The views of physicians on health care quality

Objectives: There are four primary goals for this research project: To develop an objective index of health care quality which represents, in the best practical way, a comprehensive range of services provided at the health region level. To develop a comparable measure representing physician assessments of health care quality, and compare this measure with the objective index. To develop an understanding of the relationships between physician ratings on the workplace issues of professional autonomy, stress, sense of equity and satisfaction and their views on health care quality.Based on the understanding of this research, provide recommendations to health care policy makers about the use of both physician viewpoints and objective measures of quality. Background: Health care in Canada has grown and evolved from a relatively simple offering of services, provided primarily by doctors and hospitals, to a complex conglomeration of programs and services, provided by a loose network of both public and private providers. As a result, physicians are under pressure to adapt to these changes and a power struggle which has always pitted physicians against policy makers. In dealing with changes to the health care system the use of statistics and evidence is gaining prominence as the basis for policy decisions, in addition to the less formal tools of rhetoric and politics.Design: Data from the 2004 Canada-wide survey “Emerging Issues in the Work of Physicians” is compared to a single index score of health care quality based on objective data from the annual Health Indicators Report published by Canadian Institute of Health Information and Statistics Canada (2005). These reports include a number of measures of quality and access to health care by health region and by province, using mandatory standardized data collection and reporting procedures. Measures: Nine reliable measures of health care quality were selected from the Health Indicators Reports for inclusion in the index: 30 day AMI risk; 30 day stroke risk; AMI readmission risk; asthma readmission risk; ACSC rate; hysterectomy readmission rate; prostatectomy rate; in-hospital hip fracture rate; and C-section rate. Index scores were developed for each of the measures, which were then assigned weights based on importance, resulting in a single overall index of health care quality. These scores are compared to a similar index score which is based on physician views on quality, as collected in the national survey.Results: Physician views on health care quality are aligned with the objective data when examined on an aggregate basis. However, there is a high degree of variability in physician responses which results in differences when examining the data on regional or individual bases. In addition, physician views on quality are influenced by factors in their work lives including autonomy, stress, equity and satisfaction. On each of these factors, those reporting high and low levels will generally over and under-rate health care quality as compared to those reporting moderate levels.Discussion: As policy makers make decisions on how to shape the future of health care, they must grapple with conflicting viewpoints of different stakeholder groups, and they must decide on the degree to which they rely on evidence (in the form of objective data) versus influence (as exerted by physicians and/or other stakeholder groups). This research shows that, while physician views on how well the health care system is performing are generally aligned with the objective data, those opinions vary greatly between individuals, and are influenced by work related factors including autonomy, stress, equity and satisfaction

The Lantern Vol. 11, No. 1, December 1942

• Friends of the Aquarium • Espionage • Fuss-Budget • Dress Blues • Alone • One Easy Lesson in How Not to Study • A Thumbtack Sketch • One Star • A Colonial Inn • Thoughts on a Dark Day • Query • Paul Revere and the World He Lived In • Sunsetshttps://digitalcommons.ursinus.edu/lantern/1028/thumbnail.jp

Elliptic logarithms, diophantine approximation and the Birch and Swinnerton-Dyer conjecture

Most, if not all, unconditional results towards the abc-conjecture rely ultimately on classical Baker's method. In this article, we turn our attention to its elliptic analogue. Using the elliptic Baker's method, we have recently obtained a new upper bound for the height of the S-integral points on an elliptic curve. This bound depends on some parameters related to the Mordell-Weil group of the curve. We deduce here a bound relying on the conjecture of Birch and Swinnerton-Dyer, involving classical, more manageable quantities. We then study which abc-type inequality over number fields could be derived from this elliptic approach.Comment: 20 pages. Some changes, the most important being on Conjecture 3.2, three references added ([Mas75], [MB90] and [Yu94]) and one reference updated [BS12]. Accepted in Bull. Brazil. Mat. So

To remove or not to remove? Removal of the unconditional stimulus electrode does not mediate instructed extinction effects

Following differential fear conditioning, the instruction that the unconditional stimulus will no longer be presented (instructed extinction) reduces differential electrodermal responding to CS+ and CS-, but does not affect differential conditional stimulus valence evaluations. Reductions in differential electrodermal responding have been attributed to the provision of verbal instructions; however, during instructed extinction the unconditional stimulus electrode is often removed as well. This removal could reduce the participants' general arousal levels rendering the detection of differential electrodermal responding difficult. The current study examined this alternative interpretation by comparing the electrodermal responses and conditional stimulus valence evaluations of an instruction/electrode-on group, an instruction/electrode-off group, and a control group who were not instructed. Following instructed extinction, differential electrodermal responding was eliminated in both instruction groups, an effect that was not influenced by the attachment/removal of the electrode. Replicating previous findings, conditional stimulus valence was not affected by instructed extinction. The results suggest that verbal instructions, not unconditional stimulus electrode removal, reduce differential electrodermal responding during instructed extinction manipulations

Internal and external cooling methods and their effect on body temperature, thermal perception and dexterity

© 2018 The Authors. Published by PLOS. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1371/journal.pone.0191416© 2018 Maley et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Objective The present study aimed to compare a range of cooling methods possibly utilised by occupational workers, focusing on their effect on body temperature, perception and manual dexterity. Methods Ten male participants completed eight trials involving 30 min of seated rest followed by 30 min of cooling or control of no cooling (CON) (34C, 58% relative humidity). The cooling methods utilised were: ice cooling vest (CV0), phase change cooling vest melting at 14C (CV14), evaporative cooling vest (CVEV), arm immersion in 10C water (AI), portable water-perfused suit (WPS), heliox inhalation (HE) and ice slushy ingestion (SL). Immediately before and after cooling, participants were assessed for fine (Purdue pegboard task) and gross (grip and pinch strength) manual dexterity. Rectal and skin temperature, as well as thermal sensation and comfort, were monitored throughout. Results Compared with CON, SL was the only method to reduce rectal temperature (P = 0.012). All externally applied cooling methods reduced skin temperature (P0.05). Conclusion The present study observed that ice ingestion or ice applied to the skin produced the greatest effect on rectal and skin temperature, respectively. AI should not be utilised if workers require subsequent fine manual dexterity. These results will help inform future studies investigating appropriate pre-cooling methods for the occupational worker.This project is financially supported by the US Government through the Technical Support Working Group within the Combating Terrorism Technical Support Office.Published versio

Phenotypic Variation and Bistable Switching in Bacteria

Microbial research generally focuses on clonal populations. However, bacterial cells with identical genotypes frequently display different phenotypes under identical conditions. This microbial cell individuality is receiving increasing attention in the literature because of its impact on cellular differentiation, survival under selective conditions, and the interaction of pathogens with their hosts. It is becoming clear that stochasticity in gene expression in conjunction with the architecture of the gene network that underlies the cellular processes can generate phenotypic variation. An important regulatory mechanism is the so-called positive feedback, in which a system reinforces its own response, for instance by stimulating the production of an activator. Bistability is an interesting and relevant phenomenon, in which two distinct subpopulations of cells showing discrete levels of gene expression coexist in a single culture. In this chapter, we address techniques and approaches used to establish phenotypic variation, and relate three well-characterized examples of bistability to the molecular mechanisms that govern these processes, with a focus on positive feedback.

The kinetics of the gas-phase reactions of selected monoterpenes and cyclo-alkenes with ozone and the NO3 radical

The relative rate method has been used to measure the room-temperature rate constants for the gasphase reactions of ozone and NO3 with selected monoterpenes and cyclo-alkenes with structural similarities to monoterpenes. Measurements were carried out at 298 ! 2 K and 760 ! 10 Torr. The following rate constants (in units of 10"18 cm3 molecule"1 s"1) were obtained for the reaction with ozone: methyl cyclohexene (132 ! 17), terpinolene (1290 ! 360), ethylidene cyclohexane (223 ! 57), norbornene (860 ! 240), t-butyl isopropylidene cyclohexane (1500 ! 460), cyclopentene (543 ! 94), cyclohexene (81 ! 18), cyclooctene (451 ! 66), dicyclopentadiene (1460 ! 170) and a-pinene (107 ! 13). For the reaction with NO3 the rate constants obtained (in units of 10"12 cm3 molecule"1 s"1) were: methyl cyclohexene (7.92 ! 0.95), terpinolene (47.9 ! 4.0), ethylidene cyclohexane (4.30 ! 0.24), norbornene (0.266 ! 0.029), cyclohexene (0.540 ! 0.017), cyclooctene (0.513 ! 0.029), dicyclopentadiene (1.20 ! 0.10) and a-pinene (5.17 ! 0.62). Errors are quoted as the root mean square of the statistical error (95% con!dence) and the quoted error in the rate constant for the reference compound. Combining these results with previous studies, new recommendations for the rate constants are presented. Molecular orbital energies were calculated for each alkene and the kinetic data are discussed in terms of the deviation from the structureeactivity relationship obtained from the rate constants for a series of simple alkenes. Lifetimes with respect to key initiators of atmospheric oxidation have been calculated suggesting that the studied reactions play dominant roles in the night-time removal of these compounds from the atmosphere

Loss of Different Inverted Repeat Copies from the Chloroplast Genomes of Pinaceae and Cupressophytes and Influence of Heterotachy on the Evaluation of Gymnosperm Phylogeny

The relationships among the extant five gymnosperm groups—gnetophytes, Pinaceae, non-Pinaceae conifers (cupressophytes), Ginkgo, and cycads—remain equivocal. To clarify this issue, we sequenced the chloroplast genomes (cpDNAs) from two cupressophytes, Cephalotaxus wilsoniana and Taiwania cryptomerioides, and 53 common chloroplast protein-coding genes from another three cupressophytes, Agathis dammara, Nageia nagi, and Sciadopitys verticillata, and a non-Cycadaceae cycad, Bowenia serrulata. Comparative analyses of 11 conifer cpDNAs revealed that Pinaceae and cupressophytes each lost a different copy of inverted repeats (IRs), which contrasts with the view that the same IR has been lost in all conifers. Based on our structural finding, the character of an IR loss no longer conflicts with the “gnepines” hypothesis (gnetophytes sister to Pinaceae). Chloroplast phylogenomic analyses of amino acid sequences recovered incongruent topologies using different tree-building methods; however, we demonstrated that high heterotachous genes (genes that have highly different rates in different lineages) contributed to the long-branch attraction (LBA) artifact, resulting in incongruence of phylogenomic estimates. Additionally, amino acid compositions appear more heterogeneous in high than low heterotachous genes among the five gymnosperm groups. Removal of high heterotachous genes alleviated the LBA artifact and yielded congruent and robust tree topologies in which gnetophytes and Pinaceae formed a sister clade to cupressophytes (the gnepines hypothesis) and Ginkgo clustered with cycads. Adding more cupressophyte taxa could not improve the accuracy of chloroplast phylogenomics for the five gymnosperm groups. In contrast, removal of high heterotachous genes from data sets is simple and can increase confidence in evaluating the phylogeny of gymnosperms

Effects of Aging and Adult-Onset Hearing Loss on Cortical Auditory Regions

Hearing loss is a common feature in human aging. It has been argued that dysfunctions in central processing are important contributing factors to hearing loss during older age. Aging also has well documented consequences for neural structure and function, but it is not clear how these effects interact with those that arise as a consequence of hearing loss. This paper reviews the effects of aging and adult-onset hearing loss in the structure and function of cortical auditory regions. The evidence reviewed suggests that aging and hearing loss result in atrophy of cortical auditory regions and stronger engagement of networks involved in the detection of salient events, adaptive control and re-allocation of attention. These cortical mechanisms are engaged during listening in effortful conditions in normal hearing individuals. Therefore, as a consequence of aging and hearing loss, all listening becomes effortful and cognitive load is constantly high, reducing the amount of available cognitive resources. This constant effortful listening and reduced cognitive spare capacity could be what accelerates cognitive decline in older adults with hearing loss

Abusive Supervision, Upward Maintenance Communication, and Subordinates\u27 Psychological Distress

This study reanalyzes data from Tepper\u27s (2000) two-wave study regarding the effects of subordinates\u27 perceptions of supervisory abuse to assess previously unexamined relationships. As predicted, we found that subordinates who more rather than less strongly perceived that they had been abused by supervisors tended to use regulative maintenance tactics with higher frequency. Further, the positive relationship between abusive supervision and subordinates\u27 psychological distress was exacerbated by subordinates\u27 use of regulative maintenance communications, and that relationship was reduced by subordinates\u27 use of direct maintenance communication. Theoretical and practical implications are discussed