Physician choice making and characteristics associated with using physician-rating websites: cross-sectional study

BACKGROUND: Over the past decade, physician-rating websites have been gaining attention in scientific literature and in the media. However, little knowledge is available about the awareness and the impact of using such sites on health care professionals. It also remains unclear what key predictors are associated with the knowledge and the use of physician-rating websites. OBJECTIVE: To estimate the current level of awareness and use of physician-rating websites in Germany and to determine their impact on physician choice making and the key predictors which are associated with the knowledge and the use of physician-rating websites. METHODS: This study was designed as a cross-sectional survey. An online panel was consulted in January 2013. A questionnaire was developed containing 28 questions; a pretest was carried out to assess the comprehension of the questionnaire. Several sociodemographic (eg, age, gender, health insurance status, Internet use) and 2 health-related independent variables (ie, health status and health care utilization) were included. Data were analyzed using descriptive statistics, chi-square tests, and t tests. Binary multivariate logistic regression models were performed for elaborating the characteristics of physician-rating website users. Results from the logistic regression are presented for both the observed and weighted sample. RESULTS: In total, 1505 respondents (mean age 43.73 years, SD 14.39; 857/1505, 57.25% female) completed our survey. Of all respondents, 32.09% (483/1505) heard of physician-rating websites and 25.32% (381/1505) already had used a website when searching for a physician. Furthermore, 11.03% (166/1505) had already posted a rating on a physician-rating website. Approximately 65.35% (249/381) consulted a particular physician based on the ratings shown on the websites; in contrast, 52.23% (199/381) had not consulted a particular physician because of the publicly reported ratings. Significantly higher likelihoods for being aware of the websites could be demonstrated for female participants (P<.001), those who were widowed (P=.01), covered by statutory health insurance (P=.02), and with higher health care utilization (P<.001). Health care utilization was significantly associated with all dependent variables in our multivariate logistic regression models (P<.001). Furthermore, significantly higher scores could be shown for health insurance status in the unweighted and Internet use in the weighted models. CONCLUSIONS: Neither health policy makers nor physicians should underestimate the influence of physician-rating websites. They already play an important role in providing information to help patients decide on an appropriate physician. Assuming there will be a rising level of public awareness, the influence of their use will increase well into the future. Future studies should assess the impact of physician-rating websites under experimental conditions and investigate whether physician-rating websites have the potential to reflect the quality of care offered by health care providers.

An overview of research activities and achievement in Geotechnics from the Scottish Universities Geotechnics Network (SUGN)

Design of geotechnical systems is often challenging as it requires the understanding of complex soil behaviour and its influence on field-scale performance of geo-structures. To advance the scientific knowledge and the technological development in geotechnical engineering, a Scottish academic community, named Scottish Universities Geotechnics Network (SUGN), was established in 2001, composing of eight higher education institutions. The network gathers geotechnics researchers, including experimentalists as well as centrifuge, constitutive, and numerical modellers, to generate multiple synergies for building larger collaboration and wider research dissemination in and beyond Scotland. The paper will highlight the research excellence and leading work undertaken in SUGN emphasising some of the contribution to the geotechnical research community and some of the significant research outcomes.

Atividades mediadas como colaboração para aprendizagem de conceitos científicos sobre doenças epidêmicas

Acompanha: Sequência didática interativa para o ensino de doenças epidêmicas

Speciation analysis of Arsenic in fish and rice samples using liquid chromatography-inductively coupled plasma mass spectrometry

Chemical speciation in foodstuffs is of uttermost importance since it is nowadays recognized that both toxicity and bioavailability of an element depend on the chemical form in which the element is present. Regarding arsenic, inorganic species are classified as carcinogenic while organic arsenic, such as arsenobetaine (AsB) or arsenocholine (AsC), is considered less toxic or even non-toxic. Coupling a High Performance Liquid Chromatographer (HPLC) with an Inductively Coupled Plasma Mass Spectrometer (ICP-MS) combines the power of separation of the first with the selectivity and sensitivity of the second. The present work aims at developing a method, using HPLC-ICP-MS technique, to identify and quantify the chemical species of arsenic present in two food matrices, rice and fish. Two extraction methods, ultrasound and microwave, and different settings were studied. The best method was chosen based on recovery percentages. To ensure that no interconversion of species was occurring, individual spikes of each species of arsenic were made in both matrices and recovery rates were calculated. To guaranty accurate results reference material BCR-627 TUNA FISH, containing certified values for AsB and DMA, was analyzed. Chromatographic separation was achieved using an anion exchange column, HAMILTON-PRP X-100, which allowed to separate the four arsenic species for which standards were available (AsB, dimethylarsenic (DMA), arsenite (AsIII), arsenate (AsV). The mobile phase was chosen based on scientific literature and adjusted to laboratory conditions. Different gradients were studied. As a result we verified that the arsenic species present in both matrices were not the same. While in fish 90% of the arsenic present was in the form of arsenobetaine, in rice 80% of arsenic was present as DMA and 20% as inorganic arsenic.

From physics to metaphysics: philosophy and style in the critical writings of T. S. Eliot (1913-1935)

This thesis considers Eliot's critical writing from the late 1910s till the mid-1930s, in the light of his PhD thesis - Knowledge and Experience in the Philosophy of F. H. Bradley - and a range of unpublished material: T S. Eliot's Philosophical Essays and Notes (1913- 4) in the Hayward Bequest (King's College, Cambridge University); T. S. Eliot's Family Papers in the T. S. Eliot Collection at the Houghton Library (Harvard University); and items from the Harvard University Archives at the Pusey Library. 'Me thesis offers a comprehensive view of Eliot's critical development throughout this important period. It starts by considering The Sacred Wood's ambivalence towards the metaphysical philosophy of F. H. Bradley and Eliot's apparent adoption of a scientific method, under the influence of Bertrand Russell. It will be argued that Eliot uses rhetorical strategies which simultaneously subvert the method he is propounding, and which set the tone for an assessment of his criticism throughout the 1920s. His indecision, in this period, about the label 'Metaphysical' for some poets of the seventeenth century, reveals the persistence of the philosophical thought he apparently rejects in 1916, when he chooses not to pursue a career in philosophy in Harvard. This rhetorical tactic achieves its fulfilment in Dante (1929), where Eliot finds a model in the medieval allegorical method and 'philosophical' poetry. Allegory is also examined in connection with the evaluation of Eliot's critical writings themselves to determine, for instance, the figurative dimension of his early scientific vocabulary and uncover metaphysical residues he had explicitly disowned but would later embrace. Finally, it is suggested that, the hermeneutics of allegory are historical and it is used here to test the relationship between Eliot's early and later critical writings, that is the early physics and the later metaphysics.

The European Registered Toxicologist (ERT): Current status and prospects for advancement

Following its inception in 1994, the certification of European Registered Toxicologists (ERT) by EUROTOX has been recognized as ensuring professional competence as well as scientific integrity and credibility. Criteria and procedures for registration are contained in the ERT "Guidelines for Registration 2012". The register of ERT currently has over 1900 members. In order to continue the harmonisation of requirements and processes between national registering bodies as a prerequisite for official recognition of the ERT title as a standard, and to take account of recent developments in toxicology, an update of the ERT Guidelines has been prepared in a series of workshops by the EUROTOX subcommittees for education and registration, in consultation with representatives of national toxicology societies and registers. The update includes details of topics and learning outcomes for theoretical training, and how these can be assessed. The importance of continuing professional development as the cornerstone of re-registration is emphasised. To help with the process of harmonisation, it is necessary to collate and share best practices of registration conditions and procedures across Europe. Importantly, this information can also be used to audit compliance with the EUROTOX standards. As recognition of professionals in toxicology, including specialist qualifications, is becoming more important than ever, we believe that this can best be achieved based on the steps for harmonisation outlined here together with the proposed new Guidelines.

A study of ignorance: suffering and freedom in early Buddhist teachings and parallels in modern neuroscience

What might early Buddhist teachings offer neuroscience and how might neuroscience inform contemporary Buddhism? Both early Buddhist teachings and cognitive neuroscience suggest that the conditioning of our cognitive apparatus and brain plays a role in agency that may be either efficacious or non-efficacious. Both consider internal time to play a central role in the efficacy of agency. Buddhism offers an approach that promises to increase the efficacy of agency. This approach is found in five early Buddhist teachings that are re-interpreted here with a view to explaining how they might be understood as a dynamic basis for ‘participatory will’ in the context of existing free will debates and the neuroscientific work of Patrick Haggard (et al.). These perspectives offer Buddhism and neuroscience a basis for informing each other as the shared themes of: (1) cognition is dynamic and complex/aggregate based, (2) being dynamic, cognition lacks a fixed basis of efficacy, and (3) efficacy of cognition may be achieved by an understanding of the concept of dynamic: as harmony and efficiency and by means of Buddha-warranted processes that involve internal time.

A pilot study on the productivity and behavior of the gestating sow housed in a flex stall

Animal welfare is a controversial topic in modern animal agriculture, partly because it generates interest from both the scientific community and the general public. The housing of gestating sows, particularly individual housing, is one of the most critical concerns in farm animal welfare. We hypothesize that the physical size of the standard gestation stall may limit movement and evoke demands and challenges on the sow to affect the physiological and psychological well-being of the individually housed sow. Thus, improvements in the design of the individual gestation stall system that allow more freedom to move, such as increasing stall width or designing a stall that could accommodate the changing size of the pregnant sow, may improve sow welfare. The objective of this pilot study was to evaluate the effects of a width adjustable stall (FLEX) on productivity and behavior of dry sows. The experiment consisted of 3 replications (block 1, n=4 sows; block 2, n=4 sows; block 3, n=8 sows), and multi-parious sows were allotted to either a FLEX stall or standard gestation stall for 1 gestation period. Sow mid-girth (top of the back to bottom of the udder) was measured 5-6 times throughout gestation to determine the best time points for FLEX stall width expansions. FLEX stall width was adjusted according to mid-girth measurements, and expanded to achieve an additional 2 cm of space between the bottom of the sow’s udder and floor of the stall so that sows could lie in full lateral recumbency without touching the sides of the stall. Productivity data recorded included: sow body weight (BW) and BW gain, number of piglets born and born alive, proportions of piglets stillborn, mummified, lost between birth and weaning, and weaned, and litter and mean piglet birth BW, weaning BW, and average BW gain from birth-to-weaning. Lesions were recorded on d 21 and d 111 of gestation. Sub-pilot behavior data were observed and registered for replicate 1 sows using continuous video-records for the l2 hour lights on period (period 1, 0600-1000; period 2, 1000-1400; period 3, 1400-1800) prior FLEX stall adjustment and 12 hour lights on period post adjustment on d 21, 22, 23, 43, 44, 45, 93, 94, 95. A randomized complete block design with a 2 × 2 factorial arrangement for treatments was used to analyze sow productivity and performance traits. Data were analyzed using the Mixed Models procedure of SAS. A preliminary analysis of data means and numerical trends was used to analyze sow behavior measurements. Sows housed in a FLEX stall had more (P < 0.05) total born and a tendency for more piglets born alive (P = 0.06) than sows housed in a standard stall. Sow body weight also tended to be higher (P = 0.06) for sows housed in a FLEX stall compared to sows housed in a standard stall. There were numerical trends for mean durations of sit, lay, lay (OUT), and eat behaviors to be greater for sows housed in a FLEX stall compared with sows housed in a standard stall. The mean duration of lay (IN) behavior tended to be numerically less for sows housed in a FLEX stall compared with sows housed in a standard stall. There were numerical trends for the mean durations of stand and drink behaviors to be greater for sows housed in a standard stall compared with sows housed in a FLEX stall. The mean frequencies of postural changes and mean durations of oral-nasal-facial and sham-chew behaviors were numerically similar between types of gestation stall. Mean durations and numerical trends indicate that time of day influenced all of the behaviors assessed in this study. The results of this pilot study indicate that the adjustable FLEX stall may affect sow productivity and behavior differently than the standard gestation stall, and thus potentially improve sow well-being. Future research should continue to compare the new FLEX stall design to current housing systems in use and examine physiological traits and immune status in addition to behavioral and productivity traits to assess the effects that this housing system has on the overall welfare of the gestating sow.

Ética na pesquisa em Administração

Ethics on scientific research is approached and often discussed in several areas of knowledge connected to health. In the Administration area there are very few studies which approach the topic of ethics on research. The present paper tried to fill in this gap in the production of knowledge about the topic, investigating how the ethical principles found in the literature and in the codes of conduct are noticed and taken into account in Administration research activities developed by acting researchers in Administration Post Graduation Programs. Theoretically speaking, the study was based mainly on the approaches by Creswell (2007) and Bell and Bryman (2007), which discuss the research ethical principles. Methodologically speaking it was all about an exploratory kind of study, with qualitative research approach. Upon data collection, personal interviews were made aiming at its depth and focus groups were formed. The first stage had interviews with four experienced researchers who took part on a teaching and researching event and on the second stage we used the focus group technique. The focus groups were done in four college institutions along with the post graduation programs in Administration in the states of Rio Grande do Norte, Paraíba and Pernambuco, in Brazil. The results suggest the existence of general principles and parameters for the scientific research recommended in the literature and on official resolution. However, in the Administration area, there are only a few recommendations of good practices when it comes to submitting articles for scientific publications but we found no guidance with ethical principles and parameters which cover all the activities in the scientific research and which specifically meet the research particularities in Administration. The main ethical dilemma pointed by the researchers refers to ethical questions which arise at the time of data collection and on disclosing the results. Most researchers do not know the guidelines and the ethical norms on ethics about research that we have in our country neither do they send in their projects to the research ethics committee. When dilemma arises, they decide the ethical question based on their values and common sense. These elements confirm the thesis that the researcher s procedure in the research activities in Administration is predominantly signed by personal values or by common sense and less by ethical principles, whether by not knowing the normative instruments related to ethics or by disagreeing with any disciplining rules on ethical behavior in the research

Predictors of stress and depressive mood in portuguese middle-aged women

This cross-sectional study investigates the predictors of psychological symptoms-stress and depressive mood-in a sample of middle-aged women. A community sample of 1,003 women filled in the questionnaires and instruments, which included the Depression, Anxiety and Stress Scales and the Life Events Survey; sociodemographic, health, and menopause-related and lifestyle information was also collected. Structural equation modeling was used to build the model that had stress and depressive mood as dependent variables. Health status (both physical and psychological), recent life events, income and menopausal phase were significantly associated with the frequency of stress and depressive symptoms. Additionally, educational level and parity were also significant predictors of depressive mood. This study emphasizes that psychological symptoms occurrence in midlife depends not only on personal variables (such as health and menopausal status) but also on contextual ones (including recent stressful events) that can be a strong influence on how middle-aged women feel.

A NOVEL NON-LETHAL LAPAROSCOPIC APPROACH TO DETECT INTERSEX (TESTICULAR OOCYTES) IN LARGEMOUTH BASS (MICROPTERUS SALMOIDES) AND SMALLMOUTH BASS (MICROPTERUS DOLOMIEU)

The appearance of testicular oocytes (TO) in wild fish populations has received considerable attention in the scientific literature and public media. Current methods to quantify TO are lethal; instead, a non-lethal alternative was examined. Laparoscopic insertion into the genital pore allowed internal visualization of the gonad and detection of TO by collecting five testis biopsies in smallmouth bass Micropterus dolomieu and largemouth bass Micropterus salmoides. Overall, biopsies quantified similar levels of TO detection and severity to conventional transverse sectioning with less than 10% mortality. Suitability of surgical anesthetics, tricaine methanesulfonate and electronarcosis were examined in laboratory and field applications. Electronarcosis had the added benefit of rapid sex identification and immediate release of female fish with minimal trauma, representing significant benefits when sampling small or compromised populations. Laparoscopy may be useful for monitoring the prevalence and severity of TO in these fish species when lethal sampling is not a desired outcome.

Combining Collaborative Networks and Knowledge Management: The SENAI Case

Part 19: Knowledge Management in Networks

Articulação curricular e continuidade educativa - pré-escolar / 1º ciclo do ensino básico: representações em torno da problemática

Dissertação de mest. em Observação e Análise da Relação Educativa, Faculdade de Ciências Humanas e Sociais, Univ. do Algarve, 2005

Wage Matters & Globalization: South Florida’s Low-Wage Immigrant Plant Nursery Workers and Business Protectionism in the Age of Neoliberalism

Ornamental plant production in the State of Florida is an anomaly with respect to current theories of globalization and particularly their explanation of the employment of low-wage, immigrant labor. Those theories dictate that unskilled jobs that do not need to be performed within highly developed countries are outsourced to where labor is cheaper and more flexible. However, the State of Florida remains an important site of ornamental plant production in the US amidst a global economic environment of outsourcing and transnational corporate expansion. This dissertation relies on 50 semi-structured interviews with insiders of the Florida plant nursery industry, focus groups, and participant observation to explain how US trade, labor, and migration policy-making at local levels are not removed from larger global processes taking place in the world since the 1970s. In Florida, elite market players of the plant nursery industry have been able to resist global trends in free trade, operating instead in a protected market. They have done this by appealing to scientific justifications and through arbitrary implementations of neoliberal ideology that keeps small and middle range business alive, while maintaining a seemingly endless supply of marginalized and exploited low-wage, immigrant workers.

Developmental, relational and situational characteristics of maritally abusive men

Rapport de stage présenté à la Faculté des Arts et Sciences en vue de l’obtention du grade de Maître des Sciences (M. Sc.) en Criminologie, Option Stage en Intervention