Health impact assessment and short-term medical missions: A methods study to evaluate quality of care

<p>Abstract</p> <p>Background</p> <p>Short-term medical missions (STMMs) are a well-established means of providing health care to the developing world. Despite over 250 million dollars and thousands of volunteer hours dedicated to STMMs, there is a lack of standardized evaluation to assess patient safety, quality control, and mission impact. The objective of this project is to design and implement an assessment tool that defines objective parameters of quality of care as identified by STMMs.</p> <p>Methods</p> <p>The study was conducted in 3 phases: 1) Base-need analysis to determine factors critical to the quality of STMMs, 2) Design of 5 surveys for mission personnel and patients to enable 360-degree evaluation based on factors from phase 1, and 3) Field testing of the surveys with 5 STMMs.</p> <p>Results</p> <p>An evaluation tool was created assessing 6 major and 30 minor factors identified as important to the quality of STMMs. 5 mission directors, 43 personnel, 10 local hosts, and 55 patients completed the surveys. Of the 6 major measures of quality, missions performed best in Cost (mean score 86%), and Impact (84%). The poorest performance was in Education (64%). Efficiency, Sustainability, and Preparedness showed mean scores of 76%, 77%, and 73%, respectively.</p> <p>Conclusion</p> <p>Our study provides a novel standardized tool for STMM evaluation. Use of the assessment instrument identified areas of strength and weakness of a particular mission, and delineated general trends in performance compared to other STMMs. We anticipate that the use of this tool may improve the quality of care provided by missions, and stimulate solution-sharing and scholarly discussion among missions.</p

Cleaning the air with the invisible hand

Environmental policy ; Economic policy

Shifts in Gamma Phase–Amplitude Coupling Frequency from Theta to Alpha Over Posterior Cortex During Visual Tasks

The phase of ongoing theta (4–8 Hz) and alpha (8–12 Hz) electrophysiological oscillations is coupled to high gamma (80–150 Hz) amplitude, which suggests that low-frequency oscillations modulate local cortical activity. While this phase–amplitude coupling (PAC) has been demonstrated in a variety of tasks and cortical regions, it has not been shown whether task demands differentially affect the regional distribution of the preferred low-frequency coupling to high gamma. To address this issue we investigated multiple-rhythm theta/alpha to high gamma PAC in two subjects with implanted subdural electrocorticographic grids. We show that high gamma amplitude couples to the theta and alpha troughs and demonstrate that, during visual tasks, alpha/high gamma coupling preferentially increases in visual cortical regions. These results suggest that low-frequency phase to high-frequency amplitude coupling is modulated by behavioral task and may reflect a mechanism for selection between communicating neuronal networks

Awareness and perceptions of clinical guidelines for the diagnostics and treatment of severe behavioural problems in children across Europe : A qualitative survey with academic experts

Background: Severe behavioural problems (SBPs(1)) in childhood are highly prevalent, impair functioning, and predict negative outcomes later in life. Over the last decade, clinical practice guidelines for SBPs have been developed across Europe to facilitate the translation of scientific evidence into clinical practice. This study outlines the results of an investigation into academic experts' perspectives on the current prevalence, implementation, and utility of clinical guidelines for SBPs in children aged 6-12 across Europe. Methods: An online semi-structured questionnaire was completed by 28 psychiatry and psychology experts from 23 countries. Results: Experts indicated that approximately two thirds of the included European countries use at least an unofficial clinical document such as textbooks, while nearly half possess official guidelines for SBPs. Experts believed that, although useful for practice, guidelines' benefits would be maximised if they included more specific recommendations and were implemented more conscientiously. Similarly, experts suggested that unofficial clinical documents offer a wide range of treatment options to individualise treatment from. However, they stressed the need for more consistent, evidence-based clinical practices, by means of developing national and European clinical guidelines for SBPs. Conclusions: This study offers a preliminary insight into the current successes and challenges perceived by experts around Europe associated with guidelines and documents for SBPs, acting as a stepping stone for future systematic, in-depth investigations of guidelines. Additionally, it establishes experts' consensus for the need to develop official guidelines better tailored to clinical practice, creating a momentum for a transition towards European clinical guidelines for this population. (c) 2019 The Authors. Published by Elsevier Masson SAS. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).Peer reviewe

Incorporating Concepts of Nanotechnology into the Materials Science and Engineering Classroom and Laboratory

The National Science Foundation-supported Materials Research Science and Engineering Center (MRSEC) on Nanostructured Materials and Interfaces at the University of Wisconsin – Madison has an extensive and highly successful education and outreach effort. One theme of this effort is the development of instructional materials based on cutting-edge research in nanoscale science and engineering. Nanotechnology examples, such as light emitting diodes (LEDs), shape memory alloys, amorphous metals, and ferrofluids, illustrate interdisciplinary research that provides connections among materials science, chemistry, physics, and engineering. They also highlight the tools of nanotechnology, such as scanning probe microscopy, electron microscopy, self-assembly, x-ray diffraction, and chemical vapor deposition, associated with the preparation and characterization of nanostructured materials. These and other nanotechnology concepts are illustrated with video demonstrations in a web-based resource called the Nanoworld Cineplex, which contains movies of experiments and demonstrations that can be brought into the classroom. Numerous experiments are also available in the Nanotechnology Lab Manual, which can be used as either a virtual laboratory or as a web-based video lab manual. These resources for using nanotechnology to teach fundamental materials science and engineering principles are available at

New trends in active faulting studies for seismic hazard assessment

Vulnerability to earthquakes increases steadily as urbanization and development expand in areas that are prone to the effects of significant earthquakes. As virtually all of the largest earthquakes of the past decade demonstrated, the development of large cities in high seismicity areas is often based on an insufficient knowledge or distorted perception of the local seismic hazard, a condition often worsened by the construction of seismically unsafe buildings and infrastructures

Stochastic analysis of exit fluid temperature records from the active TAG hydrothermal mound (Mid-Atlantic Ridge, 26°N) : 2. Hidden Markov models of flow episodes

Author Posting. © American Geophysical Union, 2007. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Journal of Geophysical Research 112 (2007): B09102, doi:10.1029/2007JB004961.I develop a stochastic signal model for episodic modes of variability in hydrothermal flow records using probabilistic functions of Markov processes (i.e., hidden Markov models, HMMs) and fit the model to exit fluid temperature time series data from diffuse flow sites on the active TAG hydrothermal mound. The flow states are modeled using Gamma densities to provide flexibility for application to a range of signal types. Between three and five flow states are needed to fit the diffuse flow temperature records from TAG, which correspond to models with between 10 and 28 degrees of freedom. The number of flow states required to fit a given record is related to the signal variance, with more variable records requiring a larger state space. HMMs thus provide an efficient signal model for episodic variability in hydrothermal flow records, suggesting that Markov processes may provide a means to generate stochastic subsurface flow models for deep-sea hydrothermal fields if the spatial flow correlations can be incorporated into a statistical framework. I also use the Viterbi algorithm to “decode” the time series data into best fitting state sequences, which can be used to classify the records into discrete flow episodes. This may provide an objective means to identify discrete events in a flow record if misclassification issues arising from nonepisodic variability (e.g., tidal forcing) can be addressed.This work was supported by the National Science Foundation (OCE-0137329)

Author Correction: A consensus-based transparency checklist.

An amendment to this paper has been published and can be accessed via a link at the top of the paper

Population dynamics of species-rich ecosystems: the mixture of matrix population models approach

Matrix population models are widely used to predict population dynamics, but when applied to species-rich ecosystems with many rare species, the small population sample sizes hinder a good fit of species-specific models. This issue can be overcome by assigning species to groups to increase the size of the calibration data sets. However, the species classification is often disconnected from the matrix modelling and from the estimation of matrix parameters, thus bringing species groups that may not be optimal with respect to the predicted community dynamics. We proposed here a method that jointly classified species into groups and fit the matrix models in an integrated way. The model was a special case of mixture with unknown number of components and was cast in a Bayesian framework. An MCMC algorithm was developed to infer the unknown parameters: the number of groups, the group of each species and the dynamics parameters. We applied the method to simulated data and showed that the algorithm efficiently recovered the model parameters. We applied the method to a data set from a tropical rain forest in French Guiana. The mixture matrix model classified tree species into well-differentiated groups with clear ecological interpretations. It also accurately predicted the forest dynamics over the 16-year observation period. Our model and algorithm can straightforwardly be adapted to any type of matrix model, using the life cycle diagram. It can be used as an unsupervised classification technique to group species with similar population dynamics. (Résumé d'auteur

Social Attention in Children with Epilepsy

Children with epilepsy may be vulnerable to impaired social attention given the increased risk of neu- robehavioural comorbidities. Social attentional orienting and the potential modulatory role of attentional control on the perceptual processing of gaze and emotion cues have not been examined in childhood onset epilepsies. Social attention mechanisms were investigated in patients with epilepsy (n = 25) aged 8–18 years old and performance compared to healthy controls (n = 30). Dynamic gaze and emotion facial stimuli were integrated into an antisaccade eye-tracking paradigm. The time to orient attention and exe- cute a horizontal saccade toward (prosaccade) or away (antisaccade) from a peripheral target measured processing speed of social signals under conditions of low or high attentional control. Patients with epi- lepsy had impaired processing speed compared to healthy controls under conditions of high attentional control only when gaze and emotions were combined meaningfully to signal motivational intent of approach (happy or anger with a direct gaze) or avoidance (fear or sad with an averted gaze). Group dif- ferences were larger in older adolescent patients. Analyses of the discrete gaze emotion combinations found independent effects of epilepsy-related, cognitive and behavioural problems. A delayed disengage- ment from fearful gaze was also found under low attentional control that was linked to epilepsy devel- opmental factors and was similarly observed in patients with higher reported anxiety problems. Overall, findings indicate increased perceptual processing of developmentally relevant social motivations during increased cognitive control, and the possibility of a persistent fear-related attentional bias. This was not limited to patients with chronic epilepsy, lower IQ or reported behavioural problems and has implica- tions for social and emotional development in individuals with childhood onset epilepsies beyond remission