A study to determine the degree to which student nurses identify scientific principles and apply them in the bed bath procedure

Thesis (M.S.)--Boston Universit

Health Coverage for Children and Families in Medicaid and SCHIP: State Efforts Face New Hurdles

Surveys eligibility rules, enrollment and renewal procedures, and cost-sharing practices authorized in July 2006-January 2008 in Medicaid and State Children's Health Insurance Programs, as well as new hurdles to expanding coverage for low-income families

Determining Income Eligibility in Children's Health Coverage Programs: How States Use Disregards in Children's Medicaid and SCHIP

Outlines how and why states disregard or deduct certain earnings and expenses in determining eligibility for Medicaid and the State Children's Health Insurance Program to help cover low-income working families. Summarizes a survey of state policies

Doctors’ Pride and Ethics: Time to Introspect

A doctor’s role in society is unique. Over years, medical science has advanced; publics’ expectations have changed; recentpandemic challenged it. Doctors’ face is blemished by accusations. An online survey was done to analyze the change in theattitude and respect of the public towards doctors. For this a questionnaire was forwarded through WhatsApp contacts.Data was extracted to an excel sheet and analyzed. The cohort (n = 328) included both doctors (34.1%) and non-doctors(65.9%). Non-doctors comprised of the general public (47.3%) and people who worked with doctors (18.6%). Overall, 93.3%of those surveyed agreed that “doctors deserve respect”. More doctors (89.3%) as compared to non-doctors (39.4%) (p < 0.001)perceived a reduction in respect towards doctors. On an objective scale (0-10), respect had reduced from an average of8.55 to 6.76 over 10 years; doctors felt steeper reduction (8.68 to 5.42 [p < 0.05] than non-doctors [8.48 to 7.46 [p < 0.05]).Among doctors, 64.3% opined that “doctors’ profession should be considered as service”, while 49.1% agreed that “doctors’profession can be a business model”. A portion of the public, agreed that medications (61.3%) and investigations (56.1%)were prescribed/advised only when necessary. An important reason for reduction in respect was the perception that the“medical profession is run as a business model” (16.8%). Respondents other than doctors, when given an opportunity,wanted to practice ethically (19.4%)

Ecology of Prince of Wales spruce grouse

Thesis (M.S.) University of Alaska Fairbanks, 2010Recently, spruce grouse on Prince of Wales Island (POW) in southeast Alaska have been proposed as a separate subspecies. Furthermore, life-history of spruce grouse on POW, which is temperate coastal rainforest, varies sufficiently from birds in mainland areas, mostly boreal forest, to warrant specific management. Therefore, I examined the ecology of spruce grouse on POW to determine how timber harvest influences their survival and habitat selection and ultimately to provide recommendations for their conservation. During 2007-2009, we found that the greatest variation in survival probability was attributed to breeding status. The annual survival of non-breeding birds was 0.72±0.082 (S±) while for breeding birds it was 0.08±0.099. Logging did not adequately predict survival, with no differences among habitats. Conversely, I found differences in selection among habitats. At the watershed scale, spruce grouse preferred unharvested forest. At both watershed and homerange scales, spruce grouse avoided edges and preferred roads. Road-related mortality was the largest known source of death. POW spruce grouse and mainland subspecies exhibit sufficiently different survival rates and habitat preference to warrant specific management. We recommend limited road closures during periods when POW spruce grouse are most vulnerable due to the high rates of mortality associated with this preferred habitat.1. Survival of Prince of Wales spruce grouse in southeast Alaska -- 2. Habitat selection by Prince of Wales spruce grouse in intensively logged coastal temperate rainforest

Neurocognitive Mechanisms of Learning and Decision-Making in Adolescent-OCD: A Computational Approach

Early-onset obsessive-compulsive disorder (OCD) is substantially less researched than adult-OCD, resulting in prevalent equivocation surrounding the neurocognitive profile of child-OCD. Research into this area is pivotal as population studies report that youths with OCD struggle significantly in academic settings. In the General Introduction of this thesis, I reviewed existing literature and found that strikingly, young patients do not show impairment on features that are considered both hallmarks of adult OCD and tightly linked to disorder symptomatology, such as response inhibition and cognitive flexibility. Among the characteristics that are thought to be present in children and adolescents with OCD are abnormal decision-making under uncertainty and impaired learning, and I decided to focus on these features as they may be driving poor academic attainment in young people with the disorder. In addition, I sought to investigate other cognitive processes that have not been well-researched in adolescent-OCD but are found to be robustly altered in adult OCD such as goal directed/model-based reasoning, meta-cognition, and feedback sensitivity. I aimed to delineate these various processes using a battery of suitably complex cognitive tasks. Moreover, I highlighted that majority of past studies fail to find differences between young patients and controls due to behavioural signatures being too subtle to be uncovered by standard statistical analyses. Hence, I employed computational modelling of cognitive task data to disentangle latent decision-making processes displayed by adolescents with OCD. In Chapter 2, I modelled data from the Wisconsin Card Sorting task, a frequently used paradigm of cognitive flexibility, and confirmed that youths with OCD show equivalent performance on the task to controls. Only patients on serotonergic medication showed increased response latencies and a tendency to make unique errors (choosing a deck associated with no rule present on the test card). Next, in Chapter 3, I sought to understand instrumental and Pavlovian learning, and whether adolescents with OCD show increased punishment sensitivity on a novel aversive Pavlovian-to Instrumental Transfer paradigm. Once again, patient performance was equivalent to that of controls. Hence, the remaining chapters were dedicated to probing behaviour on probabilistic paradigms. In Chapter 4, I formally investigated model-based and model-free learning using a well-validated two step decision-making task, and fit a reinforcement learning drift diffusion model to both choice and reaction time data. Patients showed increased exploration on the task as well as faster and more erratic decisions compared to controls. Nonetheless, model-based learning was equivalent between groups. In the penultimate chapter, I demonstrate on a predictive-inference task that patients with OCD update their choices more frequently compared to controls independent of prediction error magnitude. Finally, in Chapter 6, I administered a probabilistic reversal learning paradigm to a large sample of 50 adolescent patients and 53 matched controls. Standard analyses revealed a significant reversal learning deficit in patients with OCD, wherein they displayed more errors and a lower propensity to repeat choices following positive feedback during the post-reversal phase. Crucially, computational modelling revealed striking group differences where adolescents with OCD displayed elevated reward learning and lower punishment learning, increased exploration, and decreased perseveration compared to controls. In the General Discussion, I emphasise that atypical learning and decision-making in adolescent-OCD are more pronounced on probabilistic tasks, where task environments are more volatile. Results are partly discussed in the context of the uncertainty model of OCD, where subjective feelings of doubt experienced by patients drive compulsive behaviours such as checking and certainty-seeking in daily life, alongside excessive exploration on probabilistic tasks. I also consider various explanations for cognitive distinctions between adult- and adolescent OCD. More general implications of the findings are discussed for understanding OCD in the context of adolescent development and for treatment/support strategies.WELLCOME TRUST (104631/Z/14/Z

Intérêts et signification écophysiologique de l'estimation de la biomasse et de l'activité photosynthétique de diverses fractions de taille phytoplanctonique en milieu lacustre eutrophe

L'évolution saisonnière de la biomasse phytoplanctonique (estimée par les biovolumes après dénombrements cellulaires et par le dosage de la chlorophylle a), de la production primaire et des coefficients d'activité (P/"BComptage" et P/"BChlorophylle") a été étudiée, par classes de taille, de mars à novembre 1985 dans un lac eutrophe (lac d'Aydat, Massif Central).Il apparaît que la fraction de taille 12-45 µm contribue pour environ 50 % à la biomasse phytoplanctonique totale quelque soit le descripteur de ta biomasse utilisé et pour 65 % à l'activité photosynthétique totale, l'importance quantitative de cette fraction de taille se traduit au niveau des phénomènes d'extinction de la lumière par une relation inverse et hautement significative entre concentrations en chlorophylle a associée à cette classe et les profondeurs de disparition du disque de Secchi (Zs).Si les corrélations linéaires établies entre la production primaire et les rapports surface/volume (S/V) sont significatives au sein de chaque classe, confirmant ainsi l'existence d'une relation directe entre ces 2 paramètres, les valeurs moyennes de P/B de la fraction de taille < 12 µm sont très différentes selon le mode d'expression de la biomasse. L'explication de cette divergence est à rattacher aux divers biais méthodologiques introduits dans les estimations de biomasse retenues dans notre étude. D'une part, la sous estimation de la fraction nanoplanctonique par la technique des dénombrements cellulaires entraîne par voie de conséquence une surestimation des valeurs de P/B"Comptage" attribuées à la fraction < 12 µm. D'autre part, il est reconnu que les teneurs en pigments sont, par unité de volume, supérieures pour la fraction nanoplanctonique que pour les cellules de grande taille. L'adoption d'un facteur unique de conversion entraîne donc une surestimation de ta biomasse de cette fraction.The seasonal distribution of phytoplanktonic biomass (estimated by biovolumes after cell counts and by chlorophyll a concentrations), primary production and primary production to biomass ratios (P/B"Counts" and P/B"Chlorophyll a") was studied by size fractionation in a eutrophic lake (lake Aydat, Massif Central).It appears that the 12-45 µm size fraction contributes about 50 % of the total phytoplanktonic biomass, regardless of what descriptor of the biomass is used and up to 65 % of the total photosynthetic activity. Clearly, the quantitative predominance of this fraction affects the water transparency (Zs) through the highly significant negative correlation obtained between Zs and the 12-45 µm chlorophyll a size fraction.The highly significant linear correlations obtained between the primary production of each fraction and surface to volume ratios (S/V) confirm the direct link between these two parameters. The mean values relative to the P/B of the < 12 µm fraction depend largely on the method used for the biomass estimates. First, the underestimation of the nanoplanktonic fraction by cell counts leads to an over-estimation of the < 12 µm P/B"Counts" fraction. Second, it is well known that chlorophyll a concentrations per unit volume are higher for nanoplankton than for larger cells. Thus, the use of the same biomass conversion factor for all the fractions, overestimates the nanoplankton biomass

Comparaison des peuplements chironomidiens du lac de l'Abbaye obtenus par différentes méthodes d'échantillonnage. Intérêts de la récolte des exuvies nymphales

Une étude des espèces chironomidiennes du lac de l'Abbaye a été effectuée au cours de l'année 1993. Le répertoire spécifique a été établi à partir de l'étude des peuplements imaginaux, nymphals et larvaires échantillonnés selon 5 méthodes: récolte des imagos au filet entomologique, récolte des exuvies nymphales, mise en élevage de stades pré-imaginaux, prélèvements de larves dans les sédiments et mise en place de substrats artificiels. Le peuplement chironomidien obtenu est constitué de 69 espèces. Une comparaison de la composition des peuplements obtenus par les différents modes d'échantillonnage permet de mettre en évidence les particularités de chaque méthode. La récolte des exuvies nymphales semble être la méthode la plus appropriée pour l'établissement d'un répertoire spécifique. Deux espèces dominantes du lac Chironomus anthracinus et Psilotanypus rufovittatus témoignent du caractère polyhumique et désoxygéné du lac. Cependant, la présence simultanée en forte proportion de Tanytarsus niger, Cladotanytarsus iucundus et C. atridorsum témoignent de la faible production pélagique et de la température froide du lac susceptible de minimiser les effets de la désoxygénation sur la communauté chironomidienne.A study of chironomid species was undertaken in Lake Abbaye during the year 1993. Lake Abbaye is located 910 m a.s.l., in a karstic area in the east of France near Switzerland (Figure 1). It covers 80 ha with a maximum depth of 19 m and a mean depth of 7.2 m. Profundal sediment has a high level of organic matter (30.2% dry weight) of mainly terrestrial origin. The accumulation of the organic matter resulted in hypoxic conditions at depth during the summer stratification. The lake is rather cold (maximum surface temperature: 23°C), holodimictic, and is ice-covered from late November to early April. The list of chironomid species obtained resulted from the use of 5 different sampling methods: (i) adults caught with an entomological net; (ii) pupal exuviae sampling at the sites where they were accumulated; (iii) rearing of larvae; (iv) sediment sampling and (v) sampling of larvae using artificial substrates. The sampling site locations are indicated in Figure 1. The present paper gives results and discussions about i) the taxonomic richness and composition of the total chironomid community, ii) the composition of the different communities collected and the characteristics of the five sampling methods, iii) a characterization of Lake Abbaye according to the dominating species.1. Total chironomid communityThe chironomid community of Lake Abbaye consisted of 69 species (Table 1). Compared to other European lakes, this community showed a rather high richness. In some great lakes, however, the number of chironomid species amounted to 140 or 168 species (Lake Innaren, Lake Constance). These particularly high richnesses probably resulted from the great number of substrata according to the great surface of the littoral zone of these lakes. The chironomid community of Lake Abbaye is specific to a mountain area as shown by the high proportion of species collected (82% of the total richness) found by SERRA-TOSIO and LAVILLE (1991) at altitudes exceeding 500 m. According to REISS and FITTKAU (1971), the presence of two particular species (Tanytarsus niger and T. miriforceps) reflects the glacial origin of the lake.2. Composition of the different chironomid communitiesSampling the pupal exuviae allowed us to collect more than 90% of the species with less than 5000 individuals whereas by catching adults this percentage did not exceed 79% with more than 28000 individuals collected and identified. By rearing larvae both the number of species (46 species, 66% of the total richness) and the number of emerging adults (1386 individuals) were low. The least efficient method appeared to be the sediment sampling, which allowed the identification of only 19 taxa (genera and species) compared to the 31 taxa collected by artificial substrates. This study clearly showed that pupal exuviae sampling was the most appropriate method to establish a list of species yielding the greatest ratio between species richness and the effectives.A comparison of the major contributed species among the different communities led to the conclusion that the sampling method strongly affects community composition. Whereas in adult population (Figure 2) the dominating species (relative density=10%) were Tanytarsus niger, Ablabesmyia monilis, A. longistyla and Polypedilum nubeculosum, the community of pupal exuviae (Figure 2) was dominated by Cladotanytarsus iucundus and that obtained by larvae rearing (Figure 2) showed two other (genera and species) dominating species (Psilotanypus rufovittatus and Einfeldia dissidens).The study of the chironomid community by catching adults presented two major difficulties. The first resulted from the sampling of adults that did not emerge from the lake itself. The second problem involved a better sampling of the bigger and/or the more accessible swarms. This method led to an overestimate of the species richness of the lake and modified the species proportions in the community. For example, the great proportion of two species, Ablabesmyia monilis and A. longistyla, in the adult community was observed in none of the other communities (Figure 2).In both larval populations (Figure 3), the genera Chironomus, Tanytarsus, Cladotanytarsus and Procladius dominated. The use of artificial substrates induced, however, a lot of modifications in some genera contributions. For example, the genus Einfeldia was collected at higher relative density in artificial substrates than in the sediment samples. Moreover, a lot of taxa (Glyptotendipes, Microtendipes, Paratendipes, Polypedilum, Cricotopus, Parakiefferiella) were exclusively collected, in larval communities, with the artificial substrates. Despite the well-known differences between the benthic communities collected in-situ and those sampled by artificial substrates (ROSENBERG et RESH, 1982), we think such a technique allows a correct study of the taxonomic richness. The use of identical substrates in different lakes should allow one to define a potential community also related solely to the water quality.3. Characterization of the Lake AbbayeThe study of the taxonomic composition of five different chironomid communities stresses the difficulty in characterizing the lake according to the dominating species. However, comparison between larval community (Figure 3) and imagos or exuviae populations (Figure 2) led to the conclusion that Lake Abbaye could be classified in the category of lakes with Tanytarsus (specially T. niger) and Cladotanytarsus (C. iucundus and C. atridorsum). The particularity of Lake Abbaye is that two groups of species dominated the community. The first, constituted by the aforementioned three species, is dominating in oligotrophic lakes (BRUNDIN, 1949). The second group, represented by Chironomus anthracinus and Psilotanypus rufovittatus, reflected the polyhumic and hypoxic characteristics of the lake. These results indicate that Lake Abbaye has low phytoplanktonic biomass but high organic matter content in its sediment, which originates from terrestrial or littoral inputs (VERNEAUX et al., 1987). The quite low temperature of the water probably minimizes both the degradation of the organic matter and the impact of hypoxic conditions on the chironomid community.4. ConclusionThe present paper clearly demonstrates the importance of the sampling method used to study chironomid communities. Sampling the pupal exuviae in the accumulation zones is the most appropriate method to study chironomids. In order to contribute to a better understanding of the relations between the chironomid species and the environmental conditions, our further research will concentrate on a study of the bathymetric distribution of these species. For this purpose, pupal exuviae will be sampled at different isobaths simultaneously with chemical and physical analyses of the water and sediments. The drift phenomenon of exuviae that could affect the bathymetric pattern of species seemed to be avoided when a criterion of minimum occurrence was taken into account (VERNEAUX, 1996)

Production primaire et activité bactérienne hétérotrophe potentielle au sein d'un lac eutrophe (lac d'Aydat, Puy-de-Dôme)

La production primaire phytoplanctenique et l'activité hétérotrophe bactérienne ont été étudiées parallèlement sur le lac d'AYDAT en 1985. L'activité photosynthétique, mesurée au alentours du midi solaire évolue entre 10 et 141 mg C m-2h-1, le maximum étant atteint en juillet. La vitesse maximale, V max, d'assimilation de glucose par les bactéries, (en présence de concentrations de traceur non limitantes) se situe entre 0,06 - 1,26 mg C m-2h-1. Le compartiment phytoplanctonique, de par sa production, semble être l'un des éléments régulateurs de l'activité hétérotrophe bactérienne en zone épilimnique.The seasonal distributions of phytoptanktonic primary production and bacterial heterotrophicpotentials (using respectivey 14C and 14Glucose incorporations) were studied in a eutrophic lake (Lake Aydat, Massif Central, France).Primary production and bacterial heterotrophic potentials vary respectively from 10 to 141 mg.C.m-2h-1 and from 0,06 to 1,26 mg.C.m-2h-1.The comparative evolution of these two activities in relation to the temperature shows that the general idea about "the temperature - bacterial development" model seems to be insufficient when the investigation takes place in a complex ecosystem such as Lake Aydat. Indeed, the phytoplanktonic compartment, apart from its production, seems to be one of the regulating elements of the heterotrophic bacterial activity whose variations cannot be explained by changes in temperature alone.In spite of the significant correlation obtained between bacterial activity and temperature, we should consider that the influence of this abiotic parameter on the bacterial development is an indirect one