Patient-provider communication, self-reported medication adherence, and race in a postmyocardial infarction population.

OBJECTIVES: Our objectives were to: 1) describe patient-reported communication with their provider and explore differences in perceptions of racially diverse adherent versus nonadherent patients; and 2) examine whether the association between unanswered questions and patient-reported medication nonadherence varied as a function of patients' race. METHODS: We conducted a cross-sectional analysis of baseline in-person survey data from a trial designed to improve postmyocardial infarction management of cardiovascular disease risk factors. RESULTS: Overall, 298 patients (74%) reported never leaving their doctor's office with unanswered questions. Among those who were adherent and nonadherent with their medications, 183 (79%) and 115 (67%) patients, respectively, never left their doctor's office with unanswered questions. In multivariable logistic regression, although the simple effects of the interaction term were different for patients of nonminority race (odds ratio [OR]: 2.16; 95% confidence interval [CI]: 1.19-3.92) and those of minority race (OR: 1.19; 95% CI: 0.54-2.66), the overall interaction effect was not statistically significant (P=0.24). CONCLUSION: The quality of patient-provider communication is critical for cardiovascular disease medication adherence. In this study, however, having unanswered questions did not impact medication adherence differently as a function of patients' race. Nevertheless, there were racial differences in medication adherence that may need to be addressed to ensure optimal adherence and health outcomes. Effort should be made to provide training opportunities for both patients and their providers to ensure strong communication skills and to address potential differences in medication adherence in patients of diverse backgrounds.

Ambient Noise in the Kitimat Fjord System

Sound is an important medium for communication and marine organisms have evolved to capitalize on the efficiency with which sound energy travels through water. Anthropogenic and natural sound sources contribute to ocean ambient noise, which can interfere with the use of this sensory modality by marine animals. Anthropogenic noise sources have been increasing steadily over recent decades largely due to coastal population growth, increased global transportation, and offshore industrialization. Understanding the potential impacts of anthropogenic noise requires the establishment of ambient acoustic baselines from which to measure change. Establishing baselines, especially in quiet areas still largely unaffected by anthropogenic stressors, is particularly crucial in the face of the expansion of offshore industries, increasing coastal population and growing reliance on the ocean for global transportation. Global demand for liquid natural gas (LNG), catalyzed primarily by a growing Asian market, is expected to increase significantly in the next 20 years. The geographic position of British Columbia relative to these markets, a growing supply of LNG and new technology for extraction and shipping situate British Columbia as a strong competitor in the lucrative market. The LNG industry could have many adverse impacts on these territories and ecosystems. The Kitimat Fjord System is slated for the development of these LNG export facilities increasing shipping traffic for the port and thus increasing ambient noise in the fjord system. The purpose of this study is to 1) quantify the existing sound levels in the area surrounding Gil Island and 2) identify potential source mechanisms in order to provide a baseline study of the acoustic environment in the Kitimat Fjord system prior to potential increases from LNG shipping.

Selection of Postacute Stroke Rehabilitation Facilities: A Survey of Discharge Planners From the Northeast Cerebrovascular Consortium (NECC) Region.

The process of determining the level of care and specific postacute care facility for stroke patients has not been adequately studied. The objective of this study was to better understand the factors that influence postacute care decisions by surveying stroke discharge planners. Requests were sent to discharge planners at 471 hospitals in the Northeast United States to complete an online survey regarding the factors impacting the selection of postacute care. Seventy-seven (16%) discharge planners completed the online survey. Respondents were mainly nurses and social workers and 73% reported ≥20 years healthcare experience. Patients and families were found to be significantly more influential than physicians (P < 0.001) and other clinicians (P = 0.04) in influencing postdischarge care. Other clinicians were significantly more influential than physicians (P < 0.001). Insurance and quality of postacute care were the factors likely to most affect the selection of postacute care facility. Insurance was also identified as the greatest barrier in the selection of level of postacute care (70%; P < 0.001) and specific postacute care facility (46%; P = 0.02). More than half reported that pressure to discharge patients quickly impacts a patients' final destination. Nonclinical factors are perceived by discharge planners to have a major influence on postacute stroke care decision making.

Long-distance quantum communication just around the corner?

info:eu-repo/semantics/published

Symmetrical freedom quilts: the ethnomathematics of ways of communication, liberation, and art

Symmetrical Freedom Quilts may be considered as links between mathematics, history, ethnomathematics, and the art of quilting. A quilt theme is a pedagogical way to integrate mathematics, art, and history in an interdisciplinary approach. This article combines an ethnomathematical-historical perspective by elaborating a history project related to the Underground Railroad. This work will allow teachers to develop classroom projects that help students to better understand geometry, especially concepts of symmetry and transformations. One of the objectives of this project is to stimulate student’s creativity and interest, because quilts may be considered as cultural and mathematical expressions of student’s daily life.

Multilevel mesh partitioning for heterogeneous communication networks

Multilevel algorithms are a successful class of optimisation techniques which address the mesh partitioning problem for distributing unstructured meshes onto parallel computers. They usually combine a graph contraction algorithm together with a local optimisation method which refines the partition at each graph level. To date these algorithms have been used almost exclusively to minimise the cut edge weight in the graph with the aim of minimising the parallel communication overhead, but recently there has been a perceived need to take into account the communications network of the parallel machine. For example the increasing use of SMP clusters (systems of multiprocessor compute nodes with very fast intra-node communications but relatively slow inter-node networks) suggest the use of hierarchical network models. Indeed this requirement is exacerbated in the early experiments with meta-computers (multiple supercomputers combined together, in extreme cases over inter-continental networks). In this paper therefore, we modify a multilevel algorithm in order to minimise a cost function based on a model of the communications network. Several network models and variants of the algorithm are tested and we establish that it is possible to successfully guide the optimisation to reflect the chosen architecture.

Does the medium dictate the message? Cultivating communication in an asynchronous environment

Virtual learning environments (VLEs) are often perceived by education establishments as an opportunity to widen access without traditional overheads. An integral part of most VLEs is asynchronous computer conferencing and on-line moderators must help students migrate quickly to the new virtual environment to minimize learning disruption. This paper focuses on 21 new on-line moderators and reports their changing perceptions re their role and concerns, from their first appointment through to the end of the delivery of their first on-line course. The findings suggest that it is only after socialization occurs that information can be exchanged and lead to knowledge construction. These are supported by, and extend, prior research by Z Berge, R Mason, M Paulsen and G Salmon and are reinforced by empirical work with a further 19 new on-line moderators.

Requirements and design of an integrated European environmental information communication system, (IEEICS)

The needs for various forms of information systems relating to the European environment and ecosystem are reviewed, and limitations indicated. Existing information systems are reviewed and compared in terms of aims and functionalities. We consider TWO technical challenges involved in attempting to develop an IEEICS. First, there is the challenge of developing an Internet-based communication system which allows fluent access to information stored in a range of distributed databases. Some of the currently available solutions are considered, i.e. Web service federations. The second main challenge arises from the fact that there is general intra-national heterogeneity in the definitions adopted, and the measurement systems used throughout the nations of Europe. Integrated strategies are needed.

Models and tools for an integrated European environmental management and decision support system, (IEEMDSS)

This work proceeds from the assumption that a European environmental information and communication system (EEICS) is already established. In the context of primary users (land-use planners, conservationists, and environmental researchers) we ask what use may be made of the EEICS for building models and tools which is of use in building decision support systems for the land-use planner. The complex task facing the next generation of environmental and forest modellers is described, and a range of relevant modelling approaches are reviewed. These include visualization and GIS; statistical tabulation and database SQL, MDA and OLAP methods. The major problem of noncomparability of the definitions and measures of forest area and timber volume is introduced and the possibility of a model-based solution is considered. The possibility of using an ambitious and challenging biogeochemical modelling approach to understanding and managing European forests sustainably is discussed. It is emphasised that all modern methodological disciplines must be brought to bear, and a heuristic hybrid modelling approach should be used so as to ensure that the benefits of practical empirical modelling approaches are utilised in addition to the scientifically well-founded and holistic ecosystem and environmental modelling. The data and information system required is likely to end up as a grid-based-framework because of the heavy use of computationally intensive model-based facilities.

Collection and analysis of pre-evacuation time data collected from evacuation trials conducted in library facilities in Brazil

Two evacuation trials were conducted within Brazilian library facilities by FSEG staff in January 2005. These trials represent one of the first such trials conducted in Brazil. The purpose of these evacuation trials was to collect pre-evacuation time data from a population with a cultural background different to that found in western Europe. In total some 34 pre-evacuation times were collected from the experiments and these ranged from 5 to 98 seconds with a mean pre-evacuation time of 46.7 seconds

Communication system model for information rate evaluation of differential detection over time-varying channels

A communication system model for mutual information performance analysis of multiple-symbol differential M-phase shift keying over time-correlated, time-varying flat-fading communication channels is developed. This model is a finite-state Markov (FSM) equivalent channel representing the cascade of the differential encoder, FSM channel model and differential decoder. A state-space approach is used to model channel phase time correlations. The equivalent model falls in a class that facilitates the use of the forward backward algorithm, enabling the important information theoretic results to be evaluated. Using such a model, one is able to calculate mutual information for differential detection over time-varying fading channels with an essentially finite time set of correlations, including the Clarke fading channel. Using the equivalent channel, it is proved and corroborated by simulations that multiple-symbol differential detection preserves the channel information capacity when the observation interval approaches infinity.

More public rescues for more private finance failures - a critique of the EC Communication on PPPs

A critique of the EC Communication on PPPs, challenging the scale of state aid offered to PPPs, the role of PPPs in the economic recovery strategy for the EU, and drawing attention to the damage done to public authorities by 'innovative' financing mechanisms.

Experiences during three generations of web based learning. Six years of web based communication

This paper tells the story of how a set of university lectures developed during the last six years. The idea is to show how (1) content, (2) communication and (3) assessment have evolved in steps which are named “generations of web learning”. The reader is offered a stepwise description of both didactic foundations of university lectures and practical implementation on a widely available web platform. The relative weight of directive elements has gradually decreased through the “three generations”, whereas characteristics of self-responsibility and self-guided learning have gained in importance. -Content was in early times presented and expected to be learned but in later phases expected to be constructed for examples of case studies. -Communication meant in early phases to deliver assignments to the lecturer but later on to form teams, exchange standpoints and review mutually. -Assessment initially consisted in marks invented and added up by the lecturer but was later enriched by peer review, mutual grading and voting procedures. How much “added value” can the web provide for teaching, training and learning? Six years of experience suggest: mainly insofar as new (collaborative and selfdirected) didactic scenarios are implemented! (DIPF/Orig.)