Stakeholders' perceptions of rehabilitation services for individuals living with disability:A survey study

Background: The World Health Organization (WHO) was tasked with developing health system guidelines for the implementation of rehabilitation services. Stakeholders' perceptions are an essential factor to take into account in the guideline development process. The aim of this study was to assess stakeholders' perceived feasibility and acceptability of eighteen rehabilitation services and the values they attach to ten rehabilitation outcomes.   Methods: We disseminated an online self-administered questionnaire through a number of international and regional organizations from the different WHO regions. Eligible individuals included persons with disability, caregivers of persons with disability, health professionals, administrators and policy makers. The answer options consisted of a 9-point Likert scale.   Results: Two hundred fifty three stakeholders participated. The majority of participants were health professional (64 %). In terms of outcomes, 'Increasing access' and 'Optimizing utilization' were the top service outcomes rated as critical (i.e., 7, 8 or 9 on the Likert scale) by >70 % of respondents. 'Fewer hospital admissions', 'Decreased burden of care' and 'Increasing longevity' were the services rated as least critical (57 %, 63 % and 58 % respectively). In terms of services, 'Community based rehabilitation' and 'Home based rehabilitation' were found to be both definitely feasible and acceptable (75 % and 74 % respectively). 'Integrated and decentralized rehabilitation services' was found to be less feasible than acceptable according to stakeholders (61 % and 71 % respectively). As for 'Task shifting', most stakeholders did not appear to find task shifting as either definitely feasible or definitely acceptable (63 % and 64 % respectively).   Conclusion: The majority of stakeholder's perceived 'Increasing access' and 'Optimizing utilization' as most critical amongst rehabilitation outcomes. The feasibility of the 'Integrated and decentralized rehabilitation services' was perceived to be less than their acceptability. The majority of stakeholders found 'Task shifting' as neither feasible nor acceptable

Sexual Differentiation of Circadian Clock Function in the Adrenal Gland

Sex differences in glucocorticoid production are associated with increased responsiveness of the adrenal gland in females. However, the adrenal-intrinsic mechanisms that establish sexual dimorphic function remain ill defined. Glucocorticoid production is gated at the molecular level by the circadian clock, which may contribute to sexual dimorphic adrenal function. Here we examine sex differences in the adrenal gland using an optical reporter of circadian clock function. Adrenal glands were cultured from male and female Period2::Luciferase (PER2::LUC) mice to assess clock function in vitro in real time. We confirm that there is a pronounced sex difference in the intrinsic capacity to sustain PER2::LUC rhythms in vitro, with higher amplitude rhythms in adrenal glands collected from males than from females. Changes in adrenal PER2::LUC rhythms over the reproductive life span implicate T as an important factor in driving sex differences in adrenal clock function. By directly manipulating hormone levels in adult mice in vivo, we demonstrate that T increases the amplitude of PER2::LUC rhythms in adrenal glands of both male and female mice. In contrast, we find little evidence that ovarian hormones modify adrenal clock function. Lastly, we find that T in vitro can increase the amplitude of PER2::LUC rhythms in male adrenals but not female adrenals, which suggests the existence of sex differences in the mechanisms of T action in vivo. Collectively these results reveal that activational effects of T alter circadian timekeeping in the adrenal gland, which may have implications for sex differences in stress reactivity and stress-related disorders

Club Deals in Leveraged Buyouts

We analyze the pricing and characteristics of club deal leveraged buyouts (LBOs)—those in which two or more private equity partnerships jointly conduct an LBO. Using a comprehensive sample of completed LBOs of U.S. publicly traded targets conducted by prominent private equity firms, we find that target shareholders receive approximately 10% less of pre-bid firm equity value, or roughly 40% lower premiums, in club deals compared to sole-sponsored LBOs. This result is concentrated before 2006 and in target firms with low institutional ownership. These results are robust to controls for target and deal characteristics, including size, Q, measures of risk, and time and industry fixed effects. We find little support for benign motivations for club deals based on capital constraints, diversification motives, or the ability of clubs to obtain favorable debt amounts or prices, but it is possible that the lower pricing of club deals is an inadvertent byproduct of an unobserved benign motivation for club formation

The Wealth Effects of Merger Activities: Further Evidence from Real Estate Investment Trusts

This paper examines the effect of merger announcements on target firm shareholder wealth. The sample is limited to Real Estate Investment Trust (REIT) targets. Previous corporate acquisition studies report strong pre-announcement and announcement day price appreciation for target firms. Significant positive abnormal returns are detected for the REIT targets at announcement but not during the pre-announcement period.

Dynamic deformation of volcanic ejecta from the Toba caldera: Possible relevance to Cretaceous/Tertiary boundary phenomena

Plagioclase and biotite phenocrysts in ignimbrites erupted from the Toba caldera, Sumatra, show microstructures and textures indicative of shock stress levels higher than 10 GPa. Strong dynamic deformation has resulted in intense kinking in biotite and, with increasing shock intensity, the development in plagioclase of planar features, shock mosaicism, incipient recrystallization, and possible partial melting. Microstructures in quartz indicative of strong shock deformation are rare, however, and many shock lamellae, if formed, may have healed during post-shock residence in the hot ignimbrite; they might be preserved in ash falls. Peak shock stresses from explosive silicic volcanism and other endogenous processes may be high and if so would obviate the need for extraterrestrial impacts to produce all dynamically deformed structures, possibly including shock features observed near the Cretaceous/Tertiary boundary

Strengthening Community Schools Through University Partnerships

Given the mounting call for academic achievement gains in America’s public schools— particularly urban schools labeled “failing”—the need for community engagement to tackle a host of underlying social challenges warrants the resources of the nation’s colleges and universities (Harkavy & Hartley, 2009). Because colleges and universities are often underutilized anchors of resources in communities, coordinated alignment of K-12 and higher education goals can create a seamless pipeline of educational attainment for communities challenged to produce high academic achievement. Higher education’s engagement with community schools further helps to address the whole child and their families in K-12 education by expanding the opportunities for the students and community to access necessary support services. Drawing upon experiences of Indiana University Purdue University Indianapolis (IUPUI) and collaboration with its adjacent neighborhoods, this article illustrates the transformative and relevant impact of university and community engagement, as well as new pedagogical approaches to teaching, learning, and training. This article reflects upon the experiences of IUPUI and nearby George Washington Community High School as it can uniquely serve as a roadmap for other school community/university partnerships that are interested in embarking upon a similar education reform path

Measuring functional ability in healthy ageing: a nationwide cross-sectional survey in the Philippine older population

OBJECTIVES: To analyse the empirical support of the functional ability concept in the healthy ageing framework developed by the WHO in a sample of the Philippine older population. According to this framework, environmental factors may enhance or hinder functional ability, which is the person's ability to do what they value, broadly represented by subjective well-being. Moreover, this network of relationships may be moderated by personal characteristics such as gender. DESIGN: Cross-sectional observational study. SETTING: Philippines, general population. PARTICIPANTS: Respondents of the 2016 National Disability Prevalence Survey/Model Functioning Survey aged 50+ (N=2825). PRIMARY AND SECONDARY OUTCOME MEASURES: Latent (unobserved) measures of functional ability, environmental factors (physical environmental factors and social network and support) and subjective well-being (positive affect, negative affect and evaluative well-being) were obtained from different items from the survey questionnaire using a SEM framework. RESULTS: We found that the relationship between environmental factors and the three components of subjective well-being considered in this study was partially explained by differences in functional ability. The portion of those effects accounted for by functional ability was comparatively larger for the physical than for the social environmental factors. We found no evidences of gender differences in this network of relationships. CONCLUSIONS: These findings suggest the relevance of functional ability at explaining the relationship between environmental factors and subjective well-being in older adults. Future studies may replicate these findings longitudinally and including other relevant measures as the person's objective level of intrinsic capacity

Atmospheric velocity fields in tepid main sequence stars

The line profiles of the stars with v sin i below a few km/s can reveal direct signatures of local velocity fields (e.g. convection) in stellar atmospheres. This effect is well established in cool main sequence stars, and has been detected and studied in three A stars. This paper reports observations of main sequence B, A and F stars with two goals: (1) to identify additional stars having sufficiently low values of v sin i to search for spectral line profile signatures of local velocity fields, and (2) to explore how the signatures of the local velocity fields in the atmosphere depend on stellar parameters such as effective temperature T_eff and peculiarity type. For stars having T_eff below about 10000 K, we always detect local atmospheric velocity fields indirectly through a non-zero microturbulence parameter, but not for hotter stars. Among the A and F stars in our sample having the sharpest lines, direct tracers of atmospheric velocity fields are found in six new stars. The velocity field signatures identified include asymmetric excess line wing absorption, deeper in the blue line wing than in the red; line profiles of strong lines that are poorly fit by computed profiles; and strong lines that are broader than they should be for the v sin i values deduced from weak lines. These effects are found in both normal and Am stars, but seem stronger in Am stars. These data still have not been satisfactorily explained by models of atmospheric convection, including numerical simulations.Comment: Acepted for publication by Astronomy and Astrophysic