Effects of Managed Care on the Professional Autonomy of Board Certified Physical Therapy Specialist\u27s Practice

Purpose: Identify perceptions of professional autonomy of Board Certified Physical Therapy Specialists (BCPTS) who practiced in managed care environments. Guiding questions: Do BCPTS perceive an increase in professional autonomy as a specialist than as a generalist? How do the perceptions of professional autonomy vary among each specialization? What variables affect perceptions of professional autonomy among BCPTS? Method: Two-hundred BCPTS throughout the country were randomly chosen as participants. One-hundred-eight respondents were used as subjects. Data analysis: Frequency distributions and Pearson\u27s correlation coefficient statistic were utilized. Results: Majority of respondents reported no increase in professional autonomy as a specialist. Greater than three-quarters of the respondents reported a decrease in professional autonomy such as clinical decisions were overriden by decisions of insurance companies . Correlational analysis revealed that percent of patients covered by managed care insurance had a major influence upon how respondents practiced and perceived their professional autonomy. Conclusion: While there were reported differences in perceptions of professional autonomy among each specialization, there was an overall perceived decrease of professional autonomy due to managed care

Towards Constructive Hybrid Semantics

With hybrid systems becoming ever more pervasive, the underlying semantic challenges emerge in their entirety. The need for principled semantic foundations has been recognized previously in the case of discrete computation and discrete data, with subsequent implementations in programming languages and proof assistants. Hybrid systems, contrastingly, do not directly fit into the classical semantic paradigms due to the presence of quite specific "non-programmable" features, such as Zeno behaviour and the inherent indispensable reliance on a notion of continuous time. Here, we analyze the phenomenon of hybrid semantics from a constructive viewpoint. In doing so, we propose a monad-based semantics, generic over a given ordered monoid representing the time domain, hence abstracting from the monoid of constructive reals. We implement our construction as a higher inductive-inductive type in the recent cubical extension of the Agda proof assistant, significantly using state-of-the-art advances of homotopy type theory. We show that classically, i.e. under the axiom of choice, our construction admits a charaterization in terms of directed sequence completion

Avaliação da influência do acoplamento de risers no movimento de jogo de um FPSO

This work presents a comparison between the coupled and uncoupled formulations for computational simulation and analysis of the roll motions of an FPSO attached to a set of flexible risers in a deep-water scenario. The evaluation of the motions of the hull and the structural dynamic behavior of the subsea lines are usually made in different steps of the design, so that the dynamic interaction between the two physical domains is rarely considered. Descriptions of the analysis methodologies and the theories associated to the physical phenomena are included. In this study, a set of simulations using regular and irregular waves were performed to quantify this interaction. Besides the variation in the roll motions due to the coupling effects, the influence in the top tensions of a few selected risers is also investigated. The results show significant reductions in both parameters studied, leading to the conclusion that coupling effects can be relevant to the riser design.Este trabalho apresenta uma comparação entre as formulações acoplada e desacoplada para simulação computacional e análise dos movimentos de jogo de um FPSO em águas profundas acoplado a um conjunto de risers flexíveis. Tradicionalmente, as avaliações dos movimentos do casco e do comportamento dinâmico estrutural das linhas submarinas são feitas em etapas distintas do projeto, de modo que a interação dinâmica entre os dois domínios físicos raramente é plenamente contemplada. Descrições das metodologias de análise e das teorias que regimentam os principais fenômenos envolvidos estão incluídas. Neste estudo, um conjunto de simulações utilizando ondas regulares e irregulares foram realizadas com o objetivo de quantificar tal interação. Além da variação no movimento de jogo devido aos efeitos do acoplamento, a influência na tração de topo de algumas linhas selecionadas também foi investigada. Os resultados apontam reduções bastante significativas em ambos os parâmetros, conduzindo à conclusão de que os efeitos associados ao acoplamento podem ser relevantes para o projeto

The inclusion of complementary medicine in Australian nursing and midwifery courses : a survey pre-test

University of Technology Sydney. Graduate School of Health.Complementary medicine (CM) is a health service that is highly accessed by the public and evidence of the prevalence of CM use has grown over the last two decades. CM use by the choice of individuals under the care of conventional healthcare professionals, such as midwives and nurses, is increasing due to the general acceptance of CM use. Existing competency standards underpin the accreditation process for nurses and midwives and ensure these practicing professionals can better navigate patient choices and understand the implications of their patients accessing a variety of health services. These standards allude to the need for nurses and midwives to be familiar with and able to competently practice in a healthcare landscape that is characterised by high CM use. Despite this, there has been insufficient study of conventional healthcare courses (CHC) in nursing and midwifery or of key decision-makers in nursing and midwifery teaching programs to explore the current inclusion of CM in course offerings. This study aimed to develop a quantitative tool to investigate CM content inclusion in Australian nursing and midwifery courses, to be mapped

A one-year comparison of new wind atlases over the North Sea

The New European Wind Atlas (NEWA) and the Norwegian hindcast archive (NORA3) database have become publicly available since the end of 2019 and mid-2021, respectively. They aim to model the long-term wind climatology with a spatial resolution of ca. 3 km and a temporal resolution of 1 h (NORA3) or 30 min (NEWA). Both products have a high potential for wind energy applications. Although their geographical coverages partly overlap, an inter-comparison of the NEWA and NORA3 databases in an offshore environment is still lacking. The paper compares the hourly mean wind speed and wind direction recorded in 2009 at the FINO1 platform (North Sea) with hindcast data from the NEWA and the NORA3 database. Both products were found to provide reliable estimates of the mean wind speed at 101 m above sea level. However, NORA3 shows slightly better performances than NEWA for the mean wind speed in terms of root-mean-square error, bias, earth mover's distance (EMD) and Pearson correlation coefficient. For the mean wind direction, a larger circular EMD than previously documented is found, which could be due to a directional bias in the wind vane data. Finally, the Brunt-Väisälä frequency is computed using sea-surface temperature analyses and the air temperature from NORA3 and NEWA at 101 m above sea level. The encouraging description of the static atmospheric stability by the wind atlases opens the possibility to study in more detail thermally-induced wind events for wind resource assessment or wind turbine design.publishedVersio

Transitioning to practice: a qualitative investigation of Australian graduate naturopath's experiences of being in practice.

BACKGROUND: The transition from student to practitioner can be challenging, resulting in stress, burnout and attrition. While there has been ample research examining graduate medical and allied health practitioner experiences of transitioning to practice, there is a paucity of research exploring such experiences in newly qualified naturopathic medicine practitioners. In light of this knowledge gap, the objective of this study was to ascertain the experiences of practicing as a naturopath in Australia within the first 5 years post-graduation. METHODS: Using a qualitative descriptive approach, recent graduates of an Australian Bachelor of Naturopathy (or equivalent) program were invited to participate in a semi-structured telephone interview to address the study objective. Data were analysed utilising a framework approach. RESULTS: A total of 19 new graduates (94.7% female; 57.9% aged 40-59 years) undertook an interview. Five inter-related themes emerged from the data: practitioner, practice, proprietorship, professions, and perceptions. Connected with these themes were contrasting feelings, multiplicity of duties, small business challenges, professional collaboration, and professional identity, respectively. CONCLUSIONS: Participants were generally content with their decision to become a naturopath. However, most were confronted by a range of challenges as they transitioned from graduate to practitioner, for which many felt ill-prepared. In light of the complexity of the issue, and the potential impact on the sustainability of the profession, it is evident that a multi-pronged, multi-stakeholder approach would be needed to better support graduate naturopath transition to practice