Identifying barriers to influenza vaccination recommendation adherence in an academic outpatient primary care clinic setting

Objective: The objectives of this study were to identify barriers to influenza vaccination recommendation adherence and determine potential methods to improve influenza vaccination rates at the outpatient primary care health centers within an academic health care system. Methods: This descriptive study consisted of a questionnaire distributed to primary care providers at outpatient health centers within an academic health care system. The questionnaire assessed provider opinions regarding knowledge of influenza vaccination recommendations, barriers to following clinical guidelines, and methods to decrease delay of guideline use. Influenza vaccination rates at each of the health centers were also determined through documentation of vaccination for adults who visited a primary care provider during the 2011-2012 influenza season. Vaccination rates were used as a potential model for vaccination recommendation adherence. Results: When providers were asked about barriers to guideline implementation, 75.0% stated lack of awareness that guidelines have been released and 62.5% identified insufficient time to learn new guidelines as barriers. When asked which would be useful to more quickly implement clinical guidelines, respondents selected education for providers of new guidelines (79.2%), reminders in the electronic medical record (62.5%), and involvement of other health care professionals including pharmacists (54.2%) as potential strategies. Most questionnaire respondents (70.8%) strongly agreed that well-developed guidelines would improve quality of care at their practice site. During the 2011-2012 influenza season, 26.0% of 67,827 adults with an office visit at all outpatient health centers had documentation of administration of an influenza vaccine. Conclusion: Influenza vaccination rates at the outpatient primary care health centers at this academic health care system represent an area for improvement. Provider perceived barriers to clinical practice guideline implementation and adherence at the health centers include lack of awareness of new guidelines and lack of resources such as time and personnel to follow all recommendations. A health care system-wide process needs to be created to better identify strategies to improve adherence to influenza vaccination recommendations and vaccination documentation

‘We Make the Law and the Law Makes Us’:

Summaries How much does law really matter in the lives of the poor? The article develops a relational theory of law as a politically determined resource that emerges from the interactions between agents of the state and collective social actors. On the one hand, law is a tool of social regulation used principally but not exclusively by the state. On the other hand, it is a social institution which exists as a set of practices, constantly shaping and being reshaped in a context of power relations and opportunities. It is argued that the point of departure for research should be national or state law, insofar as it has empirical primacy over other regulatory orders. The state interacts with people's lives not just through its formal legal institutions but through a whole range of political and regulatory agencies which are subject to contestation and interpretation. These points are illustrated with cases concerning the legal regulation of social movements in the USA and Brazil

Identification of Stipules reduced, a leaf morphology gene in pea (Pisum sativum)

Pea (Pisum sativum) is one of relatively few genetically amenable plant species with compound leaves. Pea leaves have a variety of specialized organs: leaflets, tendrils, pulvini and stipules, which enable the identification of mutations that transform or affect distinct parts of the leaf. Characterization of these mutations offers insights into the development and evolution of novel leaf traits. The previously characterized morphological gene Cochleata, conferring stipule identity, was known to interact with Stipules reduced (St), which conditions stipule size in pea, but the St gene remained unknown. Here we analysed Fast Neutron irradiated pea mutants by restriction site associated DNA sequencing. We identified St as a gene encoding a C2H2 zinc finger transcription factor that is regulated by Cochleata. St regulates both cell division and cell expansion in the stipule. Our approach shows how systematic genome-wide screens can be used successfully for the analysis of traits in species for which whole genome sequences are not available

Mirroring Opposition Threats

Hugo Chávez and his Bolivarian Movement came to power in 1999 promising to refound the Venezuelan state and restructure the polity in ways that would build “popular power” through the promotion of grassroots participation, organization, and mobilization. Once in office, the Bolivarian forces launched a series of initiatives to sponsor organization and mobilization among supporters, which ranged widely in their functions and strategic purpose. State-mobilized organizations can be seen as operating in three different arenas of politics: the local governance arena; the electoral arena; and the protest arena. From an ideological standpoint, the Bolivarian Movement was oriented toward sponsoring organizations that could operate in the first of these arenas, helping realize Chávez’s vision of constructing a “protagonistic democracy” by establishing vehicles for citizen participation in local governance. In the terminology of this volume, these activities are best seen as a form of “infrastructural mobilization,” working to solidify political support and achieve the government’s longer-term aims