30 research outputs found
Identifying barriers to influenza vaccination recommendation adherence in an academic outpatient primary care clinic setting
No full textObjective: The objectives of this study were to identify barriers to influenza vaccination recommendation adherence and determine potential methods to improve influenza vaccination rates at the outpatient primary care health centers within an academic health care system.
Methods: This descriptive study consisted of a questionnaire distributed to primary care providers at outpatient health centers within an academic health care system. The questionnaire assessed provider opinions regarding knowledge of influenza vaccination recommendations, barriers to following clinical guidelines, and methods to decrease delay of guideline use. Influenza vaccination rates at each of the health centers were also determined through documentation of vaccination for adults who visited a primary care provider during the 2011-2012 influenza season. Vaccination rates were used as a potential model for vaccination recommendation adherence.
Results: When providers were asked about barriers to guideline implementation, 75.0% stated lack of awareness that guidelines have been released and 62.5% identified insufficient time to learn new guidelines as barriers. When asked which would be useful to more quickly implement clinical guidelines, respondents selected education for providers of new guidelines (79.2%), reminders in the electronic medical record (62.5%), and involvement of other health care professionals including pharmacists (54.2%) as potential strategies. Most questionnaire respondents (70.8%) strongly agreed that well-developed guidelines would improve quality of care at their practice site. During the 2011-2012 influenza season, 26.0% of 67,827 adults with an office visit at all outpatient health centers had documentation of administration of an influenza vaccine.
Conclusion: Influenza vaccination rates at the outpatient primary care health centers at this academic health care system represent an area for improvement. Provider perceived barriers to clinical practice guideline implementation and adherence at the health centers include lack of awareness of new guidelines and lack of resources such as time and personnel to follow all recommendations. A health care system-wide process needs to be created to better identify strategies to improve adherence to influenza vaccination recommendations and vaccination documentation.Buu, Jenni; Mullin, Shantel; McAdam-Marx, Carrie; Solomon, Margaret; Jennings, Brandon T.. (2014). Identifying barriers to influenza vaccination recommendation adherence in an academic outpatient primary care clinic setting. Retrieved from the University Digital Conservancy, https://hdl.handle.net/11299/171868
Two-level preconditioning applied on the ssSNPBLUP model
No full textThe single-step single nucleotide polymorphism best linear unbiased prediction (ssSNPBLUP) model can potentially be used in animal breeding for genetic evaluations. It has been reported that this model has convergence issues when the Preconditioned Conjugate Gradient (PCG) method is applied. This is due to the linear system being ill-conditioned. Moreover, in a recent research a subspace decomposition deflation method has been proposed. Unfortunately, the method requires too many deflation vectors, which results in an implementation of the Deflated PCG (DPCG) algorithm that requires a high demand of RAM. In this thesis a different subdomain decomposition strategy is proposed. This subdomain decomposition method utilises the -means algorithm applied on the matrix of correlation among the single nucleotide polymorphisms (SNPs). This method has been applied on a simulated data set of dairy cattle. This method results in halving the number of deflation vectors required for the same rate of convergence compared with the previous subdomain decomposition deflation method. In practice for genetic evaluations the data sets increases over time by incorporating new information. In this thesis a specific initial solution has been investigated. This initial solution closely resembles the solution of the updated system to solve the ssSNPBLUP model efficiently. Also a deflation method that utilises the previous solutions of genetic evaluations can be applied. The Proper Orthogonal Decomposition (POD) based deflation method is proposed in this thesis to full fill this requirement. Moreover, only a few deflation vectors are needed to improve the rate of convergence.Furthermore, the subdomain decomposition deflation method deflates the largest eigenvalues of the preconditioned coefficient matrix and the POD deflation method deflates the smallest eigenvalues of the preconditioned matrix. Combining the deflation vectors of both methods results in an improvement in the rate of convergence compared with the methods on their own.Based on the results the best performing method is a combination of selecting the initial solution as the previous genetic evaluation, the POD deflation method and the k-means++ clustering applied on the subdomain decomposition deflation method. In this research a reduction of 81% in iteration time and 19% in total computation time has been observed. Note that the initial solution as the previous genetic evaluation approach can only be employed if that solution is available. Likewise, the POD method can only be applied if multiple solutions of genetic evaluations are available.Applied Mathematic
Wa?ási - kehkí buu naaósa-buga
No full textPor el alto río Mayo, en las barrancas de la Sierra Tarahumara, vive la gran mayoría de los guarijó: pueblo indígena que comparte prácticas culturales y una cercanía lingüística con otros grupos yutoaztecas de la región. Actualmente, residen entre poblados de rancheros mestizos que, desde hace tiempo, llegaron a establecerse en el territorio tradicional. A partir de entonces, su situación comprende un terreno social interétnico con personas de ideologías y prácticas lingüísticas diferentes entretejidas dentro de procesos locales conflictivos y búsquedas cotidianas de negociación, y en redes sociales que moldean las pautas del lenguaje en los espacios públicos y privados. En este contexto, la presente investigación examina los usos cotidianos de la lengua guarijó para encontrar, dentro de sus redes, las manifestaciones de ideología lingüística y su funcionamiento en la vitalidad o en el desplazamiento. Por medio de una etnografía de la comunicación, y su análisis interpretativo enmarcado en la antropología lingüística, el estudio aporta conocimiento sobre los procesos significativos de este grupo y contribuye a las discusiones sobre las estrategias de persistencia lingüística de los pueblos indígenas del noroeste de México.Este trabajo fue presentado como tesis para obtener el grado de Doctora en Ciencias del Lenguaje en la Escuela Nacional de Antropología e Historia, siendo el jurado: Dr. José Luis Moctezuma Zamarrón (director de tesis), Dra. Jane H. Hill, Dr. Pedro Ernesto Lewin Fischer, Dr. Roberto Flores Ortiz, Dr. Ronald Terborg, Dra. María Regina Martínez Casas, Dra. Celia María Zamudio Mesa y la Secretaria de actas Dra. Ana Paulina Pintado Cortina.- Símbolos utilizados en los diálogos. – Prefacio. - Capítulo I: - Introducción. - Capítulo II. – Conceptualización: - El enfoque para el caso guarijó. - La etnografía de la comunicación y la antropología lingüística. - Ideología lingüística e identidad étnica. - Los estudios previos. - Técnicas y métodos utilizados en el campo. - Capítulo III. - Contexto sociohistórico: - Contexto social. - Conformación del territorio interétnico. - Consolidación del poder de los yori. - Territorio interétnico hoy. - Actuales espacios de conflicto lingüístico. - Capítulo IV. - Los nichos de vitalidad lingüística. Una etnografía de la comunicación en las rancherías guarijó: - Las rancherías. - Las redes sociales. - El silencio en la comunicación guarijó. - Interacciones cotidianas. - Los cuentos en la cotidianidad. - Pichikená, “la creencia”. La tradición oral, lenguaje e identidad étnica. - El lenguaje ritual. Los cantos guarijós, normatividad y vida cotidiana. - Las palabras “feas”. Caciques, hechiceros, chismes y mentiras. - “Problemas en el paraíso”. Los conflictos lingüísticos en los nichos de vitalidad. - Acerca de los yori, el español y la lengua guarijó. - Capítulo V. – Conclusiones: - Conclusiones. La ideología lingüística e identidad étnica entre los guarijós. - El silencio, estilo discursivo, redes sociales e identidad étnica. - La diversidad de ideologías lingüísticas. - Consideraciones finales. - Capítulo VI: - Epílogo. - Bibliografía
Measuring and Managing Blood Pressure in a Primary Care Setting: A Pragmatic Implementation Study
No full textEarly Implementation of Comprehensive Medication Management within an Academic Medical Center Primary Care Pharmacy Team
No full textIntroduction: University of Utah Health is an academic health care system that serves residents in Utah and beyond. Clinical pharmacists with the health care system’s pharmacy primary care services (PPCS) team provide medication education, population-based care, and medication management through collaborative practice agreements. With the expansion of clinical pharmacist and technician positions and services, the need to measure and assess the impact of pharmacy services and create a value proposition for internal and external stakeholders became an important goal, and the decision was made to better align practices across all PPCS sites. This paper highlights University of Utah Health’s approach to implement comprehensive medication management (CMM) across all primary care clinics with embedded clinical pharmacy staff and subsequent evaluation of implementation fidelity.
Methods: Implementation of CMM was assisted by participation in the National A3 Collaborative and by using selected principles from the Active Implementation Framework. Stages of implementation included exploration, instillation, and initiating improvement cycles. An implementation team consisting of PPCS employees was created to help with standardization, developing implementation plans, and creating a dissemination strategy for all PPCS team members. The CMM care process was subsequently presented and implemented by clinical pharmacists in primary care clinics. Following implementation, fidelity measures were collected including identification and resolution of medication therapy problems (MTPs) and responses from a questionnaire distributed to the clinical pharmacists to self-report understanding and implementation of CMM key elements. The number and type of MTPs identified were tracked over 18 months.
Results: Within the measurement window, clinical pharmacists identified 17,953 MTPs. Of the total number of MTPs identified, 21% were related to indication, 53% to efficacy, 15% to safety and 11% to adherence. The questionnaire was distributed to clinical pharmacists 9 months after CMM implementation, with a 71% response rate. Pharmacists reported “always” or “often” performing each step in the patient care process as follows: indication (93%), effectiveness (93%), safety (87%), and adherence (93%). Reported barriers to implementation of the CMM include lack of time to complete all aspects of the process efficiently, lack of a standardized format for documentation, and changing practice habits.
Conclusion: Implementation of a CMM process within University of Utah Health’s PPCS services with the help of a national collaborative and implementation framework yielded identification of 17,953 MTPs over 18 months and foundational fidelity to core principles. 
Deflation techniques applied on mixed model equations
No full textIn this paper, we consider a block Jacobi preconditioner and various deflation techniques applied in the Deflated Preconditioned Conjugate Gradient (DPCG) method for solving a sparse system of linear equations derived from a statistical linear mixed model that analyses simultaneously phenotypic and pedigree information of genotyped and ungenotyped animals with Single Polymorphism Nucleotide genotypes of genotyped animals. In livestock production systems, evaluating the genetic merit of the animals through such a model is a key process to ensure an improvement of animals for some characteristics of interest at each generation. First, we propose to define the deflation vectors using a subdomain deflation approach that considers some biological properties of the genotypes. Using simulated data, this approach reduces the number of iterations by up to 87% in comparison to a Preconditioned Conjugate Gradient method with a Jacobi preconditioner. Furthermore, compared to a DPCG method with same number of subdomains but defined randomly, this approach reduces the number of iterations by up to 20% for the same computational costs of one DPCG iteration. The properties of the resulting systems show that this approach annihilates the largest eigenvalues of the preconditioned coefficient matrix. Second, we propose the use of solution vectors of 12 systems of equations that include between 0.25% and 3% less data, as deflation vectors. For reducing the computational costs, we also consider a Proper Orthogonal Decomposition-reduced set of these 12 vectors. The properties of the resulting systems show that this recycling information approach annihilates the smallest eigenvalues of the preconditioned coefficient matrix, and results in a reduction of up to 39% in comparison to the PCG method. Finally, based on our experiment, the combination of the subdomain deflation approach relying on biological properties and of the POD-based approach to recycle previous solution vectors, for defining the deflation vectors, results in annihilating both the smallest and largest eigenvalues, and in a reduction of up to 88 % of the number of iterations in comparison to the PCG method.Numerical Analysi
Synthesis of tri-aryl ketone amine isomers and their cure with epoxy resins
No full textIsomeric tri-aryl ketone amines, 1,3-bis(3-aminobenzoyl)benzene (133 BABB), 1,3-bis(4-aminobenzoyl)benzene (134 BABB), and 1,4-bis(4-aminobenzoyl)benzene (144 BABB) are synthesized and cured with diglycidyl ether of bisphenol A and diglycidyl ether of bisphenol F in this work. Differential scanning calorimetry and near-infrared spectroscopy reveal higher rate constants and enhanced secondary amine conversion with increasing para substitution attributed to resonance effects and the electron withdrawing nature of the carbonyl linkages. Glass transition temperatures increase from 133 BABB to 134 BABB, but decrease modestly for the 144 BABB hardener. With increasing para substitution, the flexural modulus and strength both decrease while the strain to failure increases but all BABB amines displaying higher mechanical properties than the corresponding 4,4-diaminodiphenyl sulfone (44 DDS) networks. The thermal stability of the BABB networks is found to be modestly lower than 44 DDS, but char yields are significantly higher. Changes in thermal and mechanical properties are described in terms of molecular structure and equilibrium packing density.Novel Aerospace Material
TRADISI MEAMUK-AMUKAN DI DESA PADANG BULIA KECAMATAN SUKASADA KABUPATEN BULELENG KAJIAN TEOLOGI HINDU
No full textThe implementation of the rampage tradition that was carried out in Padang Bulia Village is a tradition that has been passed down by the ancestors to the Padang Bulia traditional village community. This rampage tradition has been going on for years and is always held every year, which coincides with the day before Nyepi. The Meamuk-Amukan tradition is often also called a fire war by using facilities such as danyuh which later when it is over is used when mecaru or mebuu-buu in each resident's house. Those who carried out the rampage or fire war were all residents of Padang Bulia Village, especially the young men. The place was also chosen on the main road, the right time was Sandykala after carrying out the pilgrimage at each other's homes without using offerings, it's just part of the Nyepi ceremony. Based on the background above, in this study there are three issues that will be discussed, namely: (1) What is meant by the tradition of rampage. (2) How is the process of carrying out the tradition of rampage. (3) What theological values contained in the tradition of rampage. The author uses several theories to dissect the three problem formulations, namely: (1) Religious Theory, (2) Functional Theory, and (3) Value Theory. The type of data used in this study is data sourced from the field and books, articles, theses and other sources using the methods of observation, interviews, documentation and literature. The results of research on the Meamuk-Amukan tradition is a form of tradition that is believed by the people of Padang Bulia Village to expel evil spirits so that during the implementation of the pencak brata penyepian, it can be carried out in a calm and peaceful manner. The theological values contained in the tradition of rampaging in Padang Bulia Village are Harmony Theology, Social Theology, and Cultural Theology.Keywords: Tradition of Rampage, Hindu Theology
Maintenance Activities in Theory and Practice Acknowledgements I would like to thank the companies Debeka, IBM, sd&m and Volkswagen AG for the possibility of doing interviews for my thesis.
No full textI declare that this report is my own original work and that no part of it has been submitted to any other institute of learning in support of an application for another award. No other sources than those quoted have been used. The opinions expressed in the report are put forward in a personal capacity and do not represent those of the University of Koblenz or any organisation with which the author may be associated. Signature................................. Date................................
Euthygomphus yunnanensis Zhou & Wu 1992
No full textEuthygomphus yunnanensis (Zhou & Wu, 1992) Fig. 4–6, 7 a–b Previous reports from Cambodia: Burmagomphus sp. (part)— Kosterin 2010: 36, 55: 2 teneral ♀ photographed (misidentified), Koh Kong Province, Thma Bang River upstream waterfall, 5 km SW Thma Bang village, 15 iv 2010) Merogomphus parvus (Krüger, 1899) —Kosterin 2012: 34, 49, 78, figs 24, 49: still erroneous reidentification of the above photographic record; 1♀, Koh Kong Province, 6.5 km SW Thma Bang village, 23 viii 2011). Merogomphus parvus (Krüger, 1899) —Kosterin et al. 2012: 162 (listed). Merogomphus parvus (Krüger, 1899) — Kosterin 2015: 28 –29, fig. 21b, table 4: 1 teneral ♂, Pursat Province, O’Som village, 24 iii 2015). Specimens studied. 1♀ (dry, in envelope), Cambodia, Koh Kong Province, ‘ Microgomphus River’ 6.5 km SW Thma Bang village, 11°38'42–47'' N, 103°23'43–51'' E, 343–346 m a.s.l., 23 viii 2011; 1♂ (collected teneral, hardened in captivity overnight, dry in envelope), the same locality, 2 vi 2014; 1♀ (teneral, almost uncoloured, preserved in alcohol), Cambodia, Koh Kong Province, Thma Bang River 5 km SW Thma Bang village, 11°39'31'' N, 103°24'14'' E, 366 m a.s.l., 15 iv 2010; 1♂ (collected teneral, hardened in captivity overnight, preserved in alcohol), Cambodia, Pursat Province, a river at O’Som village, 12°04'40–45'' N 103°12' 21–35'', 524–531 m a.s.l., 24 iii 2015; 1♂ 1♀, Cambodia, Mondulkiri Province, downstream of Buu Sraa Waterfall, ‘ Loringae brook’ upstream its waterfall, 12°33'58''–34'19'' N 107°24'43'' –25'02'' E, 432–515 m a.s.l., 10 vi 2014 (dry in envelopes); 1♀, Cambodia, Mondulkiri Province, just downstream of Buu Sraa Waterfall, the main river right bank, 12°34'09'' N 107°25'07'' E, 456 m a.s.l., 4 viii 2016 (acetoned, dry in envelope); 1♂, Cambodia, Stung Treng Province, Thala Barivat District, a brook in open low deciduous dipterocarp forest, 13°48'02'' N 105°51'50'' E, 84 m a.s.l., 27 vii 2016 (acetoned, dry in envelope); 1♀, Cambodia, Stung Treng Province, Thala Barivat District and Commune, 0.5 km E of Srae Ruessei village, a brook similar to the above, 13°36'04''' N 105°55' 50' E, 67 m a.s.l., 28 vii 2016 (acetoned, dry in envelope); all collected by O. Kosterin, in the author’s collection. Remarks. The main diagnostic feature of this species is the penis (vesica spermalis) structure. Its distal segment (V4) in lateral view looks narrow, with a small ventrobasal expansion (Fig. 4 a,c,h–i), as illustrated before (Asahina 1986, Zhang & Wu 1991) (Fig. 3 e,m–n). Unfortunately, neither author illustrated the ventral view of the penis of this species. The actual structure of the distal segment (V4) is as follows. Its ventral (outer) surface is almost flat, only slightly lengthwise concave (more in proximal part) (Fig. 4 f–g,k); its dorsal (inner) surface has two semicircular keels in its basal part (Fig. 4 j). In ventral view its shape resembles a duck’s beak or a hippopotamus’s muzzle (Fig. 4 f–g, k) (while the whole penis looks like a duck’s head and neck, Fig. 4 h): it slightly expands at the base and strongly expands at the apex. The apical margin of the ventral surface is somewhat rounded, while that of the dorsal surface is almost rectangular, with the membranaceous distal ejaculation pores between them (Fig. 4 f–g, k). If preserved in alcohol, the two short membranaceous ventroapical processes on the medial segment (V3) are well seen (Fig. 4 g–k). No trace of cornua (claws). Other important characters are: - Simple male cerci, yellowish white with a brownish base (Fig. 5 k–m), very slightly arched in lateral view (Fig. 5 l), pointed to a small apical tooth directed back, below which the apex is rounded, with a black area of low irregular fine knobs (Fig. 5 m). (Note the cercus is blunt in the Sumatran male of M. parvus, see Lieftinck 1941 and Fig. 1 c). - Epiproct with the branches rather slender, arched down and slightly hooked apically in lateral view (Fig. 5 l), in ventral view outer sides of the branches convex (Fig. 5 m) and incision between the branches shallow, evenly roundish (Fig. 5 m). - Female vulvar scale triangular with blunt lobes and a narrowly pointed incision between them (Fig. 5 n). - Simple occiput with scarcely defined ridge, straight in males (Fig. 5 g); in females it varies from nearly straight in specimen from Koh Kong Province (Fig. 5 h) to having two slight waves in specimens from Mondulkiri and Stung Treng Provinces (Fig. 5 j); one of the Mondulkiri females has vestigial knobs and the other wellexpressed spines at its sides just near the eyes. The occiput coloration is variable, perhaps geographically. In the male (Fig. 5 e,g) and females (Fig. 5 f,i–j) from Mondulkiri Province (eastern Cambodia), most of the occiput is yellow. The male from Stung Treng Province (northern Cambodia) has the occiput black, while the female from there has a central yellow spot. The male from Pursat Province (southwestern Cambodia) has a small indistinct yellow spot in the occiput centre. In both male and female (Fig. 5 h) from Koh Kong Province (also southwestern Cambodia), the occiput is brownish black. The same variable coloration of the female occiput and presence of the knobs/spines is reported for Thai and Vietnamese specimens by Asahina (1986) as well (Fig. 3 r–t): of the two Thai females illustrated by him, one had the occiput almost entirely yellow and without knobs (Fig. 3 p,r), and in the other the yellowish colour was nearly disappearing and there were vestigial knobs (Fig. 3 q,s); in the female from South Vietnam the knobs looked like minute spines (Fig. 3 t). - On metepisternum (Fig. 5 c–d), dorsal stripes broadly confluent to collar stripes in a hockey-stick-like manner. Collar stripes narrowly interrupted at the middle. - Antealar spot present invariably. The antehumeral stripes (well expressed in the holotype, see Fig. 3 d) are absent in mature Cambodian specimens (Fig. 5 a–d, 6a), even in two males collected teneral and kept overnight. However, one of those specimens, the male from Pursat Province, had the antehumeral stripes in its teneral condition (Fig. 6 c); the teneral females from the Thma Bang River also had these stripes (Fig. 6 d). Among the five Thai specimens reported by Asahina (1986) the Mae Hong Son female had an interrupted antehumeral streak, others not (Fig. 3 k). Apparently, the antehumeral stripes are present in teneral specimens and disappear with acquisition of the full colouring. Most probably, the holotype (Liu 1991) was collected teneral, or perhaps the stripes may be retained in maturity in the northern part of the range (Yunnan). Interestingly, in about half of the hindwings available (7 of 15, right one missing in one of the Mondulkiri), the 2nd primary antenodal is 6th (Fig. 7 a–b); otherwise it is 5th (in both wings of both Stung Treng specimens, the left hindwing of one of the females from Mondulkiri and in the left hindwing of the Koh Kong Province female), and in one case 7th (the left hindwing of the Pursat Province male). On the forewing the 2nd principal antenodal is 5th (Fig. 7 a–b), with two exceptions: in the Pursat Province male it is 6th on the left forewing and in one of the Mondulkiri females it is 4th on the left forewing. An incomplete basal antenodal is present in the forewing (Fig. 5 a–b, 7b), with exception of the Stung Treng female and one of the Mondulkiri females, in which it is absent on both wings. Other characters are mostly shared with other species of the genus Euthygomphus. Measurements (mm): males: forewing 25–26, hindwing 24–25, abdomen without appendages 28–31, total length (with appendages) 39–44, hind femur 7.0–7.3, fore pterostigma 2.5–2.7, hind pterostigma 2.9–3.0: females: forewing 25–26, hindwing 24–25, abdomen without appendages 28–31, total length (with appendages) 39–44, hind femur 7.0–7.4, fore pterostigma 3.2–3.3, hind pterostigma 3.4–3.5. Antenodals: 13–16 on forewing, 9–11 on hindwing; postnodals: 9–11 on both wings.Published as part of Kosterin, Oleg E., 2016, Reconsideration of the genera Merogomphus Martin, 1904, and Anisogomphus Selys, 1857, including erection of a new genus, with a new species and discussion of additional specimens from Cambodia, pp. 51-76 in Zootaxa 4171 (1) on pages 62-68, DOI: 10.11646/zootaxa.4171.1.2, http://zenodo.org/record/26168
