Winnipeg Site Implementation Final Report

Implementation Report. iv, 30 pp., ill., digital fileThis report documents the implementation of the Mental Health Commission of Canada’s At Home/Chez Soi project in Winnipeg. It reports on the viewpoints and perspectives of the site’s stakeholders concerning the fidelity of the Site to its original plans; formative issues related to successes and challenges; stakeholder relationships; the involvement of participants; issues related to Site resources; and the influences and consequences of the local Site context in terms of adaptations made to Winnipeg Site and the resources upon which it has drawn. The report is the result of interviews and focus groups facilitated by researchers at the Institute of Urban Studies at the University of Winnipeg. The report begins with an assessment of the homelessness situation in Winnipeg prior to the implementation of the study, as well as a discussion regarding the nature of the study’s participants. The report then considers project theory from the perspectives of service philosophy, processes, staff requirements and outcomes. The major components of housing and the three service arms are seen by most to be of equal value, in the sense that one part cannot work without the other.Mental Health Commission of Canad

A Review Of Multi-Tenant Database And Factors That Influence Its Adoption.

A Multi-tenant database (MTD) is a way of deploying a Database as a Service (DaaS). This is gaining momentum with significant increase in the number of organizations ready to take advantage of the technology. A multi-tenant database refers to a principle where a single instance of a Database Management System (DBMS) runs on a server, serving multiple clients organizations (tenants). This is a database which provides database support to a number of separate and distinct groups of users or tenants. This concept spreads the cost of hardware, software and other services to a large number of tenants, therefore significantly reducing per tenant cost. Three different approaches of implementing multi-tenant database have been identified. These methods have been shown to be increasingly better at pooling resources and also processing administrative operations in bulk. This paper reports the requirement of multi-tenant databases, challenges of implementing MTD, database migration for elasticity in MTD and factors influencing the choice of models in MTD. An insightful discussion is presented in this paper by grouping these factors into four categories. This shows that the degree of tenancy is an influence to the approach to be adopted and the capital and operational expenditure are greatly reduced in comparison with an on-premises solutio

How Pregnant Women in the United States Perceive Vaccines for Themselves, their Close Contacts and their Children

Vaccine hesitancy has grown in recent decades [1-4], leading to the clustering of vaccine refusal and associated outbreaks of vaccine preventable diseases (VPDs) [5-11]. Vaccination rates of pregnant women in particular are suboptimal [12]. This dissertation contains three manuscripts discussing research performed as part of an NIH-funded large randomized controlled trial of a comprehensive prenatal intervention to increase uptake of maternal and infant vaccines (referred to as P3+) and its add-on study sponsored by Walgreen Co to increase knowledge and uptake of cocooning vaccines among close friends and family of participating P3+ pregnant women. As part of the P3+ provider-level intervention package, we performed a systematic review to update and succinctly summarize the scientific evidence assessing possible causal associations of adverse events following immunization (AEFI), with refined causality conclusions intended for health care providers. Although for 12 of the 47 AEFI studied a causal relationship was established with at least one vaccine currently routinely recommended to the general population in the United States, most of these were rare or mild, and no causal relationship was established for the other 35 AEFI studied. As part of the P3+ patient-level intervention package, we developed an application called MomsTalkShots for smartphones, tablets and computers that delivers patient-tailored education materials to pregnant women and collects survey data to monitor vaccine knowledge, attitudes and beliefs. As part of the add-on study, the MomsTalkShots app encouraged P3+ pregnant women to refer their close friends and family to the app. Baseline survey data showed suboptimal maternal vaccine knowledge and intentions among P3+ pregnant women, especially among first-time pregnant women. In addition, pregnant women who valued vaccination and perceived their social network to value vaccination were more likely to refer their close friends and family to the app. This research demonstrates the opportunity for individually-tailored vaccine education of pregnant women and their social networks to increase vaccine confidence and informed decision making at this stage of life

Ciliary Neurotrophic Factor Induces Genes Associated with Inflammation and Gliosis in the Retina: A Gene Profiling Study of Flow-Sorted, Müller Cells

Ciliary neurotrophic factor (CNTF), a member of the interleukin-6 cytokine family, has been implicated in the development, differentiation and survival of retinal neurons. The mechanisms of CNTF action as well as its cellular targets in the retina are poorly understood. It has been postulated that some of the biological effects of CNTF are mediated through its action via retinal glial cells; however, molecular changes in retinal glia induced by CNTF have not been elucidated. We have, therefore, examined gene expression dynamics of purified Müller (glial) cells exposed to CNTF in vivo.Müller cells were flow-sorted from mgfap-egfp transgenic mice one or three days after intravitreal injection of CNTF. Microarray analysis using RNA from purified Müller cells showed differential expression of almost 1,000 transcripts with two- to seventeen-fold change in response to CNTF. A comparison of transcriptional profiles from Müller cells at one or three days after CNTF treatment showed an increase in the number of transcribed genes as well as a change in the expression pattern. Ingenuity Pathway Analysis showed that the differentially regulated genes belong to distinct functional types such as cytokines, growth factors, G-protein coupled receptors, transporters and ion channels. Interestingly, many genes induced by CNTF were also highly expressed in reactive Müller cells from mice with inherited or experimentally induced retinal degeneration. Further analysis of gene profiles revealed 20-30% overlap in the transcription pattern among Müller cells, astrocytes and the RPE.Our studies provide novel molecular insights into biological functions of Müller glial cells in mediating cytokine response. We suggest that CNTF remodels the gene expression profile of Müller cells leading to induction of networks associated with transcription, cell cycle regulation and inflammatory response. CNTF also appears to function as an inducer of gliosis in the retina

Modulation of urban atmospheric electric field measurements with the wind direction in Lisbon (Portugal)

Atmospheric electric field measurements (potential gradient, PG) were retrieved in the urban environment of the city of Lisbon (Portugal). The measurements were performed with a Benndorf electrograph at the Portela Meteorological station in the suburbs of the city (NE from the centre). The period of 1980 to 1990 is considered here. According to wind direction, different content and types of ions and aerosols arrive at the measurement site causing significant variations to the PG. To the south there are significant pollution sources while to the north such sources are scarcer . The Iberian Peninsula is found east of the station and the Atlantic Ocean covers the western sector, Wind directions are divided in four sectors: i) NW: 270º ≤ θ ≤ 360º; ii) NE: 0 ≤ θ ≤ 90º; iii) SE: 90 ≤ θ ≤ 180º; iv) SW: 180º ≤ θ ≤ 270º. Analysis of weekly cycle, caused by anthropogenic pollution related with urban activity, was undertaken for each wind sector. NW sector has been shown to be less affected by this cycle, which is attributed to the effect of marine air. The daily variation of NE sector for weekends reveals a similar behaviour to the Carnegie curve, which corresponds to a clean air daily variation of PG, following universal time, independent of measurement site

Inequity in access to transplantation in the UK

Background and objectives Despite the presence of a universal health care system, it is unclear if there is intercenter variation in access to kidney transplantation in the United Kingdom. This study aims to assess whether equity exists in access to kidney transplantation in the United Kingdom after adjustment for patient-specific factors and center practice patterns. Design, setting, participants, & measurements In this prospective, observational cohort study including all 71 United Kingdom kidney centers, incident RRT patients recruited between November 2011 and March 2013 as part of the Access to Transplantation and Transplant Outcome Measures study were analyzed to assess preemptive listing (n=2676) and listing within 2 years of starting dialysis (n=1970) by center. Results Seven hundred and six participants (26%) were listed preemptively, whereas 585 (30%) were listed within 2 years of commencing dialysis. The interquartile range across centers was 6%–33% for preemptive listing and 25%–40% for listing after starting dialysis. Patient factors, including increasing age, most comorbidities, body mass index >35 kg/m2, and lower socioeconomic status, were associated with a lower likelihood of being listed and accounted for 89% and 97% of measured intercenter variation for preemptive listing and listing within 2 years of starting dialysis, respectively. Asian (odds ratio, 0.49; 95% confidence interval, 0.33 to 0.72) and Black (odds ratio, 0.43; 95% confidence interval, 0.26 to 0.71) participants were both associated with reduced access to preemptive listing; however Asian participants were associated with a higher likelihood of being listed after starting dialysis (odds ratio, 1.42; 95% confidence interval, 1.12 to 1.79). As for center factors, being registered at a transplanting center (odds ratio, 3.1; 95% confidence interval, 2.36 to 4.07) and a universal approach to discussing transplantation (odds ratio, 1.4; 95% confidence interval, 1.08 to 1.78) were associated with higher preemptive listing, whereas using a written protocol was associated negatively with listing within 2 years of starting dialysis (odds ratio, 0.7; 95% confidence interval, 0.58 to 0.9). Conclusions Patient case mix accounts for most of the intercenter variation seen in access to transplantation in the United Kingdom, with practice patterns also contributing some variation. Socioeconomic inequity exists despite having a universal health care system

Integrated Remote Sensing, Structural and Petroleum Systems Modeling of the Iraqi‐Kurdish Fold Belt

An integrated two‐dimensional remote sensing, structural and petroleum systems modeling study was carried out for the Iraqi‐Kurdish Fold Belt to analyze potential trap structures as well as the driving mechanisms of petroleum generation, migration and accumulation in the structural complex thrust belt area. Processing of Landsat‐7 ETM data has been used to create false color images, highlighting lithological differences, from which geological maps can be generated. Analysis of lineaments in these images is used to generate fault and fracture maps, producing a suite of geological surface maps. In addition, analysis of drainage patterns and erosional features is used to understand the relative age of the structures. Key regions were selected for ground‐truthing. Lastly, these maps were combined with published and proprietary subsurface data to create a structural cross‐section of the Qara Chauq to Bina Bawi transect of the Kurdish Folded Belt. The cross‐section indicates that a minimum of 20% shortening has occurred across this region. Twelve paleo‐sections, including pre‐ and post erosion geometries, were used for the model building process. The model features both, basement faults and surface folds as well as thrust geometries that accommodate the structural framework and its development. The strata were modeled as an alternating limestone and shale sequence. The Sargelu and the Kurra Chine Fm were considered as source rock intervals. The reservoir rocks include the Shiranish, Aqra‐Bekhme and the Sargelu Fm. The Gercus Fm acts as a regional seal horizon. Special focus was laid on the N‐S trending basement faults and their evolution through time since these faults appear to divide the petroleum system into areas of differing maturity. The influence of fault permeability evolution upon petroleum migration has been evaluated to unfold the charge history of the region. Temperature and vitrinite reflectance data derived from key wells and literature have been used for thermal calibration. The model results and a detailed petroleum systems analysis show the differential maturation and generation behavior of the source rock compartments and reveal the major influence of timing and fault migration for the oil & gas charge over time