Conflicts Credentialing: Hospitals and the Use of Financial Considerations to Make Medical Staffing Decisions

The emerging practice of conflicts credentialing represents a significant change in the economic and professional interests of physicians and in the relationship between medical staffs and hospitals. In this article, the authors explain the interrelationship between the authority of hospitals and medical staffs to manage their respective affairs and the legal developments that have led toward conflicts credentialing. The authors next discuss the medical community’s reaction to conflicts credentialing and the legal challenges facing the use of economic factors in physician credentialing

Geobase Information System Impacts on Space Image Formats

As Geobase Information Systems increase in number, size and complexity, the format compatability of satellite remote sensing data becomes increasingly more important. Because of the vast and continually increasing quantity of data available from remote sensing systems the utility of these data is increasingly dependent on the degree to which their formats facilitate, or hinder, their incorporation into Geobase Information Systems. To merge satellite data into a geobase system requires that they both have a compatible geographic referencing system. Greater acceptance of satellite data by the user community will be facilitated if the data are in a form which most readily corresponds to existing geobase data structures. The conference addressed a number of specific topics and made recommendations

Studies of the nonlinear dynamics effects of APPLE-II type EPUs at the ALS

Elliptically Polarizing Undulators (EPUs) have become more and more popular at synchrotron radiation sources, providing full polarization control of the photon beam. The fields of the most commonly used APPLE-II type EPUs have a very fast, intrinsic field roll-off, creating significant non-linearities of the beam motion with in some cases large impact on the dynamic (momentum) aperture. In general, the nonlinear effects get stronger with longer periods and higher undulator magnetic fields. One of the planned future beamlines at the ALS (MERLIN) will use a quasiperiodic EPU with 9 cm period and maximum B fields of about 1.3 T. We will present simulation studies for the proposed shimming schemes for this future device to reduce the nonlinear effects to acceptable values, as well as experimental studies for the existing 5 cm period EPUs already installed in the ALS

Traps of multi-level governance. Lessons from the implementation of the Water Framework Directive in Italy

During recent decades, different patterns of multi-level governance (MLG) have spread across Europe as a consequence of Europeanisation of public policies, which have increasingly adopted decentralized and participatory procedures conceived as a tool of more effective and accountable policy-making. It appears, however, that the implementation of operational designs based on MLG may be rather problematic and it does not necessarily bring to the expected performance improvements. Referring to the case of the EU Water Framework Directive (2000/60/EC), which conceives the creation of new multi-level institutional settings as a key tool for enacting a new holistic approach to water management and protection, this article explores the difficulties that the implementation of such settings has brought in Italy, despite some favorable pre-conditions existing in the country. Evidence is provided that along with institutional and agency variables, the implementation effectiveness of MLG arrangements promoted by the EU can be challenged by their inherent characteristics

Developing an On-Line Interactive Health Psychology Module.

On-line teaching material in health psychology was developed which ensured a range of students could access appropriate material for their course and level of study. This material has been developed around the concept of smaller 'content chunks' which can be combined into whole units of learning (topics), and ultimately, a module. On the basis of the underlying philosophy that the medium is part of the message, we considered interactivity to be a key element in engaging the student with the material. Consequently, the key aim of this development was to stimulate and engage students, promoting better involvement with the academic material, and hence better learning. It was hoped that this was achieved through the development of material including linked programmes and supporting material, small Java Scripts and basic email, forms and HTML additions. This material is outlined as are some of the interactive activities introduced, and the preliminary student and tutor experience described

Multiple metrics for quantifying the intensity of water consumption of energy production

Discussion of the environmental implications of worldwide energy demand is currently dominated by the effects of carbon dioxide (CO[subscript 2]) emissions on global climate. At the regional scale, however, water resource challenges associated with energy systems are a growing concern. This paper, based on an inventory of national energy portfolios, posits an indicator-based framework for characterizing regional energy portfolios' relative water intensity. These calculations extend upon a previous paper that established a method for calculating the national water consumption of energy production (WCEP) at the global level. Intensity indicators are based on normalizing the WCEP results with a set of additional indicators (including population, gross domestic product, total energy production, and regional water availability). The results show great variability in water consumption across nations, as well as across the various water intensity measures that were applied. Therefore, it is best to apply this full suite of indicators to each country to develop an integrated understanding of the intensity of water use for energy across countries

Mitochondrial oxidative stress promotes atrial fibrillation

Oxidative stress has been suggested to play a role in the pathogenesis of atrial fibrillation (AF). Indeed, the prevalence of AF increases with age as does oxidative stress. However, the mechanisms linking redox state to AF are not well understood. In this study we identify a link between oxidative stress and aberrant intracellular Ca(2+) release via the type 2 ryanodine receptor (RyR2) that promotes AF. We show that RyR2 are oxidized in the atria of patients with chronic AF compared with individuals in sinus rhythm. To dissect the molecular mechanism linking RyR2 oxidation to AF we used two murine models harboring RyR2 mutations that cause intracellular Ca(2+) leak. Mice with intracellular Ca(2+) leak exhibited increased atrial RyR2 oxidation, mitochondrial dysfunction, reactive oxygen species (ROS) production and AF susceptibility. Both genetic inhibition of mitochondrial ROS production and pharmacological treatment of RyR2 leakage prevented AF. Collectively, our results indicate that alterations of RyR2 and mitochondrial ROS generation form a vicious cycle in the development of AF. Targeting this previously unrecognized mechanism could be useful in developing effective interventions to prevent and treat AF

The water consumption of energy production: an international comparison

Producing energy resources requires significant quantities of fresh water. As an energy sector changes or expands, the mix of technologies deployed to produce fuels and electricity determines the associated burden on regional water resources. Many reports have identified the water consumption of various energy production technologies. This paper synthesizes and expands upon this previous work by exploring the geographic distribution of water use by national energy portfolios. By defining and calculating an indicator to compare the water consumption of energy production for over 150 countries, we estimate that approximately 52 billion cubic meters of fresh water is consumed annually for global energy production. Further, in consolidating the data, it became clear that both the quality of the data and global reporting standards should be improved to track this important variable at the global scale. By introducing a consistent indicator to empirically assess coupled water–energy systems, it is hoped that this research will provide greater visibility into the magnitude of water use for energy production at the national and global scales

Profiling the educational value of computer games

There are currently a number of suggestions for educators to include computer games in formal teaching and learning contexts. Educational value is based on claims that games promote the development of complex learning. Very little research, however, has explored what features should be present in a computer game to make it valuable or conducive to learning. We present a list of required features for an educational game to be of value, informed by two studies, which integrated theories of Learning Environments and Learning Styles. A user survey showed that some requirements were typical of games in a particular genre, while other features were present across all genres. The paper concludes with a proposed framework of games and features within and across genres to assist in the design and selection of games for a given educational scenari

Preparing potential teachers for the transition from employment to teacher training: an evaluative case study of a Maths Enhancement Course

In response to a UK government drive to improve maths teaching in schools, the South West London Maths Enhancement Course (MEC) has been set up though collaboration between three Higher Education institutions (HEIs) to provide an efficient route for non maths graduates in employment to upgrade their subject knowledge and give a smooth transition into teacher training (PGCE). An evaluation of the scheme, measured against Teacher Development Agency (TDA) objectives and success criteria agreed by university staff, involved thematic analysis of focus group discussions and interviews with students and staff during both the MEC and PGCE courses. This has revealed a high level of satisfaction and success related to a number of underlying issues, particularly around student recruitment, curriculum design, peer support and staff collaboration. The model offers an example of practice transferable to a range of programmes aimed at supporting students in the transition between levels and institutions