1996 OERI specialty area directory /

Shipping list no.: 96-0342-P.

Using DEA to estimate potential savings at GP units at medical specialty level

The aim of this paper is to identify benchmark cost-efficient General Practitioner (GP) units at delivering health care in the Geriatric and General Medicine (GMG) specialty and estimate potential cost savings. The use of a single medical specialty makes it possible to reflect more accurately the medical condition of the List population of the Practice so as to contextualize its expenditure on care for patients. We use Data Envelopment Analysis (DEA) to estimate the potential for cost savings at GP units and to decompose these savings into those attributable to the reduction of resource use, to altering the mix of resources used and to those attributable to securing better resource 'prices'. The results reveal a considerable potential for savings of varying composition across GP units. © 2013 Elsevier Ltd.

Small farmer market knowledge and specialty coffee commodity chains in Western Highlands Guatemala

For producers motivated by their new status as self-employed, landowning, capitalist coffee growers, specialty coffee presents an opportunity to proactively change the way they participate in the international market. Now responsible for determining their own path, many producers have jumped at the chance to enhance the value of their product and participate in the new "fair trade" market. But recent trends in the international coffee price have led many producers to wonder why their efforts to produce a certified Fair Trade and organic product are not generating the price advantage they had anticipated. My study incorporates data collected in eighteen months of fieldwork, including more than 45 interviews with coffee producers and fair trade roasters, 90 surveys of coffee growers, and ongoing participant observation to understand how fair trade certification, as both a market system and development program, meets the expectations of the coffee growers. By comparing three coffee cooperatives that have engaged the Fair Trade system to disparate ends, the results of this investigation are three case studies that demonstrate how global processes of certification, commodity trade, market interaction, and development aid effect social and cultural change within communities. This study frames several lessons learned in terms of (1) socioeconomic impacts of fair trade, (2) characteristics associated with positive development encounters, and (3) potential for commodity producers to capture value further along their global value chain. Commodity chain comparisons indicate the Fair Trade certified cooperative receives the highest per-pound price, though these findings are complicated by costs associate with certification and producers' perceptions of an "unjust" system. Fair trade-supported projects are demonstrated as more "successful" in the eyes of recipients, though their attention to detail can just as easily result in "failure". Finally, survey results reveal just how limited is the market knowledge of producers in each cooperative, though fair trade does, in fact, provide a rare opportunity for producers to learn about consumer demand for coffee quality. Though bittersweet, the fair trade experiences described here present a learning opportunity for a wide range of audiences, from the certified to the certifiers to the concerned public and conscientious consumer.

Health Care Delivery Practices in Huntington's Disease Specialty Clinics : An International Survey

The CHDI Foundation, Inc. funds Enroll-HD and the activities of the Enroll-HD Care Improvement Committee, including the present survey. We would like to acknowledge the Enroll-HD and REGISTRY administrative staff that assisted in the recruitment of sites and sites that completed the survey.

Protected cropping for specialty melons in North Queensland

Protective cropping could be an effective system for growing specialty melons in the dry tropics of North Queensland. The growing system could reduce outdoor risks for production loss, improve fruit quality, increase yield per m2, allow production offseason, and used for supplying niche markets in a segment of the larger melon market in Australia. First evaluations in Giru, Queensland, included seven cultivars of fruit types 'Galia', 'Hami', 'Charentais', small 'Canary', and 'Rockmelon', transplanted July 25, 2013 under a high polyethylene-covered tunnel. Plants were grown at a density of 2.8 plants m-2 in containers filled with volcanic rock and irrigated with a complete nutrient solution. Pruning and trellising was done to a single vertical stem, keeping lateral shoots on the main stem after the 7th leaf node. After bearing small fruit, lateral shoots were cut off after their second or third leaf node. To facilitate insect pollination, a screen window in the tunnel was left partially opened. On November 20 the cultivars had combined marketable yields that ranged from 2.8 to 8.2 fruits m-2 and 3.1 to 7.8 kg m-2. Total soluble solids levels in fruit ranged from 6 to 13 °Brix. Cultivars 'Tempo' ('Galia'), 'Tikal' ('Canary') and 'Sultan' ('Charentais') had fruit yields that were up to 2.6 times greater than yields commonly achieved with field-grown rockmelon crops. Sugar levels in fruits and marketable yields may be increased with changes in fertigation management. Promising results in this first evaluation justify examination of a greater number of genetic materials, in addition to the development of economic feasibility studies and further adaptive research to refine crop recommendations for growing melons in protective cropping systems.

Bacterial communities of the specialty crop phyllosphere: response to biological soil amendment use, rainfall, and insect visitation

Microorganisms in the plant rhizosphere, the zone under the influence of roots, and phyllosphere, the aboveground plant habitat, exert a strong influence on plant growth, health, and protection. Tomatoes and cucumbers are important players in produce safety, and the microbial life on their surfaces may contribute to their fitness as hosts for foodborne pathogens such as Salmonella enterica and Listeria monocytogenes. External factors such as agricultural inputs and environmental conditions likely also play a major role. However, the relative contributions of the various factors at play concerning the plant surface microbiome remain obscure, although this knowledge could be applied to crop protection from plant and human pathogens. Recent advances in genomic technology have made investigations into the diversity and structure of microbial communities possible in many systems and at multiple scales. Using Illumina sequencing to profile particular regions of the 16S rRNA gene, this study investigates the influences of climate and crop management practices on the field-grown tomato and cucumber microbiome. The first research chapter (Chapter 3) involved application of 4 different soil amendments to a tomato field and profiling of harvest-time phyllosphere and rhizosphere microbial communities. Factors such as water activity, soil texture, and field location influenced microbial community structure more than soil amendment use, indicating that field conditions may exert more influence on the tomato microbiome than certain agricultural inputs. In Chapter 4, the impact of rain on tomato and cucumber-associated microbial community structures was evaluated. Shifts in bacterial community composition and structure were recorded immediately following rain events, an effect which was partially reversed after 4 days and was strongest on cucumber fruit surfaces. Chapter 5 focused on the contribution of insect visitors to the tomato microbiota, finding that insects introduced diverse bacterial taxa to the blossom and green tomato fruit microbiome. This study advances our understanding of the factors that influence the microbiomes of tomato and cucumber. Farms are complex environments, and untangling the interactions between farming practices, the environment, and microbial diversity will help us develop a comprehensive understanding of how microbial life, including foodborne pathogens, may be influenced by agricultural conditions.

Sensory analysis of specialty coffee from different environmental conditions in the region of Matas de Minas, Minas Gerais, Brazil.

Specialty coffees can be differentiated in various ways, including the environmental conditions in which they are produced and the sensory composition of the drink. This study aimed to evaluate the effect of altitude, slope exposure and fruit color on the sensory attributes of cafes of the region of Matas de Minas. Sampling points were georeferenced in four altitude ranges (< 700 m; 700 < x> 825 m, 825 < x < 950 m and > 950 m) of the coffee crop; two fruit colors of var. Catuaí (yellowand red); and two slope exposures (North-facing and South-facing). Coffee fruit at the cherry stage were processed andsubmitted to sensory analysis. The sensory attributes evaluated were overall perception, clean cup, balance, aftertaste, sweetness, acidity , body and flavor, which made up the final score. The scores were examined by ANOVA and means werecompared by the Tukey test (p < 0.05). From the sensory standpoint, coffee fruits of both colors are similar, as well as the cof fees from both slope exposures when these factors were analyzed separately . However , at higher altitudes, Y ellow Catuaí produces coffees with better sensory quality . Similarly , coffees from North-facing slopes, at higher altitudes produce better quality cup. The altitude is the main factor that interferes with coffee quality in the area. All factors together contribute tothe final quality of the beverage produced in the region of Matas de Minas.

Predictors Of Silent Myocardial Ischemia In Resistant Hypertensive Patients.

Hypertension is the most prevalent and significant modifiable risk factor for coronary heart disease. A portion of patients with uncontrolled hypertension are considered to have resistant hypertension (RHTN). Myocardial ischemia incidence increases along with blood pressure (BP) levels. However, the prevalence of myocardial ischemia in patients with RHTN, as well as the factors associated with it, is unknown. We enrolled 129 patients with true RHTN regularly followed in our specialty hypertension clinic and evaluated then by resting and dipyridamole pharmacological stress myocardial perfusion scintigraphy. Patients were then divided into 2 groups: those with (I-RHTN; n = 36) and those without (NI-RHTN; n = 93) myocardial ischemia. Echocardiography, 24-hour ambulatory BP monitoring (ABPM), and flow mediated dilation (FMD) were also evaluated. Thirty six (28%) patients had myocardial ischemia. There was no difference between groups regarding age, sex, biochemical parameters, office, and 24-hour ABPM levels. Patients in the I-RHTN group were more likely diabetic (31% vs. 11%; P < 0.05) and obese (75% vs. 40%; P < 0.001). Adjusting for age and body mass index, multiple logistic regression showed that diabetes (odds ratio (OR) = 6.5; 95% confidence interval (CI) = 1.06-40.14; P = 0.04), FMD (OR = 0.18; 95% CI = 0.07-0.41; P < 0.001), heart rate (OR = 1.23; 95% CI = 1.11-1.36; P < 0.001), left ventricular mass index (OR = 1.02; 95% CI = 1.01-1.04; P = 0.04), and microalbuminuria (OR = 1.02; 95% CI = 1.01-1.04; P = 0.002) were independent predictors of ischemia. In conclusion, there is a high prevalence of myocardial ischemia in patients with RHTN. Increased microalbuminuria, heart rate, endothelial dysfunction, and left ventricular mass can be useful to guide the investigation for myocardial ischemia in these high risk patients.

Pedagogia da roda ginástica (alemã) : análise da proposta metodológica desenvolvida no clube Bayer Leverkusen na Alemanha

Universidade Estadual de Campinas. Faculdade de Educação Física

Preparação profissional em educação fisica : das leis a implementação dos curriculos

Universidade Estadual de Campinas . Faculdade de Educação Física

Termo do 1º Consenso em Disfunção Temporomandibular e Dor Orofacial

O Termo do 1º Consenso em Disfunção Temporomandibular e Dor Orofacial* foi criado com o propósito de substituir divergências por evidência científica dentro dessa especialidade da Odontologia. O documento oferece informações claras e fundamentadas para orientar o cirurgião-dentista e demais profissionais de saúde sobre os cuidados demandados pelo paciente, tanto no processo de diagnóstico diferencial quanto na fase de aplicação das terapias de controle da dor e disfunção. O Termo foi aprovado no mês de janeiro de 2010 em reunião realizada durante o Congresso Internacional de Odontologia do Estado de São Paulo e converge o pensamento dos profissionais mais conceituados do Brasil na especialidade Disfunção Temporomandibular e Dor Orofacial.

Triagem sorológica e influência do conhecimento sobre a dengue em pacientes do ambulatório de especialidades do SUS

INTRODUÇÃO: A dengue é causa de preocupação em países como o Brasil. OBJETIVO: Verificar a soropositividade dos pacientes do ambulatório de especialidades do Sistema Único de Saúde (SUS) para anticorpos antidengue, relacionando os resultados com os dados sociodemográficos. METODOLOGIA: Foram respondidos 184 questionários de avaliação sociodemográfica e de conhecimento sobre a transmissão da dengue. Foi utilizado o método de imunoensaio enzimático (ELISA) para pesquisar imunoglobulina da classe M (IgM) e da classe G (IgG) contra os vírus. RESULTADOS: Quinze por cento dos pacientes apresentaram IgG contra o vírus, sem a presença de IgM. CONCLUSÃO: Os pacientes demonstraram conhecimento sobre a doença e sua prevenção, independentemente da classe econômica. A infecção assintomática deve ser avaliada, principalmente nos casos de doença febril.