Exploring patient and family satisfaction in pediatric neurological surgery

Introduction Patient and family satisfaction during outpatient visits is correlated with a continuance of care and likelihood to recommend the practice to others. Additionally, patient-family satisfaction can determine the success of the practice and influence medical outcomes. Utilizing a well-validated surveys instrument, patient and family satisfaction can be explored in the office setting. Methods During a consecutive 36 month period, a standardized and validated patient satisfaction survey instrument was provided to the family members of patients who presented to two pediatric neurosurgery clinics associated with Nemours Children\u27s Health System. The completed surveys were analyzed statistically to identify correlations between overall satisfaction, defined as “Likelihood to Recommend (LTR) the Practice”, and relevant practice and provider variables. Results The factors that exhibited the greatest correlation to LTR were: ‘Cheerfulness of Practice’ (r = 0.74), ‘Ability to Get Desired Appointment’ (r = 0.70), ‘Likelihood of Recommending Care Provider’ (r = 0.65), ‘Staff Worked Together’ (r = 0.65), and ‘Waiting Area Comfort and Pleasantness’ (r = 0.60). Discussion and conclusions Patient and family satisfaction surveys are useful for gaining insight into pediatric neurosurgical practices. Data from this cohort suggest that the environment in which patient care is delivered, timeliness of appointments and positive perceptions of the healthcare team correlate most strongly with overall satisfaction. © 201

Spatial and Temporal Habitat Use of an Asian Elephant in Sumatra

Increasingly, habitat fragmentation caused by agricultural and human development has forced Sumatran elephants into relatively small areas, but there is little information on how elephants use these areas and thus, how habitats can be managed to sustain elephants in the future. Using a Global Positioning System (GPS) collar and a land cover map developed from TM imagery, we identified the habitats used by a wild adult female elephant (Elephas maximus sumatranus) in the Seblat Elephant Conservation Center, Bengkulu Province, Sumatra during 2007–2008. The marked elephant (and presumably her 40–60 herd mates) used a home range that contained more than expected medium canopy and open canopy land cover. Further, within the home range, closed canopy forests were used more during the day than at night. When elephants were in closed canopy forests they were most often near the forest edge vs. in the forest interior. Effective elephant conservation strategies in Sumatra need to focus on forest restoration of cleared areas and providing a forest matrix that includes various canopy types

Spatial and temporal variability in the relative contribution of king mackerel (Scomberomorus cavalla) stocks to winter mixed fisheries off South Florida

King mackerel (Scomberomorus cavalla) are ecologically and economically important scombrids that inhabit U.S. waters of the Gulf of Mexico (GOM) and Atlantic Ocean (Atlantic). Separate migratory groups, or stocks, migrate from eastern GOM and southeastern U.S. Atlantic to south Florida waters where the stocks mix during winter. Currently, all winter landings from a management-defined south Florida mixing zone are attributed to the GOM stock. In this study, the stock composition of winter landings across three south Florida sampling zones was estimated by using stock-specific otolith morphological variables and Fourier harmonics. The mean accuracies of the jackknifed classifications from stepwise linear discriminant function analysis of otolith shape variables ranged from 66−76% for sex-specific models. Estimates of the contribution of the Atlantic stock to winter landings, derived from maximum likelihood stock mixing models, indicated the contribution was highest off southeastern Florida (as high as 82.8% for females in winter 2001−02) and lowest off southwestern Florida (as low as 14.5% for females in winter 2002−03). Overall, results provided evidence that the Atlantic stock contributes a certain, and perhaps a significant (i.e., ≥50%), percentage of landings taken in the management-defined winter mixing zone off south Florida, and the practice of assigning all winter mixing zone landings to the GOM stock shoul

The Relationship Between Molecular Gas Tracers and Kennicutt-Schmidt Laws

We provide a model for how Kennicutt-Schmidt (KS) laws, which describe the correlation between star formation rate and gas surface or volume density, depend on the molecular line chosen to trace the gas. We show that, for lines that can be excited at low temperatures, the KS law depends on how the line critical density compares to the median density in a galaxy's star-forming molecular clouds. High critical density lines trace regions with similar physical properties across galaxy types, and this produces a linear correlation between line luminosity and star formation rate. Low critical density lines probe regions whose properties vary across galaxies, leading to a star formation rate that varies superlinearly with line luminosity. We show that a simple model in which molecular clouds are treated as isothermal and homogenous can quantitatively reproduce the observed correlations between galactic luminosities in far infrared and in the CO(1->0) and HCN(1->0) lines, and naturally explains why these correlations have different slopes. We predict that IR-line luminosity correlations should change slope for galaxies in which the median density is close to the line critical density. This prediction may be tested by observations of lines such as HCO^+(1->0) with intermediate critical densities, or by HCN(1->0) observations of intensely star-forming high redshift galaxies with very high densities. Recent observations by Gao et al. hint at just such a change in slope. We argue that deviations from linearity in the HCN(1->0)-IR correlation at high luminosity are consistent with the assumption of a constant star formation efficiency.Comment: Accepted to ApJ. 11 pages, 4 figures, emulateapj format. This version has some additional models exploring the effects of varying metallicity and temperature. The conclusions are unchange

Synthesis of neutral nickel catalysts for ethylene polymerization – the influence of ligand size on catalyst stability

A facile synthesis of nickel salicylaldimine complexes with labile dissociating ligands is described. In addition to producing highly active ethylene polymerization catalysts, important insights into the effect of ligand size on catalyst stability and information on the mechanism of polymerization are provided

Characterisation of damage mechanisms in oxide ceramics indented at dynamic and quasi-static strain rates

Ceramic materials are known to display rate dependent behaviour under impact. Tests to establish the strain-rate dependent variations in damage mechanisms have been carried out on debased alumina, an alumina-zirconia composite, and 3Y-TZP. Materials were indented dynamically and quasi-statically using identical sharp hardened steel projectiles while recording the load profile. Characteristics typical of both sharp and blunt indentation types were observed using scanning electron microscopy and piezospectroscopic mapping. At dynamic strain rates both the depth of the indentation and the residual stress in the material were lower than for quasi-static tests. This was attributed to temperature-induced softening of the projectile. Unusual behaviour was observed in the 3Y-TZP samples due to the reversible transformation from tetragonal to monoclinic crystal structures during mechanical loading. These effects and the observed superior mechanical strength against impact suggest that zirconia or zirconia-composite materials may have advantages over debased alumina for application as ceramic armour materials

Maintaining Institutional Power and Constitutional Principles: A Rhetorical Analysis of United States v. Nixon

In examining these implications we argue that the Court’s Nixon decision was a uniquely strategic response to a complex rhetorical situation. In fact, the elements of the situation were so fundamental to the tenor of the Court’s response that this essay’s framework is drawn from Lloyd F. Bitzer’s construction of the rhetorical situation. The use of this system will allow for deeper consideration of the context of United States v. Nixon as well as assessment of the legal text as responsive to that context

Systematic review of the clinical effectiveness and cost-effectiveness, and economic evaluation, of denosumab for the treatment of bone metastases from solid tumours

Peer reviewedPublisher PD

The Sexual health of pupils in years 4 to 6 of primary schools in rural Tanzania

Background/objectives: There is an urgent need for effective interventions to improve the sexual and\ud reproductive health of adolescents. Reliable data on the sexual health of adolescents are needed to guide\ud the development of such interventions. The aim was to describe the sexual health of pupils in years 4 to 6 of\ud 121 rural primary schools in north western Tanzania, before the implementation of an innovative sexual\ud health intervention in 58 of the schools.\ud Methods: A cross sectional survey of primary school pupils in rural Tanzania was carried out. The study\ud population comprised pupils registered in years 4 to 6 of 121 primary schools in 20 rural communities in\ud 1998. Basic demographic information was collected from all pupils seen. Those born before 1 January\ud 1985 (aged approximately 14 years and over) were invited to participate in the survey, and asked about\ud their knowledge and attitudes towards sexual health issues, and their sexual experience. A urine specimen\ud was requested and tested for HIV, Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and, for\ud females, pregnancy.\ud Results: 9283 pupils born before 1 January 1985 were enrolled and provided demographic information\ud and a urine sample. Male pupils were significantly older than females (mean age 15.5 years v 14.8 years,\ud p,0.001), but all other demographic characteristics were similar between the sexes. 14 (0.2%) of the\ud enrolled pupils (four male and 10 female) were HIV positive, 83 (0.9%) were positive for CT, and 12\ud (0.1%) for NG. 32 female pupils (0.8%) were positive by pregnancy test. Sexual experience was reported\ud by one fifth of primary school girls, and by almost half of boys. Only 45/114 (39%) girls with biological\ud markers of sexual activity reported having had sex.\ud Conclusions: HIV, CT, NG, and pregnancy were present though at relatively low levels among pupils in\ud years 4 to 6 of primary school. A high proportion of pupils with a biological marker of sexual activity\ud denied ever having had sex. Alternative ways of collecting sensitive data about the sexual behaviour of\ud school pupils should be explored

Hitting time for the continuous quantum walk

We define the hitting (or absorbing) time for the case of continuous quantum walks by measuring the walk at random times, according to a Poisson process with measurement rate $\lambda$. From this definition we derive an explicit formula for the hitting time, and explore its dependence on the measurement rate. As the measurement rate goes to either 0 or infinity the hitting time diverges; the first divergence reflects the weakness of the measurement, while the second limit results from the Quantum Zeno effect. Continuous-time quantum walks, like discrete-time quantum walks but unlike classical random walks, can have infinite hitting times. We present several conditions for existence of infinite hitting times, and discuss the connection between infinite hitting times and graph symmetry.Comment: 12 pages, 1figur