Diatoms of the River Wear

This work was undertaken to study aspects of the distribution of diatoms in the River Wear, and to equate the changes in the diatom communities with changes in the substrates and in river conditions. This investigation was extended to show the variation in cell motility, shape and volume, from the relatively unpolluted upper reaches to the more polluted lower reaches of the river

Improving the Quality of Care in Developing Countries

Although the quantity rather than quality of health services has been the focus historically in developing countries, ample evidence suggests that quality of care (or the lack of it) must be at the center of every discussion about better health. This paper discusses the cost effectiveness of various interventions to improve the quality of care in developing countries.health economics, quality of care, cost effectiveness

Synthesis and complexation studies of cyclohexane-based tripodands

The present work has been concerned with the design and synthesis of cyclohexane-based polypodands and physico-chemical studies of the corresponding podates formed by complexation of alkali metal ions. Of particular interest has been the drastic conformational biasing of the back-bone ligand structure which is associated with the complexation process. A number of new tripodand ligands (11, 12, 13, 15, & 17) have been synthesized. The methodology central to these syntheses has been the alkylation of the cyclohexanetriol with the podal tosylates (or alkyl halide). Some of the final synthetic targets were arrived at by subsequent functional group conversions.(DIAGRAM, TABLE OR GRAPHIC OMITTED...PLEASE SEE DAI). \sp1H and \sp{13}C NMR studies were conducted to determine the ability of these ligands to complex NaBPh\sb4 (as well as some other metal salts) in CDCl\sb3. The relative complex stability constants for some of these ligands (with NaBPh\sb4 in CDCl\sb3) were determined by \sp{13}C NMR competition studies and compared. Complexation constants for 11 and 3 with NaPBh\sb4 in acetone-d\sb6 were obtained by \sp{13}C NMR Titrations. \sp{13}C-T\sb1 relaxation times were used to study the motional dynamics of uncomplexed and Na\sp{+}-complexed 3 in CDCl\sb3. In general, the complexation of cyclohexane-base tripodands involves a relatively well defined reorientation of ligand to a complex conformation having a cavity with convergent binding sites. Complexation of sodium by 3 in CDCl\sb3 involves an induced cyclohexane ring inversion that organizes the oxygen donor sites in the podal groups. Hexacoordination with the sodium cation removes conformational flexibility. The overall molecular reorientational mobility of the ligand increases upon complex formation and has been rationalized in terms of a compact spherical complex geometry that rotates freely in solution

The Quality Improvement Demonstration Study: An example of evidence-based policy-making in practice

<p>Abstract</p> <p>Background</p> <p>Randomized trials have long been the gold-standard for evaluating clinical practice. There is growing recognition that rigorous studies are similarly needed to assess the effects of policy. However, these studies are rarely conducted. We report on the Quality Improvement Demonstration Study (QIDS), an example of a large randomized policy experiment, introduced and conducted in a scientific manner to evaluate the impact of large-scale governmental policy interventions.</p> <p>Methods</p> <p>In 1999 the Philippine government proposed sweeping reforms in the National Health Sector Reform Agenda. We recognized the unique opportunity to conduct a social experiment. Our ongoing goal has been to generate results that inform health policy. Early on we concentrated on developing a multi-institutional collaborative effort. The QIDS team then developed hypotheses that specifically evaluated the impact of two policy reforms on both the delivery of care and long-term health status in children. We formed an experimental design by randomizing matched blocks of three communities into one of the two policy interventions plus a control group. Based on the reform agenda, one arm of the experiment provided expanded insurance coverage for children; the other introduced performance-based payments to hospitals and physicians. Data were collected in household, hospital-based patient exit, and facility surveys, as well as clinical vignettes, which were used to assess physician practice. Delivery of services and health status were evaluated at baseline and after the interventions were put in place using difference-in-difference estimation.</p> <p>Results</p> <p>We found and addressed numerous challenges conducting this study, namely: formalizing the experimental design using the existing health infrastructure; securing funding to do research coincident with the policy reforms; recognizing biases and designing the study to account for these; putting in place a broad data collection effort to account for unanticipated findings; introducing sustainable policy interventions based on the reform agenda; and providing results in real-time to policy makers through a combination of venues.</p> <p>Conclusion</p> <p>QIDS demonstrates that a large, prospective, randomized controlled policy experiment can be successfully implemented at a national level as part of sectoral reform. While we believe policy experiments should be used to generate evidence-based health policy, to do this requires opportunity and trust, strong collaborative relationships, and timing. This study nurtures the growing attitude that translation of scientific findings from the bedside to the community can be done successfully and that we should raise the bar on project evaluation and the policy-making process.</p

Lessons Learned During the Refurbishment and Testing of an Observatory After Long-Term Storage

Thermal Fluids Analysis Workshop (TFAWS) 2015, Silver Spring, MD NCTS 21070-15. This paper addresses the lessons learned during the refurbishment and testing of the thermal control system for a spacecraft which was placed into long-term storage. The DSCOVR (Deep Space Climate Observatory) Observatory (formerly known as Triana) was originally scheduled to launch on the Space Shuttle in 2002. With the Triana spacecraft nearly complete, the mission was canceled and the satellite was abruptly put into storage in 2001. In 2008 the observatory was removed from storage to begin refurbishment and testing. Problems arose associated with hardware that was not currently manufactured, coatings degradation, and a significant lack of documentation. Also addressed is the conversion of the thermal and geometric math models for use with updated thermal analysis software tools

A psychosocial resilience curriculum provides the “missing piece” to boost adolescent physical health: A randomized controlled trial of Girls First in India

AbstractRationale and objectivesDespite a recent proliferation of interventions to improve health, education, and livelihoods for girls in low and middle income countries, psychosocial wellbeing has been neglected. This oversight is particularly problematic as attending to psychosocial development may be important not only for psychosocial but also physical wellbeing. This study examines the physical health effects of Girls First, a combined psychosocial (Girls First Resilience Curriculum [RC]) and adolescent physical health (Girls First Health Curriculum [HC]) intervention (RC + HC) versus its individual components (i.e., RC, HC) and a control group. We expected Girls First to improve physical health versus HC and controls.MethodsOver 3000 girls in 76 government middle schools in rural Bihar, India participated. Interventions were delivered through in-school peer-support groups, facilitated by pairs of local women. Girls were assessed before and after program participation on two primary outcomes (health knowledge and gender equality attitudes) and nine secondary outcomes (clean water behaviors, hand washing, menstrual hygiene, health communication, ability to get to a doctor when needed, substance use, nutrition, safety, vitality and functioning). Analyses included Difference-in-Difference Ordinary Least-Squares Regressions and F-tests for equality among conditions.ResultsGirls First significantly improved both primary and eight secondary outcomes (all except nutrition) versus controls. Additionally, Girls First demonstrated significantly greater effects, improving both primary and six secondary outcomes (clean water behaviors, hand washing, health communication, ability to get to a doctor, nutrition, safety) versus HC.ConclusionsThis study is among the first to assess the impact of a combined psychosocial and adolescent health program on physical health. We found that combining these curricula amplified effects achieved by either curriculum alone. These findings suggest that psychosocial wellbeing should receive much broader attention, not only from those interested in improving psychosocial outcomes but also from those interested in improving physical health outcomes

Improving the Quality of Care in Developing Countries

Although the quantity rather than quality of health services has been the focus historically in developing countries, ample evidence suggests that quality of care (or the lack of it) must be at the center of every discussion about better health. This paper discusses the cost effectiveness of various interventions to improve the quality of care in developing countries

Improving the Quality of Care in Developing Countries

Although the quantity rather than quality of health services has been the focus historically in developing countries, ample evidence suggests that quality of care (or the lack of it) must be at the center of every discussion about better health. This paper discusses the cost effectiveness of various interventions to improve the quality of care in developing countries

Quality of care and health status in Ukraine

BACKGROUND: We conducted a national level assessment of the quality of clinical care practice in the Ukrainian healthcare system for two important causes of death and chronic disease conditions. We tested two hypotheses: a) quality of care is predicted by physician and facility characteristics and b) health status is predicted by quality of care. METHODS: During 2009–2010 in Ukraine, we collected nationally-representative data from clinical facilities, physicians, Clinical Performance and Value (CPV) vignettes, patient surveys from the facilities, and from the general population. Each physician completed a written CPV vignette—a simulated case scenario of a typical patient visit—for each of two clinical cases, congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD). CPV vignette scores, calculated as a percentage of all care criteria completed by the physician, were used as the measure of clinical quality of care. Self-reported health measures were collected from exit and household survey respondents. Regression models were developed to test the two study hypotheses. RESULTS: 136 hospitals and 125 polyclinics were surveyed; 1,044 physicians were interviewed and completed CPV vignettes. On average physicians scored 47.4% on the vignettes. Younger, female physicians provide a higher quality of care—as well as those that have had recent continuing medical education (CME) in chronic disease or health behaviors. Higher quality was associated with better health outcomes. CONCLUSIONS: As low- and middle-income countries around the world are challenged by non-communicable diseases, higher quality of care provided to these populations may result in better outcomes, such as improved health status and life expectancy, and overcome regional shortfalls. Policy efforts that serially evaluate quality may improve chronic disease care.Keywords: Ukraine, Health policy, Health care delivery, Eastern Europe, Non-communicable diseases, Quality of car