Primary care physician decision making regarding severe obesity treatment and bariatric surgery: a qualitative study.

BACKGROUND: Less than 1% of severely obese US adults undergo bariatric surgery annually. It is critical to understand the factors that contribute to its utilization. OBJECTIVES: To understand how primary care physicians (PCPs) make decisions regarding severe obesity treatment and bariatric surgery referral. SETTING: Focus groups with PCPs practicing in small, medium, and large cities in Wisconsin. METHODS: PCPs were asked to discuss prioritization of treatment for a severely obese patient with multiple co-morbidities and considerations regarding bariatric surgery referral. Focus group sessions were analyzed by using a directed approach to content analysis. A taxonomy of consensus codes was developed. Code summaries were created and representative quotes identified. RESULTS: Sixteen PCPs participated in 3 focus groups. Four treatment prioritization approaches were identified: (1) treat the disease that is easiest to address; (2) treat the disease that is perceived as the most dangerous; (3) let the patient set the agenda; and (4) address obesity first because it is the common denominator underlying other co-morbid conditions. Only the latter approach placed emphasis on obesity treatment. Five factors made PCPs hesitate to refer patients for bariatric surgery: (1) wanting to "do no harm"; (2) questioning the long-term effectiveness of bariatric surgery; (3) limited knowledge about bariatric surgery; (4) not wanting to recommend bariatric surgery too early; and (5) not knowing if insurance would cover bariatric surgery. CONCLUSION: Decision making by PCPs for severely obese patients seems to underprioritize obesity treatment and overestimate bariatric surgery risks. This could be addressed with PCP education and improvements in communication between PCPs and bariatric surgeons.

Crowdsourcing User-Contributed Solutions to Aerospace Product Development Issues through Micro-Blogging

Revenue and production output of the United Kingdom’s Aerospace Industry (AI) is growing year on year and the need to develop new products and innovative enhancements to existing ranges is creating a critical need for the increased utilisation and sharing of employee knowledge. The capture of employee knowledge within the UK’s AI is vital if it is to retain its pre-eminent position in the global marketplace. Crowdsourcing, as a collaborative problem solving activity, allows employees to capture explicit knowledge from colleagues and teams and also offers the potential to extract previously unknown tacit knowledge in a less formal virtual environment. By using micro-blogging as a mechanism, a conceptual framework is proposed to illustrate how companies operating in the AI may improve the capture of employee knowledge to address production-related problems through the use of crowdsourcing. Subsequently, the framework has been set against the background of the product development process proposed by Maylor in 1996 and illustrates how micro-blogging may be used to crowdsource ideas and solutions during product development. Initial validation of the proposed framework is reported, using a focus group of 10 key actors from the collaborating organisation, identifying the perceived advantages, disadvantages and concerns of the framework; results indicate that the activity of micro-blogging for crowdsourcing knowledge relating to product development issues would be most beneficial during product conceptualisation due to the requirement for successful innovation.

The effect of multilingual facilitation on active participation in MOOCs Authors:

A new approach for overcoming the language and culture barriers to participation in MOOCs is reported. It is hypothesised that the juxtaposition of English as the language of instruction, used for interacting with course materials, and one’s preferred language as the language of participation, used for interaction with peers and facilitators, is preferable to ‘English only’ for participation in a MOOC. The HANDSON MOOC included seven teams of facilitators, each catering for a different language community. Facilitators were responsible for promoting active participation and peer tutoring. Comparing language groups revealed a series of predictors of intention to learn, some of which became apparent in the first days of the MOOC already. The comparison also uncovered four critical factors that influence participation: facilitation, language of participation, group size, and a pre-existing sense of community. Especially crucial was reaching a sufficient number of active participants during the first week. We conclude that multilingual facilitation activates participation in MOOCs in various ways; and that synergy between the four aforementioned factors is critical for the formation of the learning network that supports a social dynamics of active participation. Our approach suggests future targets for the development of the multilingual and community potential of MOOCs.

No second chance: junior neonatal nurses' experiences of caring for babies at the end-of-life and their families

Death of an infant is acutely stressful for parents and professionals. Little is known about junior nurses' experiences providing end-of-life care in Neonatal units (NNU). This study aimed to better understand junior nurses' experiences providing end-of-life care in NNU. Neonatal nurses (n = 12) with less than 3 years experience participated in a focus group. Nominal Group Technique (NGT) was used to build consensus around the challenges faced, alongside suggested developments in improving future care provision. Primary analysis involved successive rounds of ranking and decision-making whilst secondary analysis involved thematic analysis. All issues, whether environmental, professional or social appeared driven by an awareness on the part of nurses, that there was no ‘second chance’ which created a huge pressure to ‘get if right’ for the infants and families. Regarding future care 2 areas of improvement identified were ‘Education and Training’ and Support. This paper unpacks these findings making recommendations for practice.

An Assessment of How Nurse Practitioners Create Access to Primary Care in Canadian Residential Long-Term Care Settings

The aim of this paper is to explore the role and activities of nurse practitioners (NPs) working in long-term care (LTC) to understand concepts of access to primary care for residents. Utilizing the "FIT" framework developed by Penchanksy and Thomas, we used a directed content analysis method to analyze data from a pan-Canadian study of NPs in LTC. Individual and focus group interviews were conducted at four sites in western, central and eastern regions of Canada with 143 participants, including NPs, RNs, regulated and unregulated nursing staff, allied health professionals, physicians, administrators and directors and residents and family members. Participants emphasized how the availability and accessibility of the NP had an impact on access to primary and urgent care for residents. Understanding more about how NPs affect access in Canadian LTC will be valuable for nursing practice and healthcare planning and policy and may assist other countries in planning for the introduction of NPs in LTC settings to increase access to primary care.

Factors and mechanisms controlling soil organic carbon turnover in subsoils of agricultural sites

Two-third of the terrestrial C is stored in soils, and more than 50% of soil organic C (SOC) is stored in subsoils from 30 – 100 cm. Hence, subsoil is important as a source or sink for CO2 in the global carbon cycle. Especially the stable organic carbon (OC) is stored in subsoil, as several studies have shown that subsoil OC is of a higher average age than topsoil OC. However, there is still a lack of knowledge regarding the mechanisms of C sequestration and C turnover in subsoil. Three main factors are discussed, which possibly reduce carbon turnover rates in subsoil: Resource limitation, changes in the microbial community, and changes in gas conditions. The experiments conducted in this study, which aimed to elucidate the importance of the mentioned factors, focused on two neighbouring arable sites, with depth profiles differing in SOC stocks: One Colluvic Cambisol (Cam) with high SOC contents (8-12 g kg-1) throughout the profile and one Haplic Luvisol (Luv) with low SOC contents (3-4 g kg-1) below 30 cm depth. The first experiment was designed to gain more knowledge regarding the microbial community and its influence on carbon sequestration in subsoil. Soil samples were taken at four different depths on the two sites. Microbial biomass C (MBC) was determined to identify depth gradients in relation to the natural C availability. Bacterial and fungal residues as well as ergosterol were determined to quantify changes in the in the microbial community composition. Multi-substrate-induced-respiration (MSIR) was used to identify shifts in functional diversity of the microbial community. The MSIR revealed that substrate use in subsoil differed significantly from that in topsoil and also differed highly between the two subsoils, indicating a strong influence of resource limitations on microbial substrate use. Amino sugar analysis and the ratio of ergosterol to microbial biomass C showed that fungal dominance decreased with depth. The results clearly demonstrated that microbial parameters changed with depth according to substrate availability. The second experiment was an incubation experiment using subsoil gas conditions with and without the addition of C4 plant residues. Soil samples were taken from topsoil and subsoil of the two sites. SOC losses during the incubation, were not influenced by the subsoil gas conditions. Plant-derived C losses were generally stronger in the Cam (7.5 mg g-1), especially at subsoil gas conditions, than in the Luv (7.0 mg g-1). Subsoil gas conditions had no general effects on microbial measures with and without plant residue addition. However, the contribution of plant-derived MBC to total MBC was significantly reduced at subsoil gas conditions. This lead to the conclusion that subsoil gas conditions alter the metabolism of microorganisms but not the degradation of added plant residues is general. The third experiment was a field experiment carried out for two years. Mesh bags containing original soil material and maize root residues (C4 plant) were buried at three different depths at the two sites. The recovery of the soilbags took place 12, 18, and 24 months after burial. We determined the effects of these treatments on SOC, density fractions, and MBC. The mean residence time for maize-derived C was similar at all depths and both sites (403 d). MBC increased to a similar extent (2.5 fold) from the initial value to maximum value. This increase relied largely on the added maize root residues. However, there were clear differences visible in terms of the substrate use efficiency, which decreased with depth and was lower in the Luv than in the Cam. Hence freshly added plant material is highly accessible to microorganisms in subsoil and therefore equally degraded at both sites and depths, but its metabolic use was determined by the legacy of soil properties. These findings provide strong evidence that resource availability from autochthonous SOM as well as from added plant residues have a strong influence on the microbial community and its use of different substrates. However, under all of the applied conditions there was no evidence that complex substrates, i.e. plant residues, were less degraded in subsoil than in topsoil.

Método mãe-canguru: vivência de mães no alojamento conjunto

DAVIM, Rejane Marie Barbosa;ENDERS, Bertha Cruz; DANTAS, Janmilli da Costa; SILVA, Richardson Augusto Rosendo da; NÓBREGA, Edualeide Jeane Pereira Bulhões da. Método mãe-canguru: vivência de mães no alojamento conjunto. Revista da Rede de Enfermagem do Nordeste, Fortaleza, v. 10, n. 1, p. 37-44, jan./mar.2009.

Atuação das equipes da atenção primária na identificação precoce do câncer infanto-juvenil

Identificar o conhecimento de profissionais da atenção primária sobre a identificação precoce do câncer infanto-juvenil e descrever o desempenho das equipes de saúde antes da realização de treinamentos para identificação precoce do câncer infanto-juvenil. Método: Os dados foram obtidos por um questionário e grupo focal com 30 profissionais de uma Unidade de Saúde da Família, e analisados por temas geradores. Resultados: Os profissionais possuem conhecimentos sobre a identificação do câncer infanto-juvenil, e, demandam conhecer mais sobre os sinais e sintomas para identificação precoce, e a prestação de uma assistência sistematizada. Conclusão: Torna-se fundamental estimular a qualificação dos profissionais da atenção primária para a identificação precoce e o fortalecimento de uma rede de assistência que proporcione atendimento integral e a redução no retardo do diagnóstico de câncer infanto-juvenil

Rutiner i omvårdnad på intensivvårdavdelning av hjärnskadade patienter : Intervjustudie

Bakgrund: Traumatisk hjärnskada (THS) orsakas av våld mot huvud i samband med fallolyckor eller trafikolyckor. Varje år söker 20 000 personer vård på grund av skallskador. Vården för traumatiskt hjärnskadade patienter i Sverige skiljer sig åt, mycket beroende på avstånden som finns till specialistsjukhus, tiden och rätta åtgärder är avgörande faktorer för denna patientgrupp. Syfte: Att undersöka vikten och intensivvårdssjuksköterskors behov av rutiner i samband med vård av patienter med hjärnskador på allmänintensivvårdsavdelningar och på neurointensivvårdavdelningar. Metod: Kvalitativ studie med fokusgruppsintervjuer av tio intensivvårdsjuksköterskor som arbetar på en allmänintensivvårdsavdelning (IVA) och specialistneurointensivvårdavdelningen (NIVA). Resultat: På NIVA finns väl inarbetade rutiner och tydliga riktlinjer nedskrivna. Sjuksköterskornas upplevelse var att det fanns tillräckligt med rutiner, men några rutiner kunde utvecklas. På IVA fanns det inga nedskrivna riktlinjer och inga tydliga rutiner för att vårda denna patientgrupp. Vården och kontrollerna ordinerades av läkare som är i tjänst. Slutsats: Vården kring hjärnskadade patienter är ytterst viktigt då man ständigt måste förebygga sekundära skador/insulter. Rutiner är väl inarbetade på specialistsjukhuset, men vården börjar först på hemsjukhuset på IVA där tydliga rutiner och riktlinjer saknas.

Rede Social Pessoal, Qualidade de Vida e Depressão em Idosos

Em Portugal e no Mundo Ocidental a população está a envelhecer, colocando esta nova realidade enormes desafios à sociedade. A sua crescente relevância deve-se sobretudo às consideráveis repercussões a nível pessoal, familiar, sociopolítico e económico e que afetam pessoas de todas as idades e a sociedade como um todo, colocando desafios específicos relativamente às relações interpessoais, à qualidade de vida e à saúde mental na pessoa idosa. Deste modo, o presente trabalho tem como objetivo analisar a associação entre a qualidade de vida, a depressão e as características das redes sociais pessoais dos idosos. Participaram no estudo 317 indivíduos, sendo 202 do sexo feminino e 115 do sexo masculino, com idade igual ou superior a 65 anos, com uma média de 77 anos (DP=7,57). Na recolha de dados recorremos a três instrumentos: Geriatric Depression Scale (GDS Short Form 15), (Yesavage et al., 1983; Almeida & Almeida, 1999); Instrumento de Avaliação de Qualidade de Vida da OMS (WHOQOL), (OMS, 1998; Canavarro et al., 2006); Instrumento de Avaliação das Redes Sociais Pessoais (IARSP – Idosos), (Guadalupe, 2010; Guadalupe & Vicente, 2012). Dos resultados destacamos que as características funcionais da rede social pessoal se diferenciaram de forma estatisticamente significativa entre as subamostras de idosos segundo os níveis de qualidade de vida percebida. Saliente-se que, além da relação significativa entre a depressão e qualidade de vida, em que os idosos com um nível mais baixo de qualidade de vida percebida apresentam maiores níveis de depressão (p<0,001), as características funcionais das redes sociais apresentam uma associação clara com a qualidade de vida (p<0,005) e a maioria com a depressão (p<0,014), o que não acontece com as estruturais e com as relacionais-contextuais. Outros resultados indicam que indivíduos com diferentes níveis de qualidade de vida percebida possuem uma estrutura idêntica da rede social pessoal. Ao nível da análise da associação entre as variáveis funcionais da Rede Social Pessoal, Qualidade de Vida e Depressão, o modelo analítico transmite-nos indicadores de investigação e intervenção precisos, o que demonstra a necessidade da continuidade e aprofundamento do presente estudo num âmbito amostral mais alargado e heterogéneo. / In Portugal and in the eastern world, the aging of population creates huge challenges to societies. It's growing relevance is owed to considerable repercussions on the personal, familiar, socio-politic and economic level that affect people of all ages and society as a whole, creating specific challenges regarding interpersonal relationships, quality of life and mental health of the elderly. The current work has the objective of analyzing the association between quality of life, depression and the characteristics of personal social networks of the elderly. 317 individuals have participated in this study, 202 female and 115 male, with age equal or above 65 years old, with an average of 77 years old (DP=7,57). We used three assessment instruments to collect data: Geriatric Depression Scale (GDS Short Form 15), (Yesavage et al., 1983; Almeida & Almeida, 1999); WHO’s Quality of Life Evaluation instrument (WHOQOL) (WHO, 1998; Canavarro et al., 2006); Personal Social Network Analysis Tool (IARSP-Elderly),(Guadalupe, 2010; Guadalupe & Vicente, 2012). The results show that the functional personal network characteristics are significantly different according to their level of quality of life. It should also be noted that not only there is a significant association between depression and quality of life, in which elderly people with a lower quality of life level show higher levels of depression (p<0,001), there is also a clear association between the functional social network characteristics and quality of life (p<0,005), and the majority with depression (p<0,014), which doesn’t happen with structural and relational-contextual social network characteristics. Other results indicate that different levels of quality of life acquire an identical social network structure. On the matter of association between the functional variables of social networks, quality of fife and depression, the analytic model shows precise indicators of research and intervention, which instills us a need to continue and enlarge this study with an wider and more heterogeneous sample.

Assessing the Knowledge and Attitude Among Somali Men In King County Towards Female Genital Mutilation

Thesis (Master's)--University of Washington, 2016-06

A Qualitative Assessment of Breast Cancer Advocates in Bolivia, Colombia, Ecuador and Peru

Thesis (Master's)--University of Washington, 2016-06

Gestão Social em Empreendimentos Econômicos Solidários: uma abordagem no Oeste Potiguar

The central research question was to search for data to ratify the theory and discourse of the so-called practitioners of economic solidarity, by defending the substantive rationality should guide the principles of economic solidary, designing the space economy incidental and not the primacy of relations in determining social as well, reflecting the predominance of dimensions of social management in administrative practices of ESS's. For both analyzed the theoretical dimensions of social management - sociopolitical, economic, organizational and environmental - manifested in organizational practices supportive of economic organization Potiguar West. For the success of the research realized the triangulation involving a combination of quantitative and qualitative methodological approaches. At first the research will use a quantitative approach, from the cluster analysis, to verify the behavior of the sample chosen for this study. In the second stage of the qualitative study was carried out focus group technique (FLICK, 2002) for further analysis of the dimensions of social management on organizational practices supportive of economic organization, related to the principles of Solidary Economy, established in a quantitative approach. In quantitative analysis, the socio-political dimension, it was clear that the more equity instruments of internal and external, from the purposeful living in public spaces, the best monetary results. Another point worth stressing concerns the economic dimension, with the practice reciprocity prevailing in market. Thus, the qualitative approach was possible to understand the processes of exchange of product or service. Rural enterprises surveyed in the allocation of the agro-ecological products have the following scale of priority, sequentially: self-consumption (domestic), market and exchange. The research leads to the fact that training and practices that enhance the socio-political dimension (knowledge, empowerment, sense of belonging) become the guiding principle for the strengthening of the social management in the context of other dimensions, leading to gains sociopolitical, economic, organizational and environmental. Despite the weaknesses found in the organizational dimension and environment, both in a quantitative as in qualitative, we determined that the practices of ESS's Potiguar West incorporate predominantly elements of social management and economic solidarity, with a preponderance of substantive rationality in the primacy of the instrumental. Finally, research has brought information that the participants of the ESS's do not give the money economy primacy in determining social relations, which in turn leads to the confirmation that, in practice the solidarity economy, prevailing the dominance of substantive rationality, as a guide for organizational practices

Relações entre mecanismos de coordenação e controle com desempenho organizacional: um estudo nas instituições públicas de ensino médio de Natal

This research aimed at relating coordination and control forms to organizational performance. The multicase study was applied in two public high schools: Centro Federal de Educação Tecnológica do Rio Grande do Norte and Floriano Cavalcanti. In order to accomplish these objectives, it was developed a qualitative analysis and considered coordination and control forms of several authors. Also was considered Sander´s (1984) model of organizational performance. The mentioned model considers two criteria to analyze organizational performance: one instrumental (efficiency and efficacy) and other substantive (effectiveness e relevance). The research attempts to show the importance of balancing these criteria in a way that effectiveness and relevance becomes more important at schools. It was proven that the use of bureaucratic coordination forms has the power to influence the evaluation on the instrumental technique. At the same time, it was observed that the use of mechanisms based on the autonomy of the school is related to efficiency and efficacy. The object of this research can be considered successful

BETA-GA2O3: A TRANSPARENT CONDUCTIVE OXIDE FOR POTENTIAL RESISTIVE SWITCHING APPLICATIONS

Thesis (Ph.D.)--University of Washington, 2016-08