Characteristics of primary care office visits to nurse practitioners, physician assistants and physicians in United States Veterans Health Administration facilities, 2005 to 2010: a retrospective cross-sectional analysis.

UNLABELLED: BACKGROUND: Primary care, an essential determinant of health system equity, efficiency, and effectiveness, is threatened by inadequate supply and distribution of the provider workforce. The Veterans Health Administration (VHA) has been a frontrunner in the use of nurse practitioners (NPs) and physician assistants (PAs). Evaluation of the roles and impact of NPs and PAs in the VHA is critical to ensuring optimal care for veterans and may inform best practices for use of PAs and NPs in other settings around the world. The purpose of this study was to characterize the use of NPs and PAs in VHA primary care and to examine whether their patients and patient care activities were, on average, less medically complex than those of physicians. METHODS: This is a retrospective cross-sectional analysis of administrative data from VHA primary care encounters between 2005 and 2010. Patient and patient encounter characteristics were compared across provider types (PA, NP, and physician). RESULTS: NPs and PAs attend about 30% of all VHA primary care encounters. NPs, PAs, and physicians fill similar roles in VHA primary care, but patients of PAs and NPs are slightly less complex than those of physicians, and PAs attend a higher proportion of visits for the purpose of determining eligibility for benefits. CONCLUSIONS: This study demonstrates that a highly successful nationwide primary care system relies on NPs and PAs to provide over one quarter of primary care visits, and that these visits are similar to those of physicians with regard to patient and encounter characteristics. These findings can inform health workforce solutions to physician shortages in the USA and around the world. Future research should compare the quality and costs associated with various combinations of providers and allocations of patient care work, and should elucidate the approaches that maximize quality and efficiency.

FLUTE MUSIC FROM THE MID-TWENTIETH CENTURY BY THREE FRENCH COMPOSERS: JEAN-MICHEL DAMASE, ANDRE JOLIVET, AND HENRI TOMASI

Jean-Michel Damase (b.1928), Andre Jolivet (1905-1974), and Henri Tomasi (1901-1971) are three prominent French composers ofthe twentieth century. Tomasi won the Prix de Rome in 1927, and Damase won the Prix de Rome in 1947. All three composers were educated and lived in Paris around the same period; however, their musical styles are quite distinct. Most of Jolivet's compositions for flute are well known and are often selected as international competition repertoire. The compositions for flute by Damase and Tomasi are not as recognized as those of Jolivet, and most of their works for flute still have not been commercially recorded. The purpose of this dissertation is to provide a more comprehensive guide to the compositions for flute by Damase, Jolivet and Tomasi, and, in addition, to make the works ofDamase and Tomasi familiar to flutists. This dissertation will focus on the compositions ofDamase, Jolivet, and Tomasi for flute alone and those for flute and piano, written between 1928 and 1971 (1928 is the year Damase was born, and 1971 is the year that Tomasi died). Damase continues French romanticism, and his music is always playful, elegant, and accessible with rhythmic and harmonic surprises, but with an underlying complexity. His compositions for flute include three concertos, two double concertos, one flute solo work, and nine works for flute and piano. Jolivet's compositions make use of ancient rituals, incantations, and spirituality, as well as repeated phrases and single notes, irregular rhythmic patterns, dissonant effects, and rhythmic drive. He composed one flute concerto, three works for flute solo, and four works for flute and piano. Tomasi's compositions also continue French romanticism and contain melodies which often seem to tell a story, and which are not only full of flourishes and vitality, but are also delicate, colorful, and romantic. Virtuosic technical demand is another characteristic of his style. Tomasi composed three flute concertos, three works for solo flute, and one work for flute and piano. Appendix I is a list of the compositions for flute by Damase, Jolivet, and Tomasi, and Appendix II is a discography of their works.

Global Rates of Free Hydrogen (H2) Production by Serpentinization and other Abiogenic Processes within Young Ocean Crust

The main conclusion of this dissertation is that global H2 production within young ocean crust (<10 Mya) is higher than currently recognized, in part because current estimates of H2 production accompanying the serpentinization of peridotite may be too low (Chapter 2) and in part because a number of abiogenic H2-producing processes have heretofore gone unquantified (Chapter 3). The importance of free H2 to a range of geochemical processes makes the quantitative understanding of H2 production advanced in this dissertation pertinent to an array of open research questions across the geosciences (e.g. the origin and evolution of life and the oxidation of the Earth’s atmosphere and oceans).

The first component of this dissertation (Chapter 2) examines H2 produced within young ocean crust [e.g. near the mid-ocean ridge (MOR)] by serpentinization. In the presence of water, olivine-rich rocks (peridotites) undergo serpentinization (hydration) at temperatures of up to ~500°C but only produce H2 at temperatures up to ~350°C. A simple analytical model is presented that mechanistically ties the process to seafloor spreading and explicitly accounts for the importance of temperature in H2 formation. The model suggests that H2 production increases with the rate of seafloor spreading and the net thickness of serpentinized peridotite (S-P) in a column of lithosphere. The model is applied globally to the MOR using conservative estimates for the net thickness of lithospheric S-P, our least certain model input. Despite the large uncertainties surrounding the amount of serpentinized peridotite within oceanic crust, conservative model parameters suggest a magnitude of H2 production (~1012 moles H2/y) that is larger than the most widely cited previous estimates (~1011 although previous estimates range from 1010-1012 moles H2/y). Certain model relationships are also consistent with what has been established through field studies, for example that the highest H2 fluxes (moles H2/km2 seafloor) are produced near slower-spreading ridges (<20 mm/y). Other modeled relationships are new and represent testable predictions. Principal among these is that about half of the H2 produced globally is produced off-axis beneath faster-spreading seafloor (>20 mm/y), a region where only one measurement of H2 has been made thus far and is ripe for future investigation.

In the second part of this dissertation (Chapter 3), I construct the first budget for free H2 in young ocean crust that quantifies and compares all currently recognized H2 sources and H2 sinks. First global estimates of budget components are proposed in instances where previous estimate(s) could not be located provided that the literature on that specific budget component was not too sparse to do so. Results suggest that the nine known H2 sources, listed in order of quantitative importance, are: Crystallization (6x1012 moles H2/y or 61% of total H2 production), serpentinization (2x1012 moles H2/y or 21%), magmatic degassing (7x1011 moles H2/y or 7%), lava-seawater interaction (5x1011 moles H2/y or 5%), low-temperature alteration of basalt (5x1011 moles H2/y or 5%), high-temperature alteration of basalt (3x1010 moles H2/y or <1%), catalysis (3x108 moles H2/y or <<1%), radiolysis (2x108 moles H2/y or <<1%), and pyrite formation (3x106 moles H2/y or <<1%). Next we consider two well-known H2 sinks, H2 lost to the ocean and H2 occluded within rock minerals, and our analysis suggests that both are of similar size (both are 6x1011 moles H2/y). Budgeting results suggest a large difference between H2 sources (total production = 1x1013 moles H2/y) and H2 sinks (total losses = 1x1011 moles H2/y). Assuming this large difference represents H2 consumed by microbes (total consumption = 9x1011 moles H2/y), we explore rates of primary production by the chemosynthetic, sub-seafloor biosphere. Although the numbers presented require further examination and future modifications, the analysis suggests that the sub-seafloor H2 budget is similar to the sub-seafloor CH4 budget in the sense that globally significant quantities of both of these reduced gases are produced beneath the seafloor but never escape the seafloor due to microbial consumption.

The third and final component of this dissertation (Chapter 4) explores the self-organization of barchan sand dune fields. In nature, barchan dunes typically exist as members of larger dune fields that display striking, enigmatic structures that cannot be readily explained by examining the dynamics at the scale of single dunes, or by appealing to patterns in external forcing. To explore the possibility that observed structures emerge spontaneously as a collective result of many dunes interacting with each other, we built a numerical model that treats barchans as discrete entities that interact with one another according to simplified rules derived from theoretical and numerical work, and from field observations: Dunes exchange sand through the fluxes that leak from the downwind side of each dune and are captured on their upstream sides; when dunes become sufficiently large, small dunes are born on their downwind sides (“calving”); and when dunes collide directly enough, they merge. Results show that these relatively simple interactions provide potential explanations for a range of field-scale phenomena including isolated patches of dunes and heterogeneous arrangements of similarly sized dunes in denser fields. The results also suggest that (1) dune field characteristics depend on the sand flux fed into the upwind boundary, although (2) moving downwind, the system approaches a common attracting state in which the memory of the upwind conditions vanishes. This work supports the hypothesis that calving exerts a first order control on field-scale phenomena; it prevents individual dunes from growing without bound, as single-dune analyses suggest, and allows the formation of roughly realistic, persistent dune field patterns.

Adaptive intervention design in mobile health: Intervention design and development in the Cell Phone Intervention for You trial.

BACKGROUND/AIMS: The obesity epidemic has spread to young adults, and obesity is a significant risk factor for cardiovascular disease. The prominence and increasing functionality of mobile phones may provide an opportunity to deliver longitudinal and scalable weight management interventions in young adults. The aim of this article is to describe the design and development of the intervention tested in the Cell Phone Intervention for You study and to highlight the importance of adaptive intervention design that made it possible. The Cell Phone Intervention for You study was a National Heart, Lung, and Blood Institute-sponsored, controlled, 24-month randomized clinical trial comparing two active interventions to a usual-care control group. Participants were 365 overweight or obese (body mass index≥25 kg/m2) young adults. METHODS: Both active interventions were designed based on social cognitive theory and incorporated techniques for behavioral self-management and motivational enhancement. Initial intervention development occurred during a 1-year formative phase utilizing focus groups and iterative, participatory design. During the intervention testing, adaptive intervention design, where an intervention is updated or extended throughout a trial while assuring the delivery of exactly the same intervention to each cohort, was employed. The adaptive intervention design strategy distributed technical work and allowed introduction of novel components in phases intended to help promote and sustain participant engagement. Adaptive intervention design was made possible by exploiting the mobile phone's remote data capabilities so that adoption of particular application components could be continuously monitored and components subsequently added or updated remotely. RESULTS: The cell phone intervention was delivered almost entirely via cell phone and was always-present, proactive, and interactive-providing passive and active reminders, frequent opportunities for knowledge dissemination, and multiple tools for self-tracking and receiving tailored feedback. The intervention changed over 2 years to promote and sustain engagement. The personal coaching intervention, alternatively, was primarily personal coaching with trained coaches based on a proven intervention, enhanced with a mobile application, but where all interactions with the technology were participant-initiated. CONCLUSION: The complexity and length of the technology-based randomized clinical trial created challenges in engagement and technology adaptation, which were generally discovered using novel remote monitoring technology and addressed using the adaptive intervention design. Investigators should plan to develop tools and procedures that explicitly support continuous remote monitoring of interventions to support adaptive intervention design in long-term, technology-based studies, as well as developing the interventions themselves.

Resources, experience and perseverance in entrepreneurs' perceived likelihood of success in an emerging economy

This paper introduces new results obtained from a statistical investigation into a 3071-observation data set collected from a Vietnamese nationwide entrepreneurship survey. From established relationships, such factors as preparedness, financial resources and participation in social networks are confirmed to have significant effects on entrepreneurial decisions. Entrepreneurs, both financially constrained and unconstrained, who have a business plan tend to start their entrepreneurial ventures earlier. Also, financial constraints have a profound impact on the entrepreneurial decisions. When perceiving the likelihood of success to be high, an entrepreneur shows the tendency for prompt action on business ideas. But when seeing the risk of prolonging the waiting time to first revenue, a prospective entrepreneur would be more likely to wait for more favorable conditions despite the vagueness of "favorable". Additionally, empirical computations indicate that there is a 41.3% probability that an extant entrepreneur who is generating revenue sees high chance of success. Past work and entrepreneurial experiences also have positive impacts on both the entrepreneurial decisions and perceived chance of success.

Personalised e-learning, semantic web and learning ontologies

Kurzel(2004) points out that researchers in e-learning and educational technologists, in a quest to provide improved Learning Environments (LE) for students are focusing on personalising the experience through a Learning Management System (LMS) that attempts to tailor the LE to the individual (see amongst others Eklund & Brusilovsky, 1998; Kurzel, Slay, & Hagenus, 2003; Martinez,2000; Sampson, Karagiannidis, & Kinshuk, 2002; Voigt & Swatman; 2003). According to Kurzel (2004) this tailoring can have an impact on content and how it’s accessed; the media forms used; method of instruction employed and the learning styles supported. This project is aiming to move personalisation forward to the next generation, by tackling the issue of Personalised e-Learning platforms as pre-requisites for building and generating individualised learning solutions. The proposed development is to create an e-learning platform with personalisation built-in. This personalisation is proposed to be set from different levels of within the system starting from being guided by the information that the user inputs into the system down to the lower level of being set using information inferred by the system’s processing engine. This paper will discuss some of our early work and ideas.

An architectural approach to autonomics and self-management of automotive embedded electronic systems

Embedded electronic systems in vehicles are of rapidly increasing commercial importance for the automotive industry. While current vehicular embedded systems are extremely limited and static, a more dynamic configurable system would greatly simplify the integration work and increase quality of vehicular systems. This brings in features like separation of concerns, customised software configuration for individual vehicles, seamless connectivity, and plug-and-play capability. Furthermore, such a system can also contribute to increased dependability and resource optimization due to its inherent ability to adjust itself dynamically to changes in software, hardware resources, and environment condition. This paper describes the architectural approach to achieving the goals of dynamically self-configuring automotive embedded electronic systems by the EU research project DySCAS. The architecture solution outlined in this paper captures the application and operational contexts, expected features, middleware services, functions and behaviours, as well as the basic mechanisms and technologies. The paper also covers the architecture conceptualization by presenting the rationale, concerning the architecture structuring, control principles, and deployment concept. In this paper, we also present the adopted architecture V&V strategy and discuss some open issues in regards to the industrial acceptance.

Coursework uploads and zero-tolerance deadlines

Clear assessment deadlines and severe penalties for late submission of coursework are a feature of a number of UK universities. This presents a severe challenge for any online upload system. Evidence from a range of different implementations at the School of Computing and Mathematical Sciences at the University of Greenwich over the past few years is examined to assess the impact of a zero-tolerance deadline policy on the way students work and the problems that arise. Suggestions are made on how to minimise any possible negative impact of a zero-tolerance deadline policy on the administration of the system and on staff and students.

'Re-using an existing wheel' developing data architecture for cooperating autonomous and semi-autonomous, agent-based web services

This short position paper considers issues in developing Data Architecture for the Internet of Things (IoT) through the medium of an exemplar project, Domain Expertise Capture in Authoring and Development ­Environments (DECADE). A brief discussion sets the background for IoT, and the development of the ­distinction between things and computers. The paper makes a strong argument to avoid reinvention of the wheel, and to reuse approaches to distributed heterogeneous data architectures and the lessons learned from that work, and apply them to this situation. DECADE requires an autonomous recording system, ­local data storage, semi-autonomous verification model, sign-off mechanism, qualitative and ­quantitative ­analysis ­carried out when and where required through web-service architecture, based on ontology and analytic agents, with a self-maintaining ontology model. To develop this, we describe a web-service ­architecture, ­combining a distributed data warehouse, web services for analysis agents, ontology agents and a ­verification engine, with a centrally verified outcome database maintained by certifying body for qualification/­professional status.

The feedback we give: university student perceptions and preferences

This paper reports the results of a study on higher education student perceptions of and preferences for feedback on their performance. The issue of feedback to students is becoming increasingly important in higher education, not only because it is an important element of learning, but also as a significant component of the student experience and its evaluation. Within a mass education context, written feedback on coursework may be an important opportunity available to students for individualised attention. The current research explored perceptions of feedback by participants who were studying in undergraduate business degrees in a UK university (N=175). The survey instrument asked participants to evaluate the feedback they receive at university in terms of its impact and influence, as well as their understanding of feedback received and preferences. Analysis of the data indicates that students generally find feedback provided to them helpful and encouraging in improving their work but they also indicate that they would prefer to discuss their work directly with their tutor instead of receiving written feedback. They comment on the illegibility of some hand written feedback received. They also report that, generally, they act on the feedback received in order to improve their work and say that it helps them to reflect on their learning. Students comment that negative feedback received does not make them angry or demotivate them. The survey found considerable variability in the students' understanding of 'typical' feedback comments. The majority of students (79%) also reported that they prefer a structured feedback matrix to general comments because they consider it more specific and easier to understand. The implications of these findings for feedback and assessment practices are discussed and suggestions for improvements developed.

The interprofessional practitioner: changing professional identity in social work

Twenty years ago the first joint training programme in learning disability nursing and social work was established as a collaborative project to develop practitioners able to work holistically with people with learning disabilities. Since then a number of programmes have continued this work and more recently the approach has developed in the mental health specialism. These programmes have changed the nature of singular social work education and created a new region of knowledge (Bernstein, 2000) for those who have experienced them. What began as a radical experiment in interprofessional education has been sustained by a strong commitment to the belief that the practitioners who qualify from such programmes are well equipped to support people with learning disabilities in changing and multi-professional services. As with much interprofessional education, however, there is an ongoing need to build an evidence base linking such education with successful outcomes in practice. This paper presents and explores the outcomes of a doctoral research study aimed at evaluating the impact of joint training in learning disability nursing and social work on the professional identity, skills and working practices of practitioners who undertook it. The research was undertaken with almost fifty jointly trained practitioners and involved a national survey followed by semi-structured interviews. The results suggest that practitioners who experience the dual socialisation inherent in this type of training found both gains and losses in the process. They appear to emerge, however, with a confidence, resilience and breadth of knowledge which were part of the early vision for this transformative approach to professional training. Bernstein B. (2000). Pedagogy, Symbolic Control and Identity. Theory, Research, Critique. Revised Edition. Lanham: Rowman and Littlefield (USA).

Chronotype, sleep quality and sleep duration in adult distance education: Not related to study progress

Research in traditional education shows chronotype, sleep duration and sleep quality to be related to learning performance. Research in adult students participating in distance education (DE) is scarce. This study aims to provide knowledge on these relationships in this educational setting. In an observational longitudinal study, chronotype, sleep duration (i.e., for work and free days separately) and sleep quality of 894 students were analyzed in a multiple regression analyses. Students provided information on sleep-relatedmeasures and important covariates at the start of their study and study progress was evaluated after 14 months (i.e., the number of successfully completed modules). In linewith previous research, chronotype did not predict study progress. Further, sleep duration did not predict study progress, neither as a linear nor as a polynomial term. Third, sleep quality did not predict study progress. Concluding, these results are in linewith previous research that DE provides a solution to the asynchrony problem. Findings regarding sleep duration and sleep quality are new and unexpected, asking for attention and further research. Despite the study's observational nature, findings suggest that students participating in DE may benefit from this type of education as the asynchrony problem appears not to apply here, as students can choose their own study schedule.

Coccolithophore bloom detection in the north east Atlantic using SeaWiFS: Algorithm description, application and sensitivity analysis

Coccolithophores are the largest source of calcium carbonate in the oceans and are considered to play an important role in oceanic carbon cycles. Current methods to detect the presence of coccolithophore blooms from Earth observation data often produce high numbers of false positives in shelf seas and coastal zones due to the spectral similarity between coccolithophores and other suspended particulates. Current methods are therefore unable to characterise the bloom events in shelf seas and coastal zones, despite the importance of these phytoplankton in the global carbon cycle. A novel approach to detect the presence of coccolithophore blooms from Earth observation data is presented. The method builds upon previous optical work and uses a statistical framework to combine spectral, spatial and temporal information to produce maps of coccolithophore bloom extent. Validation and verification results for an area of the north east Atlantic are presented using an in situ database (N = 432) and all available SeaWiFS data for 2003 and 2004. Verification results show that the approach produces a temporal seasonal signal consistent with biological studies of these phytoplankton. Validation using the in situ coccolithophore cell count database shows a high correct recognition rate of 80% and a low false-positive rate of 0.14 (in comparison to 63% and 0.34 respectively for the established, purely spectral approach). To guide its broader use, a full sensitivity analysis for the algorithm parameters is presented.

Playback Theatre: the art of being oneself. A tool for empowerment and real change for individuals and communities

This article presents the application of a theatrical technique—Playback Theatre, which was developed in the United States during the 1970s—to social intervention, as a narrative and listening space that confers value and dignity upon the person and the unique and distinct individual experiences that facilitate their social and relational integration. This art of being oneself, as the author states, uses the oral tradition and spontaneous and creative communication of psychodrama and combines them with theatrical expression. This technique has been shown to be pertinent to both community social work and support groups for persons in problematic situations. The aim of this is to celebrate some specific moment of their lives, as individuals or as a community, and to define strategies for improving living conditions or resolving or alleviating conflicts. It is also used to assess the achievements of the proposed objectives, to strengthen the motivation to change and to transform existing relationships into collaborative ones. This is possible not only owing to the participation of persons, but also to the assumption of different roles that can permit the overcoming of certain traumatic events.In addition to support groups, it is used for the training and supervision of social work professionals. The theatrical technique in question allows them to assume roles as diverse as narrator, audience or actor, whether simultaneously or successively. Taking the role of «performer» or guide to the theatrical action requires prior preparation in order for the group of participants to be able to pool their individualities and their emotions and reflect on them. The participatory methodology that Playback Theatre proposes is important in community social work and is posed in a new and transformative key.

Calling for resistance: The political economy of Indian and Canadian call centre industries

Call centres have in the last three decades come to define the interaction between corporations, governments, and other institutions and their respective customers, citizens, and members. From telemarketing to tele-health services, to credit card assistance, and even emergency response systems, call centres function as a nexus mediating technologically enabled labour practices with the commodification of services. Because of the ubiquitous nature of the call centre in post-industrial capitalism, the banality of these interactions often overshadows the nature of work and labour in this now-global sector. Advances in telecommunication technologies and the globalization of management practices designed to oversee and maintain standardized labour processes have made call centre work an international phenomenon. Simultaneously, these developments have dislocated assumptions about the geographic and spatial seat of work in what is defined here as the new international division of knowledge labour. The offshoring and outsourcing of call centre employment, part of the larger information technology and information technology enabled services sectors, has become a growing practice amongst governments and corporations in their attempts at controlling costs. Leading offshore destinations for call centre work, such as Canada and India, emerged as prominent locations for call centre work for these reasons. While incredible advances in technology have permitted the use of distant and “offshore” labour forces, the grander reshaping of an international political economy of communications has allowed for the acceleration of these processes. New and established labour unions have responded to these changes in the global regimes of work by seeking to organize call centre workers. These efforts have been assisted by a range of forces, not least of which is the condition of work itself, but also attempts by global union federations to build a bridge between international unionism and local organizing campaigns in the Global South and Global North. Through an examination of trade union interventions in the call centre industries located in Canada and India, this dissertation contributes to research on post-industrial employment by using political economy as a juncture between development studies, critical communications, and labour studies.