Global practice experience: A useful lens for understanding patient and staff perceptions of successful integration of health information technology in primary care

Making healthcare comprehensive and more efficient remains a complex challenge. Health Information Technology (HIT) is recognized as an important component of this transformation but few studies describe HIT adoption and it's effect on the bedside experience by physicians, staff and patients. This study applied descriptive statistics and correlation analysis to data from the Patient-Centered Medical Home National Demonstration Project (NDP) of the American Academy of Family Physicians. Thirty-six clinics were followed for 26 months by clinician/staff questionnaires and patient surveys. This study characterizes those clinics as well as staff and patient perspectives on HIT usefulness, the doctor-patient relationship, electronic medical record (EMR) implementation, and computer connections in the practice throughout the study. The Global Practice Experience factor, a composite score related to key components of primary care, was then correlated to clinician and patient perspectives. This study found wide adoption of HIT among NDP practices. Patient perspectives on HIT helpfulness on the doctor-patient showed a suggestive trend that approached statistical significance (p = 0.172). Clinicians and staff noted successful integration of EMR into clinic workflow and their perception of helpfulness to the doctor-patient relationship show a suggestive increase also approaching statistical significance (p=0.06). GPE was correlated with clinician/staff assessment of a helpful doctor-patient relationship midway through the study (R 0.460, p = 0.021) with the remaining time points nearing statistical significance. GPE was also correlated to both patient perspectives of EMR helpfulness in the doctor-patient relationship (R 0.601, p = 0.001) and computer connections (R 0.618, p = 0.0001) at the start of the study. ^

Primates, Provisioning and Plants: Impacts of Human Cultural Behaviours on Primate Ecological Functions

Human provisioning of wildlife with food is a widespread global practice that occurs in multiple socio-cultural circumstances. Provisioning may indirectly alter ecosystem functioning through changes in the eco-ethology of animals, but few studies have quantified this aspect. Provisioning of primates by humans is known to impact their activity budgets, diets and ranging patterns. Primates are also keystone species in tropical forests through their role as seed dispersers; yet there is no information on how provisioning might affect primate ecological functions. The rhesus macaque is a major human-commensal species but is also an important seed disperser in the wild. In this study, we investigated the potential impacts of provisioning on the role of rhesus macaques as seed dispersers in the Buxa Tiger Reserve, India. We studied a troop of macaques which were provisioned for a part of the year and were dependent on natural resources for the rest. We observed feeding behaviour, seed handling techniques and ranging patterns of the macaques and monitored availability of wild fruits. Irrespective of fruit availability, frugivory and seed dispersal activities decreased when the macaques were provisioned. Provisioned macaques also had shortened daily ranges implying shorter dispersal distances. Finally, during provisioning periods, seeds were deposited on tarmac roads that were unconducive for germination. Provisioning promotes human-primate conflict, as commensal primates are often involved in aggressive encounters with humans over resources, leading to negative consequences for both parties involved. Preventing or curbing provisioning is not an easy task as feeding wild animals is a socio-cultural tradition across much of South and South-East Asia, including India. We recommend the initiation of literacy programmes that educate lay citizens about the ill-effects of provisioning and strongly caution them against the practice.

Reducing energy demand: what are the practical limits?

Concern over the global energy system, whether driven by climate change, national security, or fears of shortage, is being discussed widely and in every arena but with a bias toward energy supply options. While demand reduction is often mentioned in passing, it is rarely a priority for implementation, whether through policy or through the search for innovation. This paper aims to draw attention to the opportunity for major reduction in energy demand, by presenting an analysis of how much of current global energy demand could be avoided. Previous work led to a "map" of global energy use that traces the flow of energy from primary sources (fuels or renewable sources), through fuel refinery, electricity generation, and end-use conversion devices, to passive systems and the delivery of final energy services (transport, illumination, and sustenance). The key passive systems are presented here and analyzed through simple engineering models with scalar equations using data based on current global practice. Physically credible options for change to key design parameters are identified and used to predict the energy savings possible for each system. The result demonstrates that 73% of global energy use could be saved by practically achievable design changes to passive systems. This reduction could be increased by further efficiency improvements in conversion devices. A list of the solutions required to achieve these savings is provided.

Dialética da pratica e ação sem prática

O conceito de prática recobriria o de sistema de ação, não fosse a existência de sistemas de ação sem prática. Resta que uma prática é um sistema de ação. Como conseqüência, suposta a reciprocação de sistema com teoria e uma atenta inspeção nos termos da proposição, há equivalência semântica entre prática teóricae sistema de ação prático. Num e noutro caso, a contradição interna aos pares de conceitos se resolve dialeticamente. Graças à dialética, são fundidos numa unidade de sentido, síntese de tensões opostas. Daí a proposta de uma dialética da prática global, conjuntamente abstrata e histórica. Destotalizada ou à margem dessa dialética, pode ser destacada a ação sem prática, exemplificada no drama. Dramática é precisamente uma ação que não é prática. O tempo e o lugar da prática são a história e o mundo do homem; o tempo e o lugar do drama são a ficção cultural e a substância simbólica. Mimese da prática, o drama, reproduz, não os traços do modelo, mas a sua produção, tornando-se por sua vez modelo do modelo. Mimese não é cópia, é forma autônoma de eficiência, paradoxalmente sem prática mas especular.

Strategic environmental assessment in tourism planning - Extent of application and quality of documentation

Strategic environmental assessment (SEA) has been applied throughout the world in different sectors and in various ways. This paper reports on results of a PhD research on SEA applied to tourism development planning, reflecting the situation in mid-2010. First, the extent of tourism specific SEA application world-wide is established. Then, based on a review of the quality of 10 selected SEA reports, good practice, as well as challenges, trends and opportunities for tourism specific SEA are identified. Shortcomings of SEA in tourism planning are established and implications for future research are outlined. (C) 2012 Elsevier Inc. All rights reserved.

Advanced nursing practice : a global perspective

Aim: To review the titles, roles and scope of practice of Advanced Practice Nurses internationally.----- Background: There is a worldwide shortage of nurses but there is also an increased demand for nurses with enhanced skills who can manage a more diverse, complex and acutely ill patient population than ever before. As a result, a variety of nurses in advanced practice positions has evolved around the world. The differences in nomenclature have led to confusion over the roles, scope of practice and professional boundaries of nurses in an international context.----- Method: CINAHL, Medline, and the Cochrane database of Systematic Reviews were searched from 1987 to 2008. Information was also obtained through government health and professional organisation websites. All information in the literature regarding current and past status, and nomenclature of advanced practice nursing was considered relevant.----- Findings: There are many names for Advanced Practice Nurses, and although many of these roles are similar in their function, they can often have different titles.----- Conclusion: Advanced Practice Nurses are critical for the future, provide cost-effective care and are highly regarded by patients/clients. They will be a constant and permanent feature of future health care provision. However, clarification regarding their classification and regulation is necessary in some countries.

Recruiting local public relations professionals for global relations practice : a comparative analysis between Australian and Indian public relations recruitment advertisements

The aim of this exploratory study was to gain an insight into Asian and Western public relations practices by investigating them through job advertisements and thus reflecting on what organisations expect from the public relations professionals. Grunig's (1984) four models of public relations and the concept of relationships management were used as the foundation for this study. Australia was used to represent the Western region and India was used to represent the Asian region. Sample sets of public relations recruitment advertisements from both countries were examined against Grunig's one-way communication, two-way communication and relationship management attributes.

Public disclosure of biological sequences in global patent practice

Biological sequences are an important part of global patenting, with unique challenges for their effective and equitable use in practice and in policy. Because their function can only be determined with computer-aided technology, the form in which sequences are disclosed matters greatly. Similarly, the scope of patent rights sought and granted requires computer readable data and tools for comparison. Critically, the primary data provided to the national patent offices and thence to the public, must be comprehensive, standardized, timely and meaningful. It is not yet. The proposed global Patent Sequence (PatSeq) Data platform can enable national and regional jurisdictions meet the desired standards.

Digital libraries: principles and practice in a global environment

Tedd, L.A. & Large, A. (2005). Digital libraries: principles and practice in a global environment. Munich: K.G. Saur.

Global research collaboration: the UKIERI India-UK initiative – lessons from practice for sustainable international partnerships

As knowledge development is claimed to underpin the development of globalisation, interest in research collaboration and its internationalisation has become more widespread. This paper looks at the motivations behind, and development of, higher educational collaborations with a focus on research collaboration, and also compares some of the key issues surrounding academic collaborations. It employs current thinking on strategic alliances and in particular on social network and social capital theories to judge how collaborations can best be encouraged and managed. The paper uses the specific case of India-UK relationship as an example and looks at the context and motivation for collaboration in these two countries. It presents the UK India Education and Research Initiative (UKIERI) and reviews how this initiative deals with the issues discussed by current writers in relation to collaboration, as well as drawing lessons from the initiative for research collaboration more widely.