2,011 research outputs found

    A Quasi-Global Presentation of TIROS III Radiation Data

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    The TIROS III meteorological satellite was equipped with a five-channel medium resolution radiometer to measure the reflected solar radiation as well as the infrared emission of the earth-atmosphere system in five different spectral regions (Reference 1). According to the initial design of this radiation experiment, one of the most useful applications of the infrared measurements was to be the derivation of day and nighttime cloudiness from Channel 2, which was sensitive within the atmospheric "window" region (8 to 12 microns). Several authors already have demonstrated and discussed the principal usefulness of these data for this particular purpose (References 2, 3, and 4). This present study was performed to investigate and demonstrate the utility of the TIROS radiation data for global synoptic analyses

    Suicide Screening in Primary Care: Use of an Electronic Screener to Assess Suicidality and Improve Provider Follow-Up for Adolescents

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    Purpose The purpose of this study was to assess the feasibility of using an existing computer decision support system to screen adolescent patients for suicidality and provide follow-up guidance to clinicians in a primary care setting. Predictors of patient endorsement of suicidality and provider documentation of follow-up were examined. Methods A prospective cohort study was conducted to examine the implementation of a CDSS that screened adolescent patients for suicidality and provided follow-up recommendations to providers. The intervention was implemented for patients aged 12–20 years in two primary care clinics in Indianapolis, Indiana. Results The sample included 2,134 adolescent patients (51% female; 60% black; mean age = 14.6 years [standard deviation = 2.1]). Just over 6% of patients screened positive for suicidality. A positive endorsement of suicidality was more common among patients who were female, depressed, and seen by an adolescent−medicine board-certified provider as opposed to general pediatric provider. Providers documented follow-up action for 83% of patients who screened positive for suicidality. Documentation of follow-up action was correlated with clinic site and Hispanic race. The majority of patients who endorsed suicidality (71%) were deemed not actively suicidal after assessment by their provider. Conclusions Incorporating adolescent suicide screening and provider follow-up guidance into an existing computer decision support system in primary care is feasible and well utilized by providers. Female gender and depressive symptoms are consistently associated with suicidality among adolescents, although not all suicidal adolescents are depressed. Universal use of a multi-item suicide screener that assesses recency might more effectively identify suicidal adolescents

    Developing a conversation: A strategy to engage faculty in pedagogical change

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    Personal interviews were conducted with biochemistry faculty during which they were presented with student performances on a content survey. From these interviews, four themes that reflect faculty responses to the surveys emerged: awareness of student understanding, self reflection on teaching practice, planned collaboration with colleagues, and emotional reactions. Here, we discuss these themes and their implications for creating conversation designed to promote reflection on biochemistry teaching

    Do Younger TKR and THR Patients Have Similar Disability at Time of Surgery as Older Adults? Lessons from FORCE-TJR

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    Introduction: The number of US patients under 65 year old who are undergoing total knee replacement (TKR) and total hip replacement (THR) has been rising, raising concerns that younger patients may receive surgery prematurely. Therefore, we examined demographics and clinical factors and compared the severity of operative knee pain and functional status in younger versus older TKR patients from a US national sample. Materials & methods: The FORCE-TJR registry gathers data from patients, surgeons and hospitals on sociodemographic factors (age, sex, race), BMI, comorbid conditions using the modified Charlson comorbidity scores, burden of musculoskeletal disease using the Knee/Hip injury and Osteoarthritis Outcome Score (KOOS/HOOS) in both knees and hips, emotional health based on the Short Form 36 (SF-36) Mental Component Score (MCS) and physical function based on the Physical Component Score (SF-36 PCS). Results: We analysed data from 2035 younger (\u3c65) and 3084 older (≥65) TKR patients and 1780 younger and 1831 older THR patients. Younger TKR and THR patients were more likely nonwhite (TKR: 13.1% vs. 6.6%; THR: 51.7% vs. 48.3%),), with greater body mass index (mean BMI TKR: 33.1 vs. 30.5; THR: 29.9 vs. 28.4), smokers, had fewer number of comorbid conditions. Younger TKR patients reported lower emotional health (MCS 49.1 vs. 52.6), greater joint pain, stiffness and functional impairment (based on estimated WOMAC) and global functional impairment (using PCS). Younger THR patients reported greater joint pain, stiffness and functional impairment (estimated WOMAC) but not global function. Conclusion: At the time of TKR and THR, younger patients have fewer medical illnesses, but higher rates of obesity and smoking as well as lower mental health scores. Younger have the same or greater joint specific and global functional impairment compared to older patients, suggesting surgeons use comparable standards for selecting TKR and THR candidates in younger and older adults

    Predictors of Patient-reported Outcomes after TKR not Included in Risk Models Based on Administrative Data

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    Introduction: Because total knee replacement (TKR) surgery is performed to relieve pain and improve physical function in patients with advanced arthritis, patient-reported outcomes (PROs) are important to assess TKR effectiveness. The UK and others require PROs. Understanding pre-existing clinical factors that influence PROs after surgery is needed before comparing PROs across providers. We evaluated the roles of medical and musculoskeletal comorbidities in explaining variation in 6 month post-TKR pain relief and functional gain in a national cohort of TKR patients. Materials & methods: FORCE-TJR, funded by the Agency for Healthcare Research and Quality (AHRQ), is a national consortium in which 100% patients, surgeons and hospitals submit data: patients demographics (age, gender, BMI, race), complete medical and musculoskeletal comorbidities, PROs including SF-36 Physical Component Score (PCS), Knee injury and Osteoarthritis Outcome Score (KOOS), clinically refined adverse events and implant data. Predictors of change in pre-to-6 month post-TKR pain and function were examined using linear mixed models adjusting for clustering within site. Results: TKR patients had a mean age of 67 years, mean BMI of 31.2, were 63% female and 4.5% black, 9% with Charlson Comorbidity Index (CCI) of 2-5, 15% with CCI of 6, 7% moderate/severe pain in 2-3 knee/hip joints, 27% moderate/severe lumbar pain. After adjusting for socio-demographic factors, significant predictors of poorer 6 month post-TKR pain included poorer emotional health, higher CCI, 1-2 nonsurgical hip/knee joints with moderate/severe pain, any lumbar pain at time of TKR. These same factors also predicted poorer 6 month function. Conclusion: Before adopting PROs as a standard measure of TKR outcome, a complete understanding of pre-existing clinical factors associated with poorer pain relief and functional gain is needed. Greater musculoskeletal, and medical, comorbid conditions were associated with post-operative PROs and should be included in risk-adjustment models before cross-hospital comparisons can be made

    Impact of effective instruction within middle school classrooms on at-risk student problem behavior [abstract]

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    Abstract only availableTeachers are increasingly faced with students who present challenging behavior in the classroom. When faced with such challenges, educators look for effective ways to manage problem behaviors, as well as to prevent problems, through the use of effective instructional strategies. This study investigates the impact of using classroom and student self-management supports in relation to work completion in order to increase academic success in the classroom for students identified as behavioral concerns. Direct observation data on teacher and student variables was collected and visually analyzed. Results indicated that the combination of classroom prompts and feedback paired with a self-management strategy increased student academic success. Implications for other teachers who struggle with challenging behavior in the classroom are discussed

    The Characteristics and Biological Relevance of Inorganic Amorphous Calcium Carbonate (ACC) Precipitated from Seawater

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    The importance of amorphous calcium carbonate (ACC) as a precursor phase in the biomineralization of marine calcifiers is increasingly being reported, particularly as the presence of ACC has been observed or inferred in several major groups. Here, we investigate the structure of ACC and the conditions required for its precipitation from seawater-based solutions, with an emphasis on the coinfluence of the carbonate system (pH, dissolved inorganic carbon (DIC) concentration), seawater Mg/Ca ratio, and presence of amino acids. We find that Mg2+ and the presence of aspartic acid, glutamic acid, and glycine strongly inhibit ACC precipitation. Moreover, we were unable to precipitate ACC from seawater with a carbonate chemistry within the range of that thought to characterize the calcification site of certain marine calcifiers (i.e., DIC < 6 mM, pH < 9.3), although substantial modification of the seawater Mg/Ca ratio (Mg/Casw) allowed precipitation at a reduced DIC with the implication that this could be an important component of utilizing an ACC pathway. In addition, the degree to which Mg/Casw and the presence of amino acids influences the structure of ACC and the necessary seawater [CO3 2-] for precipitation is strongly pH dependent. At lower, more biologically relevant pH than that typical of much inorganic work, decreasing Mg/Casw can result in greater long-range order and less water of crystallization but facilitates precipitation at a considerably lower [CO3 2-] than at higher pH
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