Equity among physicians and the wish to reallocate time

Objective: To examine the relationship between perceptions of equity among physicians and the wish to reallocate time by creating a fitted, multistage model of the equity distress- wish to reallocate time pathway using structural equation modelling (SEM). Background: The reorganizing of work among various health care professionals and better management of scarce resources are seen as necessary for the delivery of effective and efficient health care. Physicians play a key role in the health care system, and any substantive changes in their work will require their cooperation. Gaining support from physicians for changes in the allocation of their time will depend, in part, on the degree to which these changes are seen to promote their professional and personal objectives. Whether physicians perceive their practice conditions to be equitable, and how they choose to respond to efforts by others to make changes in the work they do and the rewards they receive, has important implications for the successful reform of health care in Canada. Design: A modified panel study using questionnaires mailed to a stratified random sample of 840 physicians in Saskatchewan and British Columbia. A total of 384 physicians responded at baseline (110 from Saskatchewan and 274 from British Columbia). At follow-up, 240 usable questionnaires were returned from the remaining 371 eligible respondents for a response rate of 64.7% (72 from Saskatchewan and 168 from British Columbia). Measures: Reliable constructs were developed for: intrinsic and extrinsic equity; distress; coping with practice demands; and the four components of professional activity (patient care, teaching and research, continuing education, and administration). Latent variables were created for: local health care conditions; distributive equity; wish to reallocate professional time; and wish to reallocate administrative time. Results: SEM produced a well-fitted model (P = 0.112; NFI = 0.991; RMSEA = 0.029; P for Test of Close Fit =0.965; and Hoelter 0.05 Index =255) that explained a substantial amount of variance at each stage of the model, and supported the hypotheses of the main pathway. The contributions of practice condition variables to the model, however, were shown to relate almost exclusively to the equity stage of the model. Discussion/Conclusions: Inequity was significantly associated with distress. In turn, distress was significantly associated with the wish to reallocate time. The state of local health care contributed substantially to perceptions of equity among physicians. The physician's ability to cope with time demands was associated with the equity, distress, and wish to reallocate professional time (patient care, teaching & research, and continuing education). Wish to reallocate administrative time was associated with time already allocated to administrative duties, but was not associated with ability to cope with time demands. The impact of inequity on the allocation of time and the organization of the work of physicians and other health care practitioners over time should be examined in a larger study of a longitudinal design

A capillary column gas chromatography, resonance enhanced multiphoton ionization, time-of-flight mass spectrometry, laser-induced fluorescence, flame ionization detection system for the determination of polynuclear aromatic compounds in complex mixtures

Of the thousands of chemical compounds that have been deemed mutagenic or carcinogenic, it is generally agreed that the polynuclear aromatic hydrocarbons (PAC) are among the most potent. Typically, a multitude of different PAC are present, at trace levels, in a variety of environmental samples. Because of the wide range of potency of PAC, even among geometric isomers and substitutional derivatives, it is important to fully characterize these samples. This task is a formidable one, usually requiring elaborate sample clean-up and fractionation prior to analysis. Even with extensive sample preparation, however, many isomers cannot be distinguished by conventional GC/MS techniques. A multidimensional, laser-based analytical instrument has been developed that, when utilized to the full extent of its capabilities could be the solution to this complex analytical problem. The over- all technique is termed Capillary Column Gas Chromatography, Resonance Enhanced Multiphoton Ionization, Time-Of-Flight Mass Spectrometry, Laser-induced Fluorescence, with parallel Flame Ionization Detection (CC/GC-REMPI-TOF/MS-LIF-FID). This system combines the selectivity and sensitivity of two complementary laser-based methods, REMPI and LIF, with an extremely powerful and proven analytical tool, GC/MS. The GC effluent passes through the ion source of a TOF/MS, where it is interrogated by a tunable ultraviolet laser beam. Thus, PAC and other absorbing species may be selectively excited and/or ionized in the presence of nonabsorbing components. All laser-analyte interaction products (cations, electrons, and photons) are simultaneously monitored utilizing the TOF/MS, a total electron current detector (TECD), and a LIF detector. The beauty of this technique is that all analytically useful data for each absorbing chromatographic eluent may be collected on-the-fly. The simultaneous availability of this information simplifies the characterization task. The present absolute detection limits for several PAC have been determined to be low picogram range. Also, a linear dynamic range of approximately four orders of magnitude has been established for the TECD, indicating that this technique is both sensitive and quantitative. Further, the use of deuterated analogs, of selected PAC, as internal reference standards greatly assists in quantitation. (\u27(UPSILON))DOE Report IS-T-1262. This work was performed under Contract W-7405-Eng-82 with the U.S. Department of Energy

Quantifying performance of ultrasonic immersion inspection using phased arrays for curvilinear disc forgings

Use of full-matrix capture (FMC), combined with the total focusing method (TFM), has been shown to provide improvements to flaw sensitivity within components of irregular geometry. Ultrasonic immersion inspection of aerospace discs requires strict specifications to ensure full coverage – one of which is that all surfaces should be machined flat. The ability to detect defects through curved surfaces, with an equivalent sensitivity to that obtained through flat surfaces could bring many advantages. In this work, the relationship between surface curvature and sensitivity to standard defects was quantified for various front wall radii. Phased array FMC immersion inspection of curved components was simulated using finite element modelling, then visualized using surface-compensated focusing techniques. This includes the use of BRAIN software developed at the University of Bristol for production of TFM images. Modelling results were compared to experimental data from a series of test blocks with a range of curvatures, containing standard defects. The sensitivity to defects is evaluated by comparing the performance to conventional methods. Results are used to highlight the benefits and limitations of these methods relating to the application area of aerospace engine disc forgings

Measuring Gas-Liquid Distribution in a Pilot Scale Monolith Reactor Via an Industrial Tomography Scanner (ITS)

An Industrial Tomography Scanner (ITS) Was Designed and Developed to Study and Quantify the Phase Distribution in a Two-Phase Flow Pilot Scale Monolith Reactor that Was 24 In. (0.60 M) in Diameter and 192 In. (4.9 M) in Height. the Monolith Reactor Was Operated Co-Current Up-Flow in the Taylor Flow Regime with Water as the Liquid Phase and Air as the Gas Phase. the Cross-Sectional Holdup Distributions Were Measured at Three Axial Elevations. the Operating Conditions Were Selected to Bracket Commercial Operating Conditions for Fixed Bed Monolithic Reactor Systems. the Results Show that its Can Capture the Flow Features in a Large Diameter Column. Also, the Findings Suggest the Need for Careful Design of the Internals of the Reactor. Spatial Resolution Down to 1.5 Cm Was Obtained So that Gross Phase Maldistribution Could Be Reliably Observed. However, Improvement is Needed for the its to Be Effectively Utilized in Industry. © 2006 Elsevier B.V. All Rights Reserved

Cross infection control measures and the treatment of patients at risk of Creutzfeldt Jakob disease in UK general dental practice

AIMS: To determine the suitability of key infection control measures currently employed in UK dental practice for delivery of dental care to patients at risk of prion diseases. MATERIALS AND METHODS: Subjects: Five hundred dental surgeons currently registered with the General Dental Council of the UK. Data collection: Structured postal questionnaire. Analysis: Frequencies, cross-tabulations and chi-squared analysis. RESULTS: The valid response rate to the questionnaire was 69%. 33% of practices had no policy on general disinfection and sterilisation procedures. Only 10 of the 327 responding practices (3%) possessed a vacuum autoclave. 49% of dentists reported using the BDA medical history form but less than 25% asked the specific questions recommended by the BDA to identify patients at risk of iatrogenic or familial CJD. However, 63% of practitioners would refer such patients, if identified, to a secondary care facility. Of the 107 practitioners who were prepared to provide dental treatment, 75 (70%) would do so using routine infection control procedures. CONCLUSIONS: Most of the dental practices surveyed were not actively seeking to identify patients at risk of prion diseases. In many cases, recommended procedures for providing safe dental care for such patients were not in place

Resilience and survival : black teenage mothers 'looked after' by the State tell their stories about their experience of care

This is the peer reviewed version of the following article: Nadia Mantonavi, and Hilary Thomas, 'Resilience and Survival: Black Teenage Mothers ‘Looked After’ by the State Tell their Stories About their Experience of Care', Children & Society, Vol. 29 (4): 299-309, July 2015, which has been published in final form at https://doi.org/10.1111/chso.12028. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.‘Looked after’ young people are among the most disadvantaged members of our society. While their disadvantaged status should not be ignored, poor outcomes are often emphasised at the expense of good ones. This paper reports a study that adopts the concept of resilience to understand the narratives of the participants’ experience of care and foster care. A total of 15 young mothers, aged 16-19 and mainly from black African backgrounds, were interviewed. Despite lacking a ‘secure base’, informants invested in a sense of moral identity and a source of self-directedness, which enabled them to move from victim of circumstances to individuals who overcome their circumstances.Peer reviewedFinal Accepted Versio

Impacts of climate change on plant diseases – opinions and trends

There has been a remarkable scientific output on the topic of how climate change is likely to affect plant diseases in the coming decades. This review addresses the need for review of this burgeoning literature by summarizing opinions of previous reviews and trends in recent studies on the impacts of climate change on plant health. Sudden Oak Death is used as an introductory case study: Californian forests could become even more susceptible to this emerging plant disease, if spring precipitations will be accompanied by warmer temperatures, although climate shifts may also affect the current synchronicity between host cambium activity and pathogen colonization rate. A summary of observed and predicted climate changes, as well as of direct effects of climate change on pathosystems, is provided. Prediction and management of climate change effects on plant health are complicated by indirect effects and the interactions with global change drivers. Uncertainty in models of plant disease development under climate change calls for a diversity of management strategies, from more participatory approaches to interdisciplinary science. Involvement of stakeholders and scientists from outside plant pathology shows the importance of trade-offs, for example in the land-sharing vs. sparing debate. Further research is needed on climate change and plant health in mountain, boreal, Mediterranean and tropical regions, with multiple climate change factors and scenarios (including our responses to it, e.g. the assisted migration of plants), in relation to endophytes, viruses and mycorrhiza, using long-term and large-scale datasets and considering various plant disease control methods

Enter the Dragon: The Dynamic and Multifunctional Evolution of Anguimorpha Lizard Venoms

While snake venoms have been the subject of intense study, comparatively little work has been done on lizard venoms. In this study, we have examined the structural and functional diversification of anguimorph lizard venoms and associated toxins, and related these results to dentition and predatory ecology. Venom composition was shown to be highly variable across the 20 species of Heloderma, Lanthanotus, and Varanus included in our study. While kallikrein enzymes were ubiquitous, they were also a particularly multifunctional toxin type, with differential activities on enzyme substrates and also ability to degrade alpha or beta chains of fibrinogen that reflects structural variability. Examination of other toxin types also revealed similar variability in their presence and activity levels. The high level of venom chemistry variation in varanid lizards compared to that of helodermatid lizards suggests that venom may be subject to different selection pressures in these two families. These results not only contribute to our understanding of venom evolution but also reveal anguimorph lizard venoms to be rich sources of novel bioactive molecules with potential as drug design and development lead compounds