Protocol for the "Implementation, adoption, and utility of family history in diverse care settings" study.

BACKGROUND: Risk assessment with a thorough family health history is recommended by numerous organizations and is now a required component of the annual physical for Medicare beneficiaries under the Affordable Care Act. However, there are several barriers to incorporating robust risk assessments into routine care. MeTree, a web-based patient-facing health risk assessment tool, was developed with the aim of overcoming these barriers. In order to better understand what factors will be instrumental for broader adoption of risk assessment programs like MeTree in clinical settings, we obtained funding to perform a type III hybrid implementation-effectiveness study in primary care clinics at five diverse healthcare systems. Here, we describe the study's protocol. METHODS/DESIGN: MeTree collects personal medical information and a three-generation family health history from patients on 98 conditions. Using algorithms built entirely from current clinical guidelines, it provides clinical decision support to providers and patients on 30 conditions. All adult patients with an upcoming well-visit appointment at one of the 20 intervention clinics are eligible to participate. Patient-oriented risk reports are provided in real time. Provider-oriented risk reports are uploaded to the electronic medical record for review at the time of the appointment. Implementation outcomes are enrollment rate of clinics, providers, and patients (enrolled vs approached) and their representativeness compared to the underlying population. Primary effectiveness outcomes are the percent of participants newly identified as being at increased risk for one of the clinical decision support conditions and the percent with appropriate risk-based screening. Secondary outcomes include percent change in those meeting goals for a healthy lifestyle (diet, exercise, and smoking). Outcomes are measured through electronic medical record data abstraction, patient surveys, and surveys/qualitative interviews of clinical staff. DISCUSSION: This study evaluates factors that are critical to successful implementation of a web-based risk assessment tool into routine clinical care in a variety of healthcare settings. The result will identify resource needs and potential barriers and solutions to implementation in each setting as well as an understanding potential effectiveness. TRIAL REGISTRATION: NCT01956773.

Genetic deficiency of the fourth component of complement :clinical, immunological and genetical studies in a further family. IXth International Complement Workshop

info:eu-repo/semantics/published

Parliamentary party loyalty and party family: the missing link?

info:eu-repo/semantics/inPress

Expression of liver-specific member of the 3β-hydroxysteroid dehydrogenase family, an isoform possessing an almost exclusive 3-ketosteroid reductase activity

We have recently characterized two types of rat 3β-hydroxysteroid dehydrogenase/Δ5-Δ4 isomerase (3β-HSD) isoenzymes expressed in adrenals and gonads. In addition, we have cloned a third type of cDNA encoding a predicted type III 3β-HSD protein specifically expressed in the male rat liver which shares 80% similarity with the two other isoenzymes. Transient expression in human HeLa cells of the cDNAs reveals that the type III 3β-HSD protein does not display oxidative activity for the classical substrates of 3β-HSD, in contrast to the type I 3β-HSD isoenzyme. However, in the presence of NADH, type III isoenzyme, in common with the type I isoform, converts 5α-androstane-3,17-dione (A-dione) and 5α-dihydrotestosterone (DHT) to the corresponding 3β-hydroxysteroids. In fact, the type I and the type III isoenzymes have the same affinity for DHT with K(m) values of 5.05 and 6.16 μM, respectively. When NADPH is used as cofactor, the affinity for DHT of the type III isoform becomes higher than that of the type I isoform with K(m) values of 0.12 and 1.18 μM, respectively. The type III isoform is thus a 3-ketoreductase using NADPH as preferred cofactor which is responsible for the conversion of 3-keto-saturated steroids such as DHT and A-dione into less active steroids.

Heavy metals in family orchards of the NGO "A roof for my country"

p.19-29

Heavy metals in family orchards of the NGO "A roof for my country"

p.19-29

La Educación Matemática en Finlandia: un camino seguro para otros países o una anomalía

Finlandia últimamente ha recibido mucha fama por su éxito en la prueba de PISA. Varios libros, muchos artículos en revistas académicas y en la prensa popular han analizado dicho éxito. ¿Cuáles son algunas de las características demográficas de Finlandia y cómo se comparan con los países del Caribe? ¿Cuáles son algunos de los aspectos principales del éxito de Finlandia? ¿Cómo se comparan con los países del Caribe? ¿Qué debemos aprender de la experiencia de Finlandia?

La banda de Möbius: un camino que te llevará de cabeza

Este artículo se ha escrito con el objetivo de mostrar la superficie geométrica denominada banda de Möbius como herramienta para potenciar la motivación e interés de los alumnos, tanto de bachillerato como universitarios, en sus clases de Matemáticas. Esta superficie, que tiene varias propiedades muy curiosas, es en realidad un bucle girado, normalmente hecho de papel, fácilmente manipulable por los estudiantes. Para su construcción únicamente se necesitan lápiz, papel, pegamento y tijeras.

On-line algorithms for single machine scheduling with family setup times

The paper considers an on-line single machine scheduling problem where the goal is to minimize the makespan. The jobs are partitioned into families and a setup is performed every time the machine starts processing a batch of jobs of the same family. The scheduler is aware of the number of families and knows the setup time of each family, although information about a job only becomes available when that job is released. We give a lower bound on the competitive ratio of any on-line algorithm. Moreover, for the case of two families, we provide an algorithm with a competitive ratio that achieves this lower bound. As the number of families increases, the lower bound approaches 2, and we give a simple algorithm with a competitive ratio of 2.

The Richit-Richards family of distributions and its use in forestry

Johnson's SB and the logit-logistic are four-parameter distribution models that may be obtained from the standard normal and logistic distributions by a four-parameter transformation. For relatively small data sets, such as diameter at breast height measurements obtained from typical sample plots, distribution models with four or less parameters have been found to be empirically adequate. However, in situations in which the distributions are complex, for example in mixed stands or when the stand has been thinned or when working with aggregated data, then distribution models with more shape parameters may prove to be necessary. By replacing the symmetric standard logistic distribution of the logit-logistic with a one-parameter “standard Richards” distribution and transforming by a five-parameter Richards function, we obtain a new six-parameter distribution model, the “Richit-Richards”. The Richit-Richards includes the “logit-Richards”, the “Richit-logistic”, and the logit-logistic as submodels. Maximum likelihood estimation is used to fit the model, and some problems in the maximum likelihood estimation of bounding parameters are discussed. An empirical case study of the Richit-Richards and its submodels is conducted on pooled diameter at breast height data from 107 sample plots of Chinese fir (Cunninghamia lanceolata (Lamb.) Hook.). It is found that the new models provide significantly better fits than the four-parameter logit-logistic for large data sets.

An improved approximation algorithm for the two-machine open shop scheduling problem with family setup times

We consider the problem of scheduling families of jobs in a two-machine open shop so as to minimize the makespan. The jobs of each family can be partitioned into batches and a family setup time on each machine is required before the first job is processed, and when a machine switches from processing a job of some family to a job of another family. For this NP-hard problem the literature contains (5/4)-approximation algorithms that cannot be improved on using the class of group technology algorithms in which each family is kept as a single batch. We demonstrate that there is no advantage in splitting a family more than once. We present an algorithm that splits one family at most once on a machine and delivers a worst-case performance ratio of 6/5.

Family, community and politics: the fertile legacy of Michael Young

The Institute of Community Studies was set up by Michael Young in order to carry out research on politically relevant social issues, in a context free from direct political control. A research method was devised for it whereby researchers made their own values and objectives very explicit, while staying as close as possible in their reports to the concerns and language of respondents themselves. This method has often been criticized by professional sociologists: but it reflects quite well the nature of social knowledge. It has produced reports which help to increase public understanding of social processes, and provide useful guidance to policy makers. Professional sociology on the other hand has tried to develop a rigorously value-free method. As a result, though, it often seems to be tied implicitly to values shared among researchers but not more universally. Arguably this makes it harder for the general public to understand, and accept, its findings.

Insolvency: ordering a sale of the family home

Comments on the Chancery Division ruling in Nicholls v Lan on whether the interests of a bankrupt husband's creditors prevailed over those of the wife, despite her circumstances being exceptional within the meaning of the Insolvency Act 1986 s.335A on account of her suffering from chronic schizophrenia, where the wife was the joint owner of another property which could be realised to buy out the trustee in bankruptcy's half share in the equity of the matrimonial home.