Effects of Managed Care on the Professional Autonomy of Board Certified Physical Therapy Specialist\u27s Practice

Purpose: Identify perceptions of professional autonomy of Board Certified Physical Therapy Specialists (BCPTS) who practiced in managed care environments. Guiding questions: Do BCPTS perceive an increase in professional autonomy as a specialist than as a generalist? How do the perceptions of professional autonomy vary among each specialization? What variables affect perceptions of professional autonomy among BCPTS? Method: Two-hundred BCPTS throughout the country were randomly chosen as participants. One-hundred-eight respondents were used as subjects. Data analysis: Frequency distributions and Pearson\u27s correlation coefficient statistic were utilized. Results: Majority of respondents reported no increase in professional autonomy as a specialist. Greater than three-quarters of the respondents reported a decrease in professional autonomy such as clinical decisions were overriden by decisions of insurance companies . Correlational analysis revealed that percent of patients covered by managed care insurance had a major influence upon how respondents practiced and perceived their professional autonomy. Conclusion: While there were reported differences in perceptions of professional autonomy among each specialization, there was an overall perceived decrease of professional autonomy due to managed care

Towards Constructive Hybrid Semantics

With hybrid systems becoming ever more pervasive, the underlying semantic challenges emerge in their entirety. The need for principled semantic foundations has been recognized previously in the case of discrete computation and discrete data, with subsequent implementations in programming languages and proof assistants. Hybrid systems, contrastingly, do not directly fit into the classical semantic paradigms due to the presence of quite specific "non-programmable" features, such as Zeno behaviour and the inherent indispensable reliance on a notion of continuous time. Here, we analyze the phenomenon of hybrid semantics from a constructive viewpoint. In doing so, we propose a monad-based semantics, generic over a given ordered monoid representing the time domain, hence abstracting from the monoid of constructive reals. We implement our construction as a higher inductive-inductive type in the recent cubical extension of the Agda proof assistant, significantly using state-of-the-art advances of homotopy type theory. We show that classically, i.e. under the axiom of choice, our construction admits a charaterization in terms of directed sequence completion

Bone Marrow Colony-Formation In Vitro After Infection of Genetically Defined Inbred Mice with Candida Albicans

The effect of C. albicans infection on the production of haematopoietic precursor cells in the bone marrow of CBA/CaH and BALB/c mice was evaluated by assay of colony formation in vitro. In immunocompetent mice, neither systemic nor oral infection induced significant alterations in colony formation by bone marrow from the two mouse strains, and Candida infection did not alter the proportion of morphological cell types in the colonies. However, the number of neutrophil-like was relatively greater in colonies derived from acutely infected CBA/CaH nude mice than in those from BALB/c nude mice, whereas small mononuclear cells were present in higher proportions in the latter strain. In both strains of nude mice, there was an increase in colony formation at 6 days after oral infection, but at 8 weeks, when the infection had become chronic, the production of bone marrow cells by CBA/CaH nude mice was significantly less than that by BALB/c nude mice. Reconstitution of nude mice with syngeneic lymphocytes enhanced the production of bone marrow precursor cells by BALB/c, but not by CBA/CaH mice, suggesting that T cells can enhance host resistance by promoting the colony-forming response of the bone marrow in BALB/c mice that are genetically resistant to tissue damage, but not in CBA/CaH that are prone to severe lesions. Finally, culture with Candida antigen in vitro decreased the number of colony-forming cells in cultures from CBA/CaH, but not from BALB/c mice

Avaliação da influência do acoplamento de risers no movimento de jogo de um FPSO

This work presents a comparison between the coupled and uncoupled formulations for computational simulation and analysis of the roll motions of an FPSO attached to a set of flexible risers in a deep-water scenario. The evaluation of the motions of the hull and the structural dynamic behavior of the subsea lines are usually made in different steps of the design, so that the dynamic interaction between the two physical domains is rarely considered. Descriptions of the analysis methodologies and the theories associated to the physical phenomena are included. In this study, a set of simulations using regular and irregular waves were performed to quantify this interaction. Besides the variation in the roll motions due to the coupling effects, the influence in the top tensions of a few selected risers is also investigated. The results show significant reductions in both parameters studied, leading to the conclusion that coupling effects can be relevant to the riser design.Este trabalho apresenta uma comparação entre as formulações acoplada e desacoplada para simulação computacional e análise dos movimentos de jogo de um FPSO em águas profundas acoplado a um conjunto de risers flexíveis. Tradicionalmente, as avaliações dos movimentos do casco e do comportamento dinâmico estrutural das linhas submarinas são feitas em etapas distintas do projeto, de modo que a interação dinâmica entre os dois domínios físicos raramente é plenamente contemplada. Descrições das metodologias de análise e das teorias que regimentam os principais fenômenos envolvidos estão incluídas. Neste estudo, um conjunto de simulações utilizando ondas regulares e irregulares foram realizadas com o objetivo de quantificar tal interação. Além da variação no movimento de jogo devido aos efeitos do acoplamento, a influência na tração de topo de algumas linhas selecionadas também foi investigada. Os resultados apontam reduções bastante significativas em ambos os parâmetros, conduzindo à conclusão de que os efeitos associados ao acoplamento podem ser relevantes para o projeto

The inclusion of complementary medicine in Australian nursing and midwifery courses : a survey pre-test

University of Technology Sydney. Graduate School of Health.Complementary medicine (CM) is a health service that is highly accessed by the public and evidence of the prevalence of CM use has grown over the last two decades. CM use by the choice of individuals under the care of conventional healthcare professionals, such as midwives and nurses, is increasing due to the general acceptance of CM use. Existing competency standards underpin the accreditation process for nurses and midwives and ensure these practicing professionals can better navigate patient choices and understand the implications of their patients accessing a variety of health services. These standards allude to the need for nurses and midwives to be familiar with and able to competently practice in a healthcare landscape that is characterised by high CM use. Despite this, there has been insufficient study of conventional healthcare courses (CHC) in nursing and midwifery or of key decision-makers in nursing and midwifery teaching programs to explore the current inclusion of CM in course offerings. This study aimed to develop a quantitative tool to investigate CM content inclusion in Australian nursing and midwifery courses, to be mapped

Paleoproteomics explained to youngsters: how did the wedding of two-dimensional electrophoresis and protein sequencing spark proteomics on: Let there be light.

International audience: Taking the opportunity of the 20th anniversary of the word "proteomics", this young adult age is a good time to remember how proteomics came from enormous progress in protein separation and protein microanalysis techniques, and from the conjugation of these advances into a high performance and streamlined working setup. However, in the history of the almost three decades that encompass the first attempts to perform large scale analysis of proteins to the current high throughput proteomics that we can enjoy now, it is also interesting to underline and to recall how difficult the first decade was. Indeed when the word was cast, the battle was already won. This recollection is mostly devoted to the almost forgotten period where proteomics was being conceived and put to birth, as this collective scientific work will never appear when searched through the keyword "proteomics". BIOLOGICAL SIGNIFICANCE: The significance of this manuscript is to recall and review the two decades that separated the first attempts of performing large scale analysis of proteins from the solid technical corpus that existed when the word "proteomics" was coined twenty years ago. This recollection is made within the scientific historical context of this decade, which also saw the blossoming of DNA cloning and sequencing. This article is part of a Special Issue entitled: 20 years of Proteomics in memory of Viatliano Pallini. Guest Editors: Luca Bini , Juan J. Calvete, Natacha Turck, Denis Hochstrasser and Jean-Charles Sanchez