conducted; however, no research has been done to date documenting best practice in construction dispute resolution within SMEs, particularly in light of the economic recession in Ireland. It is clear that dispute resolution in Ireland is currently undergoing fundamental changes, and time is necessary to see if the new Construction Contracts Act 2013 will help this practice. Therefore, it is a fundamental requirement for project management and legal professionals to acknowledge the changing environment attributable to the economic downturn and the resultant SME best practices in dispute resolution. This paper fulfills a gap in knowledge with the emergence of the economic recession and the evolution of best practice in dispute resolution within SMEs in the Irish construction sector.<br/><br/>

Perceptions of the Nurse Practitioner Role in Facilitating the Implementation of an Onsite Pain Management Team in Long Term Care

Background: One strategy to improve pain management in long term care (LTC) is to optimize the emerging role of the nurse practitioner (NP) in LTC. The purpose of this sub study was to learn about the NP role in implementing an onsite, interdisciplinary Pain Team in the LTC home setting.<br/><br/>Methods: We used a case study design that included two NPs who worked at separate LTC homes. Each of the NPs completed a weekly questionnaire of pain-related activities that they engaged in over a one-year implementation period; and a diary, using critical reflection, about their experiences and strategies used to implement the Pain Team. Descriptive statistics and thematic content analysis were used to analyze the case study data.<br/><br/>Findings: NPs tended to be most engaged in pain assessment and collaborated more with licensed nurses and personal support workers; less with pharmacists. NPs were more involved in organizational level activities, such as participating in committee work or assisting with the development of policies and procedures about pain. NPs created palliative care and pain service protocols; engaged in policy development, in-servicing, quality assurance and advocacy; and encouraged best practices. NPs were challenged with time constraints for pain management and balancing other role priorities and felt that increased scope of practice for them was needed.<br/><br/>Conclusions: The results of this study highlight how NPs implemented a Pain Team in LTC which may be helpful to others interested in implementing a similar strategy to reduce residents��� pain.

Prospective clinical audit of chloral hydrate administration practices in a neonatal unit

<p>Aim: Chloral hydrate is generally considered a safe and effective single dosing procedural sedative for neonates in the clinical setting. However, its safety profile as a repetitive dosing maintenance sedative is largely unknown. This study aimed to document current administration practices of chloral hydrate in the Neonatal Unit, Royal Children's Hospital, Melbourne, Australia, over a 6-month period.</p><p>Methods: Patients who had been prescribed chloral hydrate during the specified audit period were recruited into the study and prospectively followed for a period of 28 days, or until they were discharged from the unit. Demographic data were collected on recruitment, and daily documentation of chloral hydrate administration was recorded.</p><p>Results: A total of 238 doses of chloral hydrate were administered to a cohort of 32 patients during the study period. The majority of the audited doses (84%) were ordered as repeating doses. Doses were more likely to be given at night than during the day, and the median dosage for repetitive dosing was found to be above the study site's recommended dosing range. Pre-dose and/or post-dose assessment of distress/agitation accompanied dosage approximately half of the time. The audit did not reveal any recognisable pattern of sedation maintenance or weaning process for patients who received multiple doses.</p><p>Conclusions: Health-care professionals caring for hospitalised infants should be made aware of the potential risks of chloral hydrate as a repetitive dosing sedative, and of the importance of systematically evaluating the appropriateness and effectiveness of utilising such pharmacological intervention for managing and treating distress.</p>

Transitional justice, demobilization, and peacebuilding amid political violence: Examining individual preferences in the Caribbean coast of Colombia

The conventional wisdom in the transitional justice literature is that there is no one-size-fits-all approach. This article suggests that this may also be true within a given state. The current paper reports on quantitative and qualitative data from 184 participants in a survey conducted in the Caribbean coast of Colombia. Results suggest widespread support for transitional justice mechanisms ��� such as perpetrator accountability, public acknowledgement and structural change ��� but dissatisfaction with national-level initiatives, specifically the 2005 Justice and Peace Law. Yet, despite a distrust of the national government and protracted conflict, individuals report social trust, community cohesion and reliance on local government institutions. These attitudes and behaviours suggest that decentralised transitional justice mechanisms may be more effective in meeting victims' needs. Moreover, analyses indicate that individual preferences are influenced by community factors, such as the presence of demobilised paramilitaries, which can be addressed through more localised approaches to promote peacebuilding. The paper concludes with best practices derived from the findings.

Knowledge translation in men���s health research: development and delivery of content for use online

Background: Men can be hard to reach with face-to-face health-related information, while increasingly, research shows that they are seeking health information from online sources. Recognizing this trend, there is merit in developing innovative online knowledge translation (KT) strategies capable of translating research on men���s health into engaging health promotion materials. While the concept of KT has become a new mantra for researchers wishing to bridge the gap between research evidence and improved health outcomes, little is written about the process, necessary skills, and best practices by which researchers can develop online knowledge translation.<br/>Objective: Our aim was to illustrate some of the processes and challenges involved in, and potential value of, developing research knowledge online to promote men���s health.<br/><br/>Methods: We present experiences of KT across two case studies of men���s health. First, we describe a study that uses interactive Web apps to translate knowledge relating to Canadian men���s depression. Through a range of mechanisms, study findings were repackaged with the explicit aim of raising awareness and reducing the stigma associated with men���s depression and/or help-seeking. Second, we describe an educational resource for teenage men about unintended pregnancy, developed for delivery in the formal Relationship and Sexuality Education school curricula of Ireland, Northern Ireland (United Kingdom), and South Australia. The intervention is based around a Web-based interactive film drama entitled ���If I Were Jack���.<br/><br/>Results: For each case study, we describe the KT process and strategies that aided development of credible and well-received online content focused on men���s health promotion. In both case studies, the original research generated the inspiration for the interactive online content and the core development strategy was working with a multidisciplinary team to develop this material through arts-based approaches. In both cases also, there is an acknowledgment of the need for gender and culturally sensitive information. Both aimed to engage men by disrupting stereotypes about men, while simultaneously addressing men through authentic voices and faces. Finally, in both case studies we draw attention to the need to think beyond placement of content online to delivery to target audiences from the outset.<br/><br/>Conclusions: The case studies highlight some of the new skills required by academics in the emerging paradigm of translational research and contribute to the nascent literature on KT. Our approach to online KT was to go beyond dissemination and diffusion to actively repackage research knowledge through arts-based approaches (videos and film scripts) as health promotion tools, with optimal appeal, to target male audiences. Our findings highlight the importance of developing a multidisciplinary team to inform the design of content, the importance of adaptation to context, both in terms of the national implementation context and consideration of gender-specific needs, and an integrated implementation and evaluation framework in all KT work.

Religion, pragmatic fundamentalism and the transformation of the Northern Ireland conflict

<p>Since 11 September 2001, the religious dimension of conflict has been the focus of increasing attention. In The Clash of Civilizations, Huntington has identified the West in religious-cultural terms, as Christian with a dominant democratic culture emphasizing tolerance, moderation and consensus. The persistence of conflict in Northern Ireland among 'White' Protestant and Catholic Christians undermines this simplistic argument and demands a more subtle understanding of the role of religion and fundamentalism in contemporary conflict. Modernization theory - which is echoed among some theorists of globalization - had predicted the declining importance of religion as the world became industrialized and increasingly interconnected. This is echoed by those who argue that the Northern Ireland conflict is 'ethno-national' and dismiss the role of religion. On the other hand, others have claimed that the conflict is religious and stress the role of Protestant fundamentalism. This article draws on new evidence from Northern Ireland of the complex and subtle ways in which religion impacts on the conflict there, incorporating insights about the pragmatism of fundamentalist Protestants and how religious actors are contributing to conflict transformation. This analysis leads to three broader conclusions about understanding conflicts with religious dimensions. First, the complexity of religion must be understood, and this includes a willingness to recognize the adaptability of fundamentalisms to particular contexts. Second, engaging with fundamentalists and taking their grievances seriously opens up possibilities for conflict transformation. Third, governments and religious actors within civil society can play complementary roles in constructing alternative (religious) ideologies and structures as part of a process of transformation. In a world in which the impact of religion is persistent, engaging with the religious dimension is a vital part of a broader-based strategy for dealing with conflict. �� 2008 Journal of Peace Research.</p>

Practicing peace: Psychological roots of transforming conflicts

The practice of sustainable peace is a process that must be initiated, nourished and revised. The<br/>���social energies��� of conflict transformation ��� truth, mercy, justice, peace ��� offer a useful model to describe the transformative power of this practice. These social energies can be conceptualized as a combination of norms or values, on the one hand, and actions directed toward social reconstruction, on the other. As such, the social energies of conflict transformation are both the guideposts and the engine in the journey of practicing sustainable peace. This article begins by<br/>linking psychological constructs of narrative/voice, empathy/altruism, individual/collective guilt, and security/fear with the social energies, highlighting the interdependence of processes and shifting the focus away from pathology toward an emphasis on harmony. An empirical application of how the four social energies contribute to the mobilization, maintenance and adaptations in on-going peace processes in post-war Guatemala is then presented. By analyzing the interaction among diverse actors and goals in the decade and a half since the signing of the 1996 Peace Accords, current theory is extended in two ways: a) differentiation between elite and grassroots initiatives, and b) specification and evaluation the impact of various efforts on episodic and structural violence. We conclude that although national and local processes have<br/>had limited success, more integrated practices of truth, mercy, justice and peace are necessary if Guatemala is to make sustainable peace a reality. The findings from this case study have policy and practical implications for other countries facing protracted, violent conflict.

Mining Money: the generative capacities of scientific and legal knowledge practices in the making of resource economies

In 1997 a scandal associated with Bre-X, a junior mining firm, and its prospecting activities in Indonesia, exposed to public scrutiny the ways in which mineral exploration firms acquire, assess and report on scientific claims about the natural environment. At stake here was not just how investors understood the provisional nature of scientific knowledge, but also evidence of fraud. Contemporaneous mining scandals not only included the salting of cores, but also unreliable proprietary sample preparation and assay methods, mis-representations of visual field estimates as drilling results and ���overly optimistic��� geological reports. This paper reports on initiatives taken in the wake of these scandals and prompted by the Mining Standards Task Force (TSE/OSC 1999). For regulators, mandated to increase investor confidence in Canada���s leading role within the global mining industry, efforts focused first and foremost upon identifying and removing sources of error and wilfulness within the production and circulation of scientific knowledge claims. A common goal cross-cutting these initiatives was ���a faithful representation of nature��� (Daston and Galison 2010), however, as the paper argues, this was manifest in an assemblage of practices governed by distinct and rival regulative visions of science and the making of markets in claims about ���nature���. These ���practices of fidelity���, it is argued, can be consequential in shaping the spatial and temporal dynamics of the marketization of nature.

A Steganalysis System Utilizing Temporal Pixel Correlation Of HEVC Video

High Efficiency Video Coding (HEVC) is the most recent video codec coming after currently most popular H.264/MPEG4 codecs and has promising compression capabilities. It is conjectured that it will be a substitute for current video compression standards. However, to the best knowledge of the authors, none of the current video steganalysis methods designed or tested with HEVC video. In this paper, pixel domain steganography applied on HEVC video is targeted for the first time. Also, its the first paper that employs accordion unfolding transformation, which merges temporal and spatial correlation, in pixel domain video steganalysis. With help of the transformation, temporal correlation is incorporated into the system. Its demonstrated for three different feature sets that integrating temporal dependency substantially increased the detection accuracy.