1,340 research outputs found

    Award Term Incentive Contracting: An Investigation of United States Air Force Strategic Purchasing

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    This research explored implementing a best commercial practice of establishing strategic purchasing relationships within the Department of Defense (DOD) procurement environment. The research was sparked by Air Force Material Command\u27s (AFMC) instituting a commercial style acquisition strategy using an award term incentive on several programs. The award term incentive provides for extensions or reductions to the term of the contract based on contractors\u27 level of performance. Forthcoming implementation of Air Force FAR supplement 5317.7X Incentive Term Extension, will likely increase the number of acquisitions using an award term incentive. Research findings indicate that management should consider expanding the AFMC award term guidance to include the model developed from this research, which identifies decision criteria for selecting the award term incentive strategic purchasing method. Findings indicate that the acquisition professionals may not have the expertise or related purchasing skills necessary to establish strategic purchasing relationships for commercial type performance based services and that training is needed. The researcher also uncovered evidence that instability and reductions in the DOD workforce affects acquisition professionals\u27 ability to maintain currency with the changing legal environment. Further, workforce instability and reductions may influence the implementation of strategic contractual relationships. The research concludes that implementing the award term incentive affects the DOD competitive market

    On the Nature of Evidence and ā€˜Provingā€™ Causality:Smoking and Lung Cancer vs. Sun Exposure, VitaminD and Multiple Sclerosis

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    If environmental exposures are shown to cause an adverse health outcome, reducing exposure should reduce the disease risk. Links between exposures and outcomes are typically based on ā€˜associationsā€™ derived from observational studies, and causality may not be clear. Randomized controlled trials to ā€˜proveā€™ causality are often not feasible or ethical. Here the history of evidence that tobacco smoking causes lung cancerā€”from observational studiesā€”is compared to that of low sun exposure and/or low vitamin D status as causal risk factors for the autoimmune disease, multiple sclerosis (MS). Evidence derives from in vitro and animal studies, as well as ecological, case-control and cohort studies, in order of increasing strength. For smoking and lung cancer, the associations are strong, consistent, and biologically plausibleā€”the evidence is coherent or ā€˜in harmonyā€™. For low sun exposure/vitamin D as risk factors for MS, the evidence is weaker, with smaller effect sizes, but coherent across a range of sources of evidence, and biologically plausible. The association is less directā€”smoking is directly toxic and carcinogenic to the lung, but sun exposure/vitamin D modulate the immune system, which in turn may reduce the risk of immune attack on self-proteins in the central nervous system. Opinion about whether there is sufficient evidence to conclude that low sun exposure/vitamin D increase the risk of multiple sclerosis, is divided. General public health advice to receive sufficient sun exposure to avoid vitamin D deficiency (<50 nmol/L) should also ensure any benefits for multiple sclerosis, but must be tempered against the risk of skin cancers.This research received no external funding

    The Need for Endometriosis Awareness: A Case Study of College Students and Medical Professionals

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    Endometriosis is an estrogen-dependent chronic illness in which tissue similar to the endometrium develops outside of the uterine cavity. This disease affects an estimated 10-15% of individuals with a uterus at reproductive age and yet it takes an average of 7.5 years for an individual to receive an accurate diagnosis. This delay in diagnosis, along with recent studies on endometriosis, suggest a severe lack of education on endometriosis within both the medical community and the general public. There is literature that suggests there is a strong need for more education and awareness of endometriosis in the global medical community. However, there is a lack of literature that addresses the knowledge of college-age individuals in the United States on endometriosis. This thesis consists of a focus group at Southern New Hampshire University that determined the knowledge of college-age individuals on endometriosis, the menstrual cycle and reproductive health. This thesis found that there is a need for more education on topics relating to endometriosis, the menstrual cycle and reproductive health. General practitioners, specifically pediatricians need to develop more knowledge on these topics and be willing to share their information with their patients in order to educate them and ultimately reduce the length of diagnostic delay of endometriosis and other diseases characterized by reproductive issues

    The Influence of Soil Moisture on the Color Morph of the Eastern Red-backed Salamander (Plethodon cinereus)

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    This project aims to determine whether or not soil moisture influences the presence of different color morphs of the Eastern Red-backed salamander (Plethodon cinereus). Soil temperature and moisture are two variables that comprise a thermal niche. Prior research suggests that different color morphs of this salamander have been known to be found at different substrate temperatures, however, this finding may be dependent on the location and season of sampling. Measuring the soil moisture and conducting a count survey on these salamanders will gather additional data that can be examined to find out if there is a correlation between the different color morphs and different soil moisture levels or thermal niches. In the SNHU Arboretum four plots were established, each consisting of 12 coverboards to allow for count surveying to take place. Count surveying and soil sampling were conducted each week for 9 weeks. This study will provide data to support the idea that certain color morphs of this salamander have become more dominant in certain thermal niches

    Can falling infection rates in one country explain rising incidence of autoimmune and allergic diseases in other countries? Caution when (over) interpreting ecological data from disparate areas

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    HT is the Canada Research Chair in Neuroepidemiology and Multiple Sclerosis. She currently receives research support from the National Multiple Sclerosis Society, the Canadian Institutes of Health Research, the Multiple Sclerosis Society of Canada and the Multiple Sclerosis Scientific Research Foundation. In addition, in the last five years she has received research support from the Multiple Sclerosis Society of Canada (Don Paty Career Development Award); the Michael Smith Foundation for Health Research (Scholar Award) and the UK MS Trust. RML is supported by a National Health and Medical Research Council of Australia Senior Research Fellowship

    Analysing complex linked administrative data in health services research: Issues and solutions

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    Introduction Linked administrative data are increasingly being used to evaluate the impact of health policy on health-service use/cost because they can comprehensively capture whole of population interactions with the health system. These analyses are complex comprising unbalanced panels and are at risk of endogeneity and associated problems. Objectives and Approach We evaluated the impact of changes in regularity of general practitioner contact on diabetes related hospitalisation before and after care coordination policies using whole of population, person-level linked primary care, hospital, Electoral Roll and death records. Complex panel random-effects modelling techniques were required due to the unbalanced structure of the data (individuals could exit and re-enter the study repeatedly), over-dispersion and high proportion of zeros, changes in availability of tests (ascertainment bias), the likelihood of prior health service use influencing the dependent variable (initial conditions and simultaneity/reverse causality bias) and likely correlation of observed and unobserved variables. Results Multivariable zero-inflated negative binomial and Cragg-hurdle clustered robust regression, which include separate components to model zero and non-zero outcomes, were required for these data. Mundlak variables (group-means of time-varying variables) were used to relax the assumption in the random-effects estimator that the observed variables were uncorrelated with the unobserved ones. Prior health service use was adjusted for using 4-year lags of GP contact and one-year lag of hospitalisation. The initial value of the dependent variable resolved the ā€œinitial conditionā€ problem. Ascertainment bias was addressed using the number of years available for identification for each person as a covariate. AIC/BIC values were used to identify the best model. We found that more regular GP contact was associated with fewer hospitalisations, however this attenuated over time. Conclusion/Implications Availability of linked data, together with increases in computing power, has vastly increased its potential for use. This has also increased the complexity of analyses being undertaken necessitating recognizing and addressing problems, such as endogeneity, that arise due to the observational nature of the studies undertaken

    A time-duration measure of continuity of care to optimise utilisation of primary health care: A threshold effects approach among people with diabetes

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    Ā© 2019 The Author(s). Background: Literature highlighted the importance of timely access and ongoing care provided at primary care settings in reducing hospitalisation and health care resource uses. However, the effect of timely access to primary care has not been fully captured in most of the current continuity of care indices. This study aimed to develop a time-duration measure of continuity of primary care ("cover index") capturing the proportion of time an individual is under the potentially protective effect of primary health care contacts. Methods: An observational study was conducted on 36,667 individuals aged 45 years or older with diabetes mellitus extracted from Western Australian linked administrative data. Threshold effect models were used to determine the maximum time interval between general practitioner (GP) visits that afforded a protective effect against avoidable hospitalisation across complication cohorts. The optimal maximum time interval was used to compute a cover index for each individual. The cover was evaluated using descriptive statistics stratified by population socio-demographic characteristics. Results: The optimal maximum time between GP visits was 9-13 months for people with diabetes with no complication, 5-11 months for people with diabetes with 1-2 complications, and 4-9 months for people with diabetes with 3+ complications. The cover index was lowest among those aged 75+ years, males, Indigenous people, socio-economically disadvantaged and those in very remote areas. Conclusions: This study developed a new measure of continuity of primary care that adds a time parameter to capturing longitudinal continuity. Cover has the potential to better capture underuse of primary care and will significantly contribute to the sparsely available methods for analysis of linked administrative data in evaluating continuity of care for people with chronic conditions

    Association between continuity of provider-adjusted regularity of general practitioner contact and unplanned diabetes-related hospitalisation: A data linkage study in New South Wales, Australia, using the 45 and Up Study cohort

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    Ā© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. Objective To assess the association between continuity of provider-adjusted regularity of general practitioner (GP) contact and unplanned diabetes-related hospitalisation or emergency department (ED) presentation. Design Cross-sectional study. Setting Individual-level linked self-report and administrative health service data from New South Wales, Australia. Participants 27 409 survey respondents aged ā‰„45 years with a prior history of diabetes and at least three GP contacts between 1 July 2009 and 30 June 2015. Main outcome measures Unplanned diabetes-related hospitalisations or ED presentations, associated costs and bed days. Results Twenty-one per cent of respondents had an unplanned diabetes-related hospitalisation or ED presentation. Increasing regularity of GP contact was associated with a lower probability of hospitalisation or ED presentation (19.9% for highest quintile, 23.5% for the lowest quintile). Conditional on having an event, there was a small decrease in the number of hospitalisations or ED presentations for the low (-6%) and moderate regularity quintiles (-8%), a reduction in bed days (ranging from -30 to -44%) and a reduction in average cost of between -23% and -41%, all relative to the lowest quintile. When probability of diabetes-related hospitalisation or ED presentation was included, only the inverse association with cost remained significant (mean of A3798 to A6350 less per individual, compared with the lowest regularity quintile). Importantly, continuity of provider did not significantly modify the effect of GP regularity for any outcome. Conclusions Higher regularity of GP contact - that is more evenly dispersed, not necessarily more frequent care - has the potential to reduce secondary healthcare costs and, conditional on having an event, the time spent in hospital, irrespective of continuity of provider. These findings argue for the advocacy of regular care, as distinct from solely continuity of provider, when designing policy and financial incentives for GP-led primary care

    A guide to best practices for Gene Ontology (GO) manual annotation.

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    The Gene Ontology Consortium (GOC) is a community-based bioinformatics project that classifies gene product function through the use of structured controlled vocabularies. A fundamental application of the Gene Ontology (GO) is in the creation of gene product annotations, evidence-based associations between GO definitions and experimental or sequence-based analysis. Currently, the GOC disseminates 126 million annotations covering >374,000 species including all the kingdoms of life. This number includes two classes of GO annotations: those created manually by experienced biocurators reviewing the literature or by examination of biological data (1.1 million annotations covering 2226 species) and those generated computationally via automated methods. As manual annotations are often used to propagate functional predictions between related proteins within and between genomes, it is critical to provide accurate consistent manual annotations. Toward this goal, we present here the conventions defined by the GOC for the creation of manual annotation. This guide represents the best practices for manual annotation as established by the GOC project over the past 12 years. We hope this guide will encourage research communities to annotate gene products of their interest to enhance the corpus of GO annotations available to all. DATABASE URL: http://www.geneontology.org

    The Effects of Physical Activity on Markers of Adipose Inflammation during Weight Cycling

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    Weight loss using diet and exercise are the main treatment strategies for obesity; however, weight loss is rarely maintained resulting in weight regain or weight cycling. Obesity is associated with chronic low-grade inflammation resulting in the release of adipokines and activation of macrophages (M1) accelerating the development of insulin resistance. In contrast, the M2 macrophage phenotype is characterized by blocking inflammatory responses and promoting tissue repair. Despite the effectiveness of exercise on preventing comorbidities of obesity during weight-loss, the influence of physical activity during weight cycling on markers of adipose inflammation remains unclear. Purpose: The purpose of this study was to determine the role of physical activity on the expression of inflammatory markers in adipose tissue during weight cycling. Methods: Male C57BL/6 mice were randomly assigned to one of three groups for 28 weeks: a high-fat diet obese control (HFD; 60% kcal from fat), an alternating high-low-high fat diet group (Diet; 60%/10%/60% kcal from fat) to simulate weight cycling, or a diet-matched weight cycling group that had unrestricted access to running wheels (Diet+PA). After weight regain, MCP-1, CD11c, CD163, F4/80, TLR4, and TNFĪ± mRNA levels were quantified in perigonadal adipose tissue using qRT-PCR. A one-way ANOVA was used to identify significant differences between groups with significance set at PWeight cycling without physical activity resulted in obesity and insulin resistance when compared to HFD obese controls. Interestingly, compared to the HFD control group, the Diet group demonstrated significantly greater expression of F4/80 (+50%), CD11c (+113%), TLR4 (+77%), and TNFĪ± (+72%) mRNA, which may represent greater macrophage infiltration and M1 macrophage polarization. Physical activity during weight cycling resulted in lower weight regain compared to both HFD and Diet groups; however, mice still developed insulin resistance and increased expression of TLR4 (+76%), TNFĪ± (+94%), and CD11c (+58%) suggesting increased M1 macrophage activation when compared to the HFD group. Conclusions: The data presented suggests weight cycling may accelerate the development of adipose dysfunction, and unrestricted physical activity appears to have minimal effects on the negative inflammatory effects of weight cycling
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