Floral surveys on Gomphonemaceae and Cymbellaceae (Bacillariophyta) from the headwaters of the Yangtze River, Qinghai, China

Gomphonemaceae and Cymbellaceae from the headwaters of the Yangtze River, Qinghai Province, China, comprised 84 taxa belonging to four genera. The dominant species were Gomphonema kaznakowi Mer., G. hedini Hust., G. olivaceum (Lyngbye) Kutz., Cymbella cistula (Ehr.) Kirchn. var. cistula and C. minuta Hilse ex Rabh. var. minuta. Some arctic and alpine forms also occurred, and the following taxa were unique to this region: C. cistula var. asiatica Mer., C. cistula var. capitata Grun., C. yabe Skvortzow var. punctata Li and Shi, G. olivaceum (Lyngbye) Kutzing var. brevistriatum Li and Shi and G. staurophorum (Pant.) Cleve-Euler var. oblongum Li and Shi. Different morphological forms of G. kaznakowi Mer. may be related to the upheaval of the plateau. Species diversity of the diatoms appears to be related not only to macro-environment (e.g., geographic zonation) but also to microhabitat and microclimate.

Spying on Science : Western Intelligence in Divided Germany, 1945-1961

Maddrell, John, Spying on Science: Western Intelligence in Divided Germany, 1945-1961 (Oxford: Oxford University Press, 2006), pp.xi+330 RAE2008

Using electronic health record data for substance use Screening, Brief Intervention, and Referral to Treatment among adults with type 2 diabetes: Design of a National Drug Abuse Treatment Clinical Trials Network study.

BACKGROUND: The Affordable Care Act encourages healthcare systems to integrate behavioral and medical healthcare, as well as to employ electronic health records (EHRs) for health information exchange and quality improvement. Pragmatic research paradigms that employ EHRs in research are needed to produce clinical evidence in real-world medical settings for informing learning healthcare systems. Adults with comorbid diabetes and substance use disorders (SUDs) tend to use costly inpatient treatments; however, there is a lack of empirical data on implementing behavioral healthcare to reduce health risk in adults with high-risk diabetes. Given the complexity of high-risk patients' medical problems and the cost of conducting randomized trials, a feasibility project is warranted to guide practical study designs. METHODS: We describe the study design, which explores the feasibility of implementing substance use Screening, Brief Intervention, and Referral to Treatment (SBIRT) among adults with high-risk type 2 diabetes mellitus (T2DM) within a home-based primary care setting. Our study includes the development of an integrated EHR datamart to identify eligible patients and collect diabetes healthcare data, and the use of a geographic health information system to understand the social context in patients' communities. Analysis will examine recruitment, proportion of patients receiving brief intervention and/or referrals, substance use, SUD treatment use, diabetes outcomes, and retention. DISCUSSION: By capitalizing on an existing T2DM project that uses home-based primary care, our study results will provide timely clinical information to inform the designs and implementation of future SBIRT studies among adults with multiple medical conditions.

Covenanter Politics: Evangelicalism, Political Liberalism and Ulster Presbyterians, 1798-1914

Historians of Ireland have devoted considerable attention to the Presbyterian origins of modern Irish republicanism in the 1790s and their overwhelming support for the Union with Great Britain in the 1880s. On the one hand, it has been argued that conservative politics came to dominate nineteenth-century Presbyterianism in the form of Henry Cooke who combined conservative evangelical religion with support for the established order. On the other hand, historians have long acknowledged the continued importance of liberal and radical impulses amongst Presbyterians. Few historians of the nineteenth century have attempted to bring these two stories together and to describe the relationship between the religion and politics of Presbyterians along the lines suggested by scholars of Presbyterian radicalism in the last quarter of the eighteenth century. This article argues that a distinctive form of Presbyterian evangelicalism developed in the nineteenth century that sought to bring the denomination back to the theological and spiritual priorities of seventeenth-century Scottish and Irish Presbyterianism. By doing so, it encouraged many Presbyterians to get involved in movements for reform and liberal politics. Supporters of ‘Covenanter Politics’ utilised their denominational principles and traditions as the basis for political involvement and as a rhetoric of opposition to Anglican privilege and Catholic tyranny. These could be the prime cause of Presbyterian opposition to the infringement of their rights, such as the marriage controversy and the Disruption of the Church of Scotland in the early 1840s, and they could also be employed as a language of opposition in response to broader social and political developments, such as the demands for land reform stimulated by the agricultural depression that accompanied the Famine. Despite their opposition to ascendancy, however, the Covenanter Politics of Presbyterian Liberals predisposed them towards pan-protestant unionism against the threat of ‘Rome Rule’.

Corporate ownership and control in Victorian Britain

Using ownership and control data for 890 firm‐years, this article examines the concentration of capital and voting rights in British companies in the second half of the nineteenth century. We find that both capital and voting rights were diffuse by modern‐day standards. However, this does not necessarily mean that there was a modern‐style separation of ownership from control in Victorian Britain. One major implication of our findings is that diffuse ownership was present in the UK much earlier than previously thought, and given that it occurred in an era with weak shareholder protection law, it somewhat undermines the influential law and finance hypothesis. We also find that diffuse ownership is correlated with large boards, a London head office, non‐linear voting rights, and shares traded on multiple markets.

Electronic health records for mobile citizens: a secure and collaborative architecture

Durante as ultimas décadas, os registos de saúde eletrónicos (EHR) têm evoluído para se adaptar a novos requisitos. O cidadão tem-se envolvido cada vez mais na prestação dos cuidados médicos, sendo mais pró ativo e desejando potenciar a utilização do seu registo. A mobilidade do cidadão trouxe mais desafios, a existência de dados dispersos, heterogeneidade de sistemas e formatos e grande dificuldade de partilha e comunicação entre os prestadores de serviços. Para responder a estes requisitos, diversas soluções apareceram, maioritariamente baseadas em acordos entre instituições, regiões e países. Estas abordagens são usualmente assentes em cenários federativos muito complexos e fora do controlo do paciente. Abordagens mais recentes, como os registos pessoais de saúde (PHR), permitem o controlo do paciente, mas levantam duvidas da integridade clinica da informação aos profissionais clínicos. Neste cenário os dados saem de redes e sistemas controlados, aumentando o risco de segurança da informação. Assim sendo, são necessárias novas soluções que permitam uma colaboração confiável entre os diversos atores e sistemas. Esta tese apresenta uma solução que permite a colaboração aberta e segura entre todos os atores envolvidos nos cuidados de saúde. Baseia-se numa arquitetura orientada ao serviço, que lida com a informação clínica usando o conceito de envelope fechado. Foi modelada recorrendo aos princípios de funcionalidade e privilégios mínimos, com o propósito de fornecer proteção dos dados durante a transmissão, processamento e armazenamento. O controlo de acesso _e estabelecido por políticas definidas pelo paciente. Cartões de identificação eletrónicos, ou certificados similares são utilizados para a autenticação, permitindo uma inscrição automática. Todos os componentes requerem autenticação mútua e fazem uso de algoritmos de cifragem para garantir a privacidade dos dados. Apresenta-se também um modelo de ameaça para a arquitetura, por forma a analisar se as ameaças possíveis foram mitigadas ou se são necessários mais refinamentos. A solução proposta resolve o problema da mobilidade do paciente e a dispersão de dados, capacitando o cidadão a gerir e a colaborar na criação e manutenção da sua informação de saúde. A arquitetura permite uma colaboração aberta e segura, possibilitando que o paciente tenha registos mais ricos, atualizados e permitindo o surgimento de novas formas de criar e usar informação clínica ou complementar.

Does Cost-Effectiveness Analysis Have a Role in US Managed Care Drug Formularies? An Empirical Study of Utilization, Costs, Outcomes, and Elasticity of Demand of a Value-Based Formulary

Thesis (Ph.D.)--University of Washington, 2015

A portal for the Canadian Virtual Health Library / Bibliothèque virtuelle canadienne de la santé (CVHL/BVCS): Accomplishments and possibilities, scope and structure - a review of best practices

Introduction: Coordination through CVHL/BVCS gives Canadian health libraries access to information technology they could not offer individually, thereby enhancing the library services offered to Canadian health professionals. An example is the portal being developed. Portal best practices are of increasing interest (usability.gov; Wikipedia portals; JISC subject portal project; Stanford clinical portals) but conclusive research is not yet available. This paper will identify best practices for a portal bringing together knowledge for Canadian health professionals supported through a network of libraries. Description: The portal for Canadian health professionals will include capabilities such as: • Authentication • Question referral • Specialist “branch libraries” • Integration of commercial resources, web resources and health systems data • Cross-resource search engine • Infrastructure to enable links from EHR and decision support systems • Knowledge translation tools, such as highlighting of best evidence Best practices will be determined by studying the capabilities of existing portals, including consortia/networks and individual institutions, and through a literature review. Outcomes: Best practices in portals will be reviewed. The collaboratively developed Virtual Library, currently the heart of cvhl.ca, is a unique database collecting high quality, free web documents and sites relevant to Canadian health care. The evident strengths of the Virtual Library will be discussed in light of best practices. Discussion: Identification of best practices will support cost-benefit analysis of options and provide direction for CVHL/BVCS. Open discussion with stakeholders (libraries and professionals) informed by this review will lead to adoption of the best technical solutions supporting Canadian health libraries and their users.

Analyse de la logique d’intervention d’une adaptation québécoise d’un modèle de soins centré sur le patient appuyé par un dossier médical personnel dans les suivis pédiatriques au sein d’un groupe de médecine de famille

Dans l'optique d'améliorer la performance des services de santé en première ligne, un projet d'implantation d'une adaptation québécoise d'un modèle de soins centré sur le patient appuyé par un dossier médical personnel (DMP) a été mis sur pied au sein d'un groupe de médecine familiale (GMF) de la région de Montréal. Ainsi, ce mémoire constitue une analyse comparative entre la logique de l'intervention telle qu'elle est décrite dans les données probantes concernant les modèles de soins centrés sur le patient et le dossier médical personnel ainsi que la logique de l'intervention issue de nos résultats obtenus dans le cadre de ce projet au sein d'un GMF. L'analyse organisationnelle se situe durant la phase de pré-déploiement de l'intervention. Les principaux résultats sont que la logique d'intervention appliquée dans le cadre du projet est relativement éloignée de ce qui se fait de mieux dans la littérature sur le sujet. Ceci est en partie explicable par les différentes résistances en provenance des acteurs du projet (ex. médecins, infirmières, fournisseur technologique) dans le projet, mais aussi par l'absence de l'interopérabilité entre le DMP et le dossier médical électronique (DME). Par ailleurs, les principaux effets attendus par les acteurs impliqués sont l'amélioration de la continuité informationnelle, de l’efficacité-service, de la globalité et de la productivité. En outre, l’implantation d’un modèle centré sur le patient appuyé par un DMP impliquerait la mise en œuvre d’importantes transformations structurelles comme une révision du cadre législatif (ex. responsabilité médicale) et des modes de rémunérations des professionnels de la santé, sans quoi, les effets significatifs sur les dimensions de la performance comme l’accessibilité, la qualité, la continuité, la globalité, la productivité, l’efficacité et la réactivité pourraient être limités. Ces aménagements structuraux devraient favoriser la collaboration interprofessionnelle, l'interopérabilité des systèmes, l’amélioration de la communication multidirectionnelle (patient-professionnel de la santé) ainsi qu'une autogestion de la santé supportée (ex. éducation, prévention, transparence) par les professionnels de la santé.