May 22, 2013 ? New research from Brigham and Women's Hospital (BWH) finds that a genetic risk factor for pulmonary fibrosis, an uncommon but deadly lung disease, may be effective in identifying individuals at risk for this disease.
These findings will be presented at the American Thoracic Society International Conference and publish online simultaneously at the New England Journal of Medicine on May 22 and will appear in the July 4, 2013 print edition.
"While this variant of the MUC5B gene is fairly common, pulmonary fibrosis is not. Our findings suggest that pulmonary fibrosis may be a part of a much more common, but likely less severe, syndrome and could potentially be predicted on the basis of the MUC5B genetic variant," said Gary M. Hunninghake, MD, MPH, a physician researcher in the pulmonary and critical care division at BWH and co-corresponding author of the research paper. "While too early to tell how important this variant may be in clinical practice, this finding could open new research avenues into this disease."
Researchers looked at a common variant of the gene for mucin-5B, a protein that is a component of the mucous produced by the bronchial tubes associated with associated with pulmonary fibrosis. Their goal was to determine whether this common gene variant was also associated with interstitial lung disease in the general population. To do this, researchers reviewed CT scans of more than 2,600 adults who did not have a clinical diagnosis of pulmonary fibrosis. Researchers found imaging evidence of interstitial lung abnormalities (lung inflammation and scarring) in about 9 percent of those over age 50. In this age group, these abnormal findings were significantly more common among the 19 percent of people with the MUC5B genetic variant. While these abnormalities do not necessarily indicate a disease that will progress, the presence of these abnormalities was associated with more shortness of breath and cough as well as smaller lung sizes and ability to transfer oxygen.
"Our findings provide important insights into the pulmonary effects of a common genetic variant in the general population, and they also suggest that the clinical condition pulmonary fibrosis may be part of the broader spectrum of abnormalities that includes more subtle and asymptomatic findings," said George O'Connor, MD, professor of medicine at Boston University School of Medicine, director of lung research at the Framingham Heart Study, and a senior collaborator in this study.
Future research efforts will focus on identifying which people with imaging abnormalities are at greatest risk for progression to pulmonary fibrosis, and reciprocally, why some people "at-risk" for pulmonary fibrosis do not develop a clinical disease. The authors believe that this work may eventually pave the way for efforts aimed at preventing pulmonary fibrosis.
Japan finance minister reluctant to cut corporate tax
Jiji Press -- May 21
Japanese Finance Minister Taro Aso expressed his reluctance Tuesday to meet the business community's request for a cut in corporate taxes. "Tax cut demands by companies that do not currently pay taxes are little convincing," Aso said at a press conference after the day's cabinet meeting.
About 1.86 million of all 2.57 million companies in Japan in fiscal 2011 were in the red and thus exempted from corporate tax payments, according to the Finance Ministry.
I am about to launch a new online business and need the help of a lawyer who specialises in online businesses to review my draft Ts and Cs and privacy statement and make any necessary changes.
The new Kinect is kind of awesome. Just by the numbers, it's a huge upgrade. You can see (most of) the full walkthrough we saw just a bit ago here at Microsoft's Redmond campus in the video above. Parts are jaw-dropping.
The demo is of a live action Kinect unit, which will be included with the new Xbox One. Right from the start, you can see the improved depth sensor. It's three times as sensitive, and can pick out bits as small as your t-shirt wrinkling or adjusting on your chest. The 60-degree-larger field of view helps here as well (up to six people can be on screen at once), and it has a deeper field of (accurate view, too).
And oh man, the IR sensing. It's seeing in a pitch black room! That is, like, totally absurd. And should be cool for using the Kinect at night, or for horror games, where you don't want to play in a well-lit room. Or just, you know, watching any movie ever.
The new 1080p cameras are a wide field of view, which we saw in greater detail during the Skype demo with four chat partners, and looks great, but no one's too concerned about that.
The truly impressive stuff, though, comes from the brains of the Kinect. Its improved skeleton mapping is crazy accurate, and can track your individual hand motions and shoulder shrugs. The muscle tracker is also borderline ridiculous. It can tell what parts of your body have pressure on them. It knows where you're putting your weight as you lean side to side, and how much power goes into each motion, by tracking speed. It knows if you lob a slow fake punch, and it knows if you slice a fast uppercut through the air, and shows you with popping white circles around your fists or feet or head. Orientation tracking is cool as well, and will apply more to how your character moves around in games.
The heart rate monitor, which reads your heart rate just by freaking LOOKING AT YOU, seems pretty accurate, but we obviously weren't able to test against an actual heart monitor. Still, do you see this, guys, seriously this is a thing that will be in living rooms. It's very cool.
The face recognition recognizes you, personally, and can tell if you're "engaged" or not engaged, meaning if you say "Xbox pause" while not looking at the TV, it won't listen to you. This seems like something you'd maybe want to turn off, but it's still impressive it can read your expression and know if you're happy, sad, or bored.
Kinect 2 doesn't just see you, though; it can hear you too. In fact, it can hear your voice, specifically, through whatever ambient game and/or movie noise that's going on around you. Want to give a command in the middle of a particularly loud concert video or melee? You don't have to shout for Kinect 2 to listen and comply.
Calling this feature set impressive is an undersell. It's breakthrough technology on many levels, with applications far beyond watching content or playing games. It's the future, and we all get to see it today.
May 21, 2013 ? Bacteria resistant to the antibiotic colistin are also commonly resistant to antimicrobial substances made by the human body, according to a study in mBio?, the online open-access journal of the American Society for Microbiology. Cross-resistance to colistin and host antimicrobials LL-37 and lysozyme, which help defend the body against bacterial attack, could mean that patients with life-threatening multi-drug resistant infections are also saddled with a crippled immune response. Colistin is a last-line drug for treating several kinds of drug-resistant infections, but colistin resistance and the drug's newfound impacts on bacterial resistance to immune attack underscore the need for newer, better antibiotics.
Corresponding author David Weiss of Emory University says the results show that colistin therapy can fail patients in two ways. "The way that the bacteria become resistant [to colistin] allows them to also become resistant to the antimicrobials made by our immune system. That is definitely not what doctors want to do when they're treating patients with this last line antibiotic," says Weiss.
Although it was developed fifty years ago, colistin remains in use today not so much because it's particularly safe or effective, but because the choices for treating multi-drug resistant Acinetobacter baumannii and other resistant infections are few and dwindling. Colistin is used when all or almost all other drugs have failed, often representing a patient's last hope for survival.
Weiss says he and his colleagues noted that colistin works by disrupting the inner and outer membranes that hold Gram-negative bacterial cells together, much the same way two antimicrobials of the human immune system, LL-37 and lysozyme, do. LL-37 is a protein found at sites of inflammation, whereas lysozyme is found in numerous different immune cells and within secretions like tears, breast milk, and mucus, and both are important defenses against invading bacteria. Weiss and his collaborators from Emory, the CDC, Walter Reed Army Institute of Research, and Grady Memorial Hospital in Atlanta set out to find whether resistance to colistin could engender resistance to attack by LL-37 or lysozyme.
Looking at A. baumannii isolates from patients around the country, they noted that all the colistin-resistant strains harbored mutations in pmrB, a regulatory gene that leads to the modification of polysaccharides on the outside of the cell in response to antibiotic exposure. Tests showed a tight correlation between the ability of individual isolates to resist high concentrations of colistin and the ability to resist attacks by LL-37 or lysozyme.
This was very convincing, write the authors, that mutations in the pmrB gene were responsible for cross-resistance to LL-37 and lysozyme, but to get closer to a causative link between treatment and cross-resistance, they studied two pairs of A. baumannii isolates taken from two different patients before and after they were treated for three or six weeks with colistin. The results helped confirm the cross-resistance link: neither strain taken before treatment was resistant to colistin, LL-37, or lysozyme, but the strains taken after treatment showed significant resistance to colistin and lysozyme. (One post-colistin isolate was no more or less resistant to LL-37 than its paired pre-colistin isolate.) Like the resistant strains tested earlier, both post-colistin isolates harbored crucial mutations in the pmrB gene that apparently bestow the ability to resist treatment.
The authors point out that the apparent link between resistance to colistin and cross-resistance to antimicrobial agents of the immune system could well extend to other pathogens that are treated with colistin, including Pseudomonas aeruginosa and Klebsiella pneumoniae. Weiss says he plans to follow up with studies to determine whether this bears out.
For Weiss, the problems with colistin are symptomatic of a much larger trio of problems: increasing levels of drug resistance, cuts in federal funding for antibiotic research, and lack of incentives for pharmaceutical companies to invest in antibiotic R&D. "We don't have enough antibiotics, and it's really important for the research community and the public to support increases in funding for research to develop new antibiotics," says Weiss.
"We got complacent for a while and the bugs are becoming resistant. This is something we can reverse -- or make a lot better -- if we have the resources."
MCW Energy Group (TSX VENTURE:MCW), a Canadian holding company involved in fuel distribution and the creation of oil sands extraction technology, today announced the appointment of Richard S. Rawdin, CPA, as Chief Financial Officer of the MCW Energy Group.
Mr. Rawdin will take over the position serving both divisions of MCW, MCW Fuels and MCW Oil Sands Recovery, LLC. during the month of June, 2013. He was formerly the Chief Financial Officer of Dalbo Holdings Inc., a Utah-based company providing services in the oil and gas industry, where he managed the Accounting/Financial Departments of Dalbo and its subsidiaries. He was a key member of Dalbo's management team which developed and implemented Dalbo's overall corporate strategies. He has an impressive track record of success in all facets of management, accounting, finance, operations and organic EBITDA growth. Mr. Rawdin has focused on strategic planning, business development, financial modelling, custom operating metrics design, corporate finance, mergers and acquisitions. He has been involved in debt financings and restructurings totalling over $1 billion. Mr. Rawdin has a BS Degree in Accounting/Business from the University of Utah.
"We are very impressed with Mr. Rawdin's credentials, not only by his financial background, but also his extensive oil and gas industry experience," stated Alexander Blyumkin, Chairman of the Board of MCW Energy Group. He added, "He will also be an asset to the MCW Team with his intimate knowledge of Utah's vast resources throughout the state, including the Uintah Basin." MCW Energy Group has accepted the resignation of Mr. Warren Dillard as the CFO of MCW and thanks him for his contributions to MCW during its formative years in transforming into a vertically?integrated energy company.
This article is for information and discussion purposes only and does not form a recommendation
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WASHINGTON (AP) ? The Supreme Court says a woman can seek lawyers' fees from the government even though her lawsuit over damage she said was caused by a vaccine was ruled untimely.
The high court on Monday ruled for Melissa Cloer, who wanted lawyers' fees for her lawsuit over damage she says was caused by hepatitis B vaccines. Shortly after finishing the vaccine, she started having symptoms of what was later diagnosed as multiple sclerosis. Cloer sued, but courts said her lawsuit was too late.
Cloer then filed for more than $118,000 in lawyers' fees, but government officials said she shouldn't get anything.
The justices disagreed, with Justice Sonia Sotomayor writing that even unsuccessful petitions under the National Childhood Vaccine Injury Act can get attorneys' fees if they are "brought in good faith and (for which) there was a reasonable basis."
AHRQ-funded journal supplement offers lessons on primary care practice transformationPublic release date: 20-May-2013 [ | E-mail | Share ]
Contact: Angela Sharma asharma@aafp.org 913-269-2269 American Academy of Family Physicians
Findings provide practices with a roadmap on how to achieve transformation
LEAWOOD, Kan. Primary care practice transformation on a large scale is the cornerstone of current health care reform efforts aimed at achieving better outcomes, better value and better experience of care. Amid emerging evidence that transformation toward the patient-centered medical home model offers a viable solution in today's health care environment, the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality funded 14 studies to learn more about the processes and determinants of successful change from practices that had already demonstrated successful transformational activities and improved outcomes. Key findings of these 14 projects, which the funders hope will inform more widespread change efforts, are published in a special supplement of Annals of Family Medicine.
The supplement, Transforming Primary Care Practice, features insights from 14 natural experiments undertaken in a wide variety of settings across the United States including independent practices, integrated delivery systems, community health centers and large government systems. The projects, which were funded by AHRQ grants awarded in 2010 totaling more than $4.1 million each year for two years, begin to identify the approaches and methods for transforming the structure, characteristics and function of primary care that are likely to be successful in a wide variety of practice types and settings.
"The lessons learned from these analyses demonstrate that true transformation toward the patient-centered medical home model is not only possible, but desirable, although not without its challenges," writes Robert J. McNellis, MPH, PA, AHRQ [insert title] and colleagues, in a commentary about the lessons learned that cut across all the projects.
In the editorial, McNellis and colleagues outline five overarching thematic findings that emerged from the projects despite the wide variety of practices studied, geographic locations, sizes, structures and motivations:
1) A strong foundation is needed for successful redesign. Existing baseline capabilities of a practice are important determinants of successful transformation. Practices must accurately assess their readiness for change and their ability to handle the change process before undertaking substantive change.
2) The process of transformation can be a long and difficult journey. The process of transforming is complex, challenging and ambitious. It takes time and is constantly evolving. Progress is a process that ebbs and flows, and practices should prepare for a taxing journey.
3) The approaches to transformation vary. The ingredients of a successful change process vary, but a few key elements seen across the projects include: integration of more team-based care, expanded access to care, use of measurement and feedback tools and the use of learning collaboratives to facilitate team communication.
4) Visionary leadership and a supportive culture ease the way for change. Having strong internal change drivers is an important facilitator of successful transformation. The two internal drivers seen to have the most influence on change were leadership and culture.
5) Contextual factors are inextricably linked to outcome. The context within which transformation occurred is critical to understanding a practice's success.
In addition to the overarching findings above, the articles raise several potential cautions, including the difficulty of measuring the financial impact of transformation on a practice. Overall, the teams found it was very difficult to understand the ultimate impact of transformation on the bottom line of the practices. Additionally, many investigators noted a difference between a true PCMH and external recognition as one, concluding that a practice could be a true PCMH without having received recognition, and a practice that has received PCMH recognition may not be a true PCMH. They warn that the journey to recognition, in contrast to true transformation, can create a culture of "box checking" rather than making the deep changes necessary to become truly patient-centered.
"Annals is excited to publish these important findings, and we hope they will inform efforts to improve health care systems' ability to support changes to improve the effectiveness and sustainability of primary care practices to better meet patient needs across the country," said Kurt Stange, MD, PhD, Annals of Family Medicine editor and corresponding author of a supplement article on the importance of reporting contextual factors. "We especially hope the grantees' innovative reporting of relevant contextual factors information critical to understanding what happened and why in the studies will help other practices as they attempt to transport these findings to their unique settings and circumstances."
"Few practices realize or are prepared to make the substantive changes necessary for true transformation. However, this research demonstrates that change is possible even in the face of payment systems that do not yet adequately support transformative efforts within a deeply fragemented health care system," McNellis concludes. "Research like that presented in this supplement can serve as a roadmap, if not a how-to manual on achieving transformation."
Supplement articles include:
Lessons Learned from the Study of Primary Care Transformation Robert J. McNellis, MPH, PA, et al
This editorial summarizes the interventions studied by the 14 grantees and synthesizes the major findings and lessons learned about the process of transforming.
Support and Strategies for Change Among Small Patient-Centered Medical Home Practices Sarah Hudson Scholle, MPH, DrPH, et al
Financial support, practical training, and other help are important in spreading the adoption of the PCMH model among small practices.
Recognition as a Patient-Centered Medical Home: Fundamental or Incidental?
Daniel Dohan, PhD, et al
Becoming patient centered and seeking NCQA recognition as a PCMH run along separate but parallel tracks in this case study.
Spreading a Medical Home Redesign: Effects on Emergency Department Use and Hospital Admissions
Robert J. Reid, MD, PhD, et al
It is possible to reduce emergency department use with PCMH transformation across a diverse set of clinics using a clear change strategy and sufficient resources and supports.
Facilitators of Transforming Primary Care: A Look Under the Hood at Practice Leadership
Katrina E. Donahue, MD, MPH, et al
Certain aspects of leadership help move practices forward in primary care transformation, including setting strategic direction and implementation.
Cultivating Engaged Leadership Through a Learning Collaborative: Lessons from Primary Care Renewal in Oregon Safety Net Clinics
Carmit K. McMullen, PhD, et al
A group of safety net organizations cultivates engaged leadership with scarce resources by partnering with organizational leaders in design of transformation efforts, sharing lessons and overcoming implementation hurdles.
Process and Outcomes of Patient-Centered Medical Care With Alaska Native People at Southcentral Foundation: Findings From a Mixed
Methods Evaluation
David L. Driscoll, PhD, MPH, MA, et al
In this study of a tribally owned and managed primary care system, all reported measures of emergency care use showed a decreasing trend after PCMH implementation.
Quality, Satisfaction and Financial Efficiency Associated With Elements of Primary Care Practice Transformation: Preliminary Findings
Julie Day, MD, et al
A study of multiple outcomes in a redesigned model of care underscores the importance of team-based-care and continuity of care.
Contrasting Trajectories of Change in Primary Care Clinics: Lessons From New Orleans Safety Net
Diane R. Rittenhouse, MD, MPH, et al
The PCMH model can successfully address the needs of safety-net populations, particularly with the support of stable, committed leadership and deep community ties.
Becoming a Patient-Centered Medical Home: A 9-Year Transition for a Network of Federally Qualified Health Centers
Neil S. Calman, MD, et al
This study, set in a large FQHC network serving a diverse population, reports on complex system change, including its component parts and the processes by which it was facilitated.
Assessment and Measurement of Patient-Centered Medical Home Implementation: The BCBSM Experience
Jeffrey A. Alexander, PhD, et al
Approaches to PCMH measurement should be driven by the intended uses and users of the measure.
Patient-Centered Medical Home Among Small Urban Practices Serving Low-Income and Disadvantaged Patients
Carolyn A. Berry, PhD, et al
Small practices can achieve important aspects of the PCMH model of primary care, often with informal rather than formal mechanisms and strategies.
Medical Home Transformation in Pediatric Primary CareWhat Drives Change?
Jeanne W. McAllister, MHA, et al
In pediatric primary care practices, medical home transformation requires continuous development, ongoing quality improvement, family partnership skills, teamwork and strong care coordination.
A Positive Deviance Approach to Understanding Key Features to Improving Diabetes Care in the Medical Home
Robert A. Gabbay, MD, PhD, et al
Key factors in primary care practices' performance improvement during medical home transformation include baseline structural capabilities and ability to buffer the stresses of change.
Medical Home Transformation: A Gradual Process and a Continuum of Attainment
Leif I. Solberg, MD, et al
Medical homes are not similar, change in outcomes is slow, and transformation occurs on a continuum.
Context Matters: The Experience of 14 Research Teams in Systematically Reporting Contextual Factors Important for Practice Change
Andrada Tomoaia-Cotisel, MPH, MHA, et al
This study offers a feasible, systematic approach for research teams to identify and convey contextual factors for understanding and transporting findings from health care research.
###
Annals of Family Medicine is a peer-reviewed, indexed research journal that provides a cross-disciplinary forum for new, evidence-based information affecting the primary care disciplines. Launched in May 2003, Annals is sponsored by seven family medical organizations, including the American Academy of Family Physicians, the American Board of Family Medicine, the Society of Teachers of Family Medicine, the Association of Departments of Family Medicine, the Association of Family Medicine Residency Directors, the North American Primary Care Research Group, and the College of Family Physicians of Canada. Annals is published six times each year and contains original research from the clinical, biomedical, social and health services areas, as well as contributions on methodology and theory, selected reviews, essays and editorials. Complete editorial content and interactive discussion groups for each published article, including those in the supplement, can be accessed free of charge on the journal's website, http://www.annfammed.org.
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AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
AHRQ-funded journal supplement offers lessons on primary care practice transformationPublic release date: 20-May-2013 [ | E-mail | Share ]
Contact: Angela Sharma asharma@aafp.org 913-269-2269 American Academy of Family Physicians
Findings provide practices with a roadmap on how to achieve transformation
LEAWOOD, Kan. Primary care practice transformation on a large scale is the cornerstone of current health care reform efforts aimed at achieving better outcomes, better value and better experience of care. Amid emerging evidence that transformation toward the patient-centered medical home model offers a viable solution in today's health care environment, the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality funded 14 studies to learn more about the processes and determinants of successful change from practices that had already demonstrated successful transformational activities and improved outcomes. Key findings of these 14 projects, which the funders hope will inform more widespread change efforts, are published in a special supplement of Annals of Family Medicine.
The supplement, Transforming Primary Care Practice, features insights from 14 natural experiments undertaken in a wide variety of settings across the United States including independent practices, integrated delivery systems, community health centers and large government systems. The projects, which were funded by AHRQ grants awarded in 2010 totaling more than $4.1 million each year for two years, begin to identify the approaches and methods for transforming the structure, characteristics and function of primary care that are likely to be successful in a wide variety of practice types and settings.
"The lessons learned from these analyses demonstrate that true transformation toward the patient-centered medical home model is not only possible, but desirable, although not without its challenges," writes Robert J. McNellis, MPH, PA, AHRQ [insert title] and colleagues, in a commentary about the lessons learned that cut across all the projects.
In the editorial, McNellis and colleagues outline five overarching thematic findings that emerged from the projects despite the wide variety of practices studied, geographic locations, sizes, structures and motivations:
1) A strong foundation is needed for successful redesign. Existing baseline capabilities of a practice are important determinants of successful transformation. Practices must accurately assess their readiness for change and their ability to handle the change process before undertaking substantive change.
2) The process of transformation can be a long and difficult journey. The process of transforming is complex, challenging and ambitious. It takes time and is constantly evolving. Progress is a process that ebbs and flows, and practices should prepare for a taxing journey.
3) The approaches to transformation vary. The ingredients of a successful change process vary, but a few key elements seen across the projects include: integration of more team-based care, expanded access to care, use of measurement and feedback tools and the use of learning collaboratives to facilitate team communication.
4) Visionary leadership and a supportive culture ease the way for change. Having strong internal change drivers is an important facilitator of successful transformation. The two internal drivers seen to have the most influence on change were leadership and culture.
5) Contextual factors are inextricably linked to outcome. The context within which transformation occurred is critical to understanding a practice's success.
In addition to the overarching findings above, the articles raise several potential cautions, including the difficulty of measuring the financial impact of transformation on a practice. Overall, the teams found it was very difficult to understand the ultimate impact of transformation on the bottom line of the practices. Additionally, many investigators noted a difference between a true PCMH and external recognition as one, concluding that a practice could be a true PCMH without having received recognition, and a practice that has received PCMH recognition may not be a true PCMH. They warn that the journey to recognition, in contrast to true transformation, can create a culture of "box checking" rather than making the deep changes necessary to become truly patient-centered.
"Annals is excited to publish these important findings, and we hope they will inform efforts to improve health care systems' ability to support changes to improve the effectiveness and sustainability of primary care practices to better meet patient needs across the country," said Kurt Stange, MD, PhD, Annals of Family Medicine editor and corresponding author of a supplement article on the importance of reporting contextual factors. "We especially hope the grantees' innovative reporting of relevant contextual factors information critical to understanding what happened and why in the studies will help other practices as they attempt to transport these findings to their unique settings and circumstances."
"Few practices realize or are prepared to make the substantive changes necessary for true transformation. However, this research demonstrates that change is possible even in the face of payment systems that do not yet adequately support transformative efforts within a deeply fragemented health care system," McNellis concludes. "Research like that presented in this supplement can serve as a roadmap, if not a how-to manual on achieving transformation."
Supplement articles include:
Lessons Learned from the Study of Primary Care Transformation Robert J. McNellis, MPH, PA, et al
This editorial summarizes the interventions studied by the 14 grantees and synthesizes the major findings and lessons learned about the process of transforming.
Support and Strategies for Change Among Small Patient-Centered Medical Home Practices Sarah Hudson Scholle, MPH, DrPH, et al
Financial support, practical training, and other help are important in spreading the adoption of the PCMH model among small practices.
Recognition as a Patient-Centered Medical Home: Fundamental or Incidental?
Daniel Dohan, PhD, et al
Becoming patient centered and seeking NCQA recognition as a PCMH run along separate but parallel tracks in this case study.
Spreading a Medical Home Redesign: Effects on Emergency Department Use and Hospital Admissions
Robert J. Reid, MD, PhD, et al
It is possible to reduce emergency department use with PCMH transformation across a diverse set of clinics using a clear change strategy and sufficient resources and supports.
Facilitators of Transforming Primary Care: A Look Under the Hood at Practice Leadership
Katrina E. Donahue, MD, MPH, et al
Certain aspects of leadership help move practices forward in primary care transformation, including setting strategic direction and implementation.
Cultivating Engaged Leadership Through a Learning Collaborative: Lessons from Primary Care Renewal in Oregon Safety Net Clinics
Carmit K. McMullen, PhD, et al
A group of safety net organizations cultivates engaged leadership with scarce resources by partnering with organizational leaders in design of transformation efforts, sharing lessons and overcoming implementation hurdles.
Process and Outcomes of Patient-Centered Medical Care With Alaska Native People at Southcentral Foundation: Findings From a Mixed
Methods Evaluation
David L. Driscoll, PhD, MPH, MA, et al
In this study of a tribally owned and managed primary care system, all reported measures of emergency care use showed a decreasing trend after PCMH implementation.
Quality, Satisfaction and Financial Efficiency Associated With Elements of Primary Care Practice Transformation: Preliminary Findings
Julie Day, MD, et al
A study of multiple outcomes in a redesigned model of care underscores the importance of team-based-care and continuity of care.
Contrasting Trajectories of Change in Primary Care Clinics: Lessons From New Orleans Safety Net
Diane R. Rittenhouse, MD, MPH, et al
The PCMH model can successfully address the needs of safety-net populations, particularly with the support of stable, committed leadership and deep community ties.
Becoming a Patient-Centered Medical Home: A 9-Year Transition for a Network of Federally Qualified Health Centers
Neil S. Calman, MD, et al
This study, set in a large FQHC network serving a diverse population, reports on complex system change, including its component parts and the processes by which it was facilitated.
Assessment and Measurement of Patient-Centered Medical Home Implementation: The BCBSM Experience
Jeffrey A. Alexander, PhD, et al
Approaches to PCMH measurement should be driven by the intended uses and users of the measure.
Patient-Centered Medical Home Among Small Urban Practices Serving Low-Income and Disadvantaged Patients
Carolyn A. Berry, PhD, et al
Small practices can achieve important aspects of the PCMH model of primary care, often with informal rather than formal mechanisms and strategies.
Medical Home Transformation in Pediatric Primary CareWhat Drives Change?
Jeanne W. McAllister, MHA, et al
In pediatric primary care practices, medical home transformation requires continuous development, ongoing quality improvement, family partnership skills, teamwork and strong care coordination.
A Positive Deviance Approach to Understanding Key Features to Improving Diabetes Care in the Medical Home
Robert A. Gabbay, MD, PhD, et al
Key factors in primary care practices' performance improvement during medical home transformation include baseline structural capabilities and ability to buffer the stresses of change.
Medical Home Transformation: A Gradual Process and a Continuum of Attainment
Leif I. Solberg, MD, et al
Medical homes are not similar, change in outcomes is slow, and transformation occurs on a continuum.
Context Matters: The Experience of 14 Research Teams in Systematically Reporting Contextual Factors Important for Practice Change
Andrada Tomoaia-Cotisel, MPH, MHA, et al
This study offers a feasible, systematic approach for research teams to identify and convey contextual factors for understanding and transporting findings from health care research.
###
Annals of Family Medicine is a peer-reviewed, indexed research journal that provides a cross-disciplinary forum for new, evidence-based information affecting the primary care disciplines. Launched in May 2003, Annals is sponsored by seven family medical organizations, including the American Academy of Family Physicians, the American Board of Family Medicine, the Society of Teachers of Family Medicine, the Association of Departments of Family Medicine, the Association of Family Medicine Residency Directors, the North American Primary Care Research Group, and the College of Family Physicians of Canada. Annals is published six times each year and contains original research from the clinical, biomedical, social and health services areas, as well as contributions on methodology and theory, selected reviews, essays and editorials. Complete editorial content and interactive discussion groups for each published article, including those in the supplement, can be accessed free of charge on the journal's website, http://www.annfammed.org.
[ | E-mail | Share ]
?
AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
KABUL, Afghanistan (AP) ? Conservative religious lawmakers in Afghanistan blocked legislation on Saturday aimed at strengthening provisions for women's freedoms, arguing that parts of it violate Islamic principles and encourage disobedience.
The fierce opposition highlights how tenuous women's rights remain a dozen years after the ouster of the hard-line Taliban regime, whose strict interpretation of Islam once kept Afghan women virtual prisoners in their homes.
Khalil Ahmad Shaheedzada, a conservative lawmaker for Herat province, said the legislation was withdrawn shortly after being introduced in parliament because of an uproar by religious parties who said parts of the law are un-Islamic.
"Whatever is against Islamic law, we don't even need to speak about it," Shaheedzada said.
The Law on Elimination of Violence Against Women has been in effect since 2009, but only by presidential decree. It is being brought before parliament now because lawmaker Fawzia Kofi, a women's rights activist, wants to cement it with a parliamentary vote to prevent its potential reversal by any future president who might be tempted to repeal it to satisfy hard-line religious parties.
The law criminalizes, among other things, child marriage and forced marriage, and bans "baad," the traditional practice of exchanging girls and women to settle disputes. It makes domestic violence a crime punishable by up to three years in prison and specifies that rape victims should not face criminal charges for fornication or adultery.
Kofi, who plans to run for president in next year's elections, said she was disappointed because among those who oppose upgrading the law from presidential decree to legislation passed by parliament are women.
Afghanistan's parliament has more than 60 female lawmakers, mostly due to constitutional provisions reserving certain seats for women.
There has been spotty enforcement of the law as it stands. A United Nations analysis in late 2011 found only a small percentage of reported crimes against women were pursued by the Afghan government. Between March 2010 and March 2011 ? the first full Afghan year the decree was in effect ? prosecutors filed criminal charges in only 155 cases, or 7 percent of the total number of crimes reported.
The child marriage ban and the idea of protecting female rape victims from prosecution were particularly heated subjects in Saturday's parliamentary debate, said Nasirullah Sadiqizada Neli, a conservative lawmaker from Daykundi province.
Neli suggested that removing the custom ? common in Afghanistan ? of prosecuting raped women for adultery would lead to social chaos, with women freely engaging in extramarital sex safe in the knowledge they could claim rape if caught.
Another lawmaker, Mandavi Abdul Rahmani of Barlkh province, also opposed the law's rape provision.
"Adultery itself is a crime in Islam, whether it is by force or not," Rahmani said.
He said the Quran also makes clear that a husband has a right to beat a disobedient wife as a last resort, as long as she is not permanently harmed. "But in this law," he said, "It says if a man beats his wife at all, he should be jailed for three months to three years."
Lawmaker Shaheedzada also claimed that the law might encourage disobedience among girls and women, saying it reflected Western values not applicable in Afghanistan.
"Even now in Afghanistan, women are running from their husbands. Girls are running from home," Shaheedzada said. "Such laws give them these ideas."
More freedoms for women are one of the most visible ? and symbolic ? changes in Afghanistan since the 2001 U.S.-led campaign that toppled the Taliban regime. While in power, the Taliban imposed a strict interpretation of Islam that put severe curbs on the freedom of women.
For five years, the regime banned women from working and going to school, or even leaving home without a male relative. In public, all women were forced wear a head-to-toe burqa, which covers even the face with a mesh panel. Violators were publicly flogged or executed.
Since the U.S.-led invasion in 2001, women's freedoms have improved vastly, but Afghanistan remains a deeply conservative culture, especially in rural areas.
Saturday's failure of the legislation in parliament reflected the power of religious parties but changed little on the ground, since the decree is still the law of the land, however loosely enforced. Kofi said the parliament decided to send the legislation to committee, and it could come to a vote again later this year.
"We will work on this law," she said. "We will bring it back."
Some activists, however, worry about potential changes to the law. Bringing the legislation before parliament also opened it up to being amended, leaving the possibility that conservatives will seek to weaken it by stripping out provisions they dislike ? or even vote to repeal it.
"There's a real risk this has opened a Pandora's box, that this may have galvanized opposition to this decree by people who in principle oppose greater rights for women," said Heather Barr, a researcher for Human Rights Watch.
That's true for lawmaker Rahmani, who said President Hamid Karzai should never have issued the decree and wants it changed, if not repealed.
"We cannot have an Islamic country with basically Western laws," he said.
___
Associated Press writer Rahim Faiez contributed in Kabul.
This week?s pet post comes from one of my favorite bloggers, Trisha with momdot.com. ?Be sure to check out her cool and very popular blog. ?When I asked her permission to use this funny picture from her website, she wrote me right back and told me that her family has six rescue pets! ?Kudos to them for their kindness and ability to give six lucky animals a loving home. ?Here are several of the pets and when I saw her dog using a cat tree, I just had to make that this week?s pet pic?.
Non only is Trish?s dog is a good friend to her cats, but he is also a good watchdog with his bionic ears.
I just love this funny picture! ?You can see more of Trisha?s pet articles, parenting articles, recipes, giveaways and more at her momdot.com blog ?Thanks for sharing Trish!
This picture reminds us to find some quality play time with our pets this weekend because it is good for them and for us humans. ?Send us your pet pics. ?We love to post them and we have received some great ones so far. ? Click under the Pet Pic section to see the gallery. ?Email you pet pics to [email?protected] and have a great weekend.
Zach Galifianakis warned Brian Williams that viewers would turn off a long interview piece with the actor if it aired on "Rock Center." But after watching several candid minutes with the comedian and "Hangover" star on Friday night, it was hard not to be left wanting more.
Galifianakis, the bearded comic turned reluctant big-time star, opened up to Williams about more than just the buddy-movie trilogy that has made his extended Greek moniker a household name.
They talked about life on the North Carolina farm where Galifianakis, 43, and his wife Quinn Lundberg spend part of each year. "I have donkeys. I have blueberries," Galifianakis said. "But enough about your Brooklyn apartment," Williams countered. "I asked about North Carolina."
NBC News
Cue the whistling: Galifianakis says a 6th grade visit from the man behind the iconic theme song of "The Andy Griffith Show" convinced him he should go into show business. "I remember being affected by that whistler, thinking I could maybe try to do something like that with my life. Not whistling ... but telling diarrhea jokes."
But it's no joke that life at home on the farm has framed Galifianakis' view of Hollywood and all that comes with being a celebrity. "It's not for me. I'm not into that scene," he said. "It's so stupid. It's all so dumb. It's so weird to me."
And for a man with the last name Galifianakis, there's a punchline waiting in the wings. "If I've always wanted to have my name up in lights I would have changed it to Don't Walk." Nod. Wink. Cheers.
Starring roles on television aside, it's the "Hangover" movies which did put Galifianakis' name in lights. Alan -- the portly, man-purse carrying sidekick to Bradley Cooper's Phil and Ed Helms' Stu -- is back in theaters May 23 in the third and final movie.
And any interview with Galifianakis wouldn't be complete without actually being interviewed with ferns for a backdrop, something he's turned into comedic art with his fake Internet talk show "Between Two Ferns."?Williams brought the two ferns to the interview and Galifianakis was game for a lengthy chat among the plants.
"This is the longest conversation I've had with anyone in, like, seven years," Galifianakis said, contradicting his earlier directive to Williams to "do a couple of jokes and then get out."
HARTFORD, Conn. (AP) ? Officials in Gov. Dannel P. Malloy's office say the governor will meet with representatives from the National Transportation Safety Board and Connecticut's two U.S. senators at the site of a Metro-North Railroad crash that injured 70 people.
Sens. Richard Blumenthal and Chris Murphy and other Connecticut officials will also participate in the tour, scheduled for 9:30 a.m. EDT Saturday near Bridgeport. The delegation will update journalists with the latest details of the crash after surveying the area.
Three people remain in critical condition following the rush-hour crash Friday between two commuter trains that serve the northern suburbs of New York City.
Anglers in this year's Winni Derby on Lake Winnipesaukee in New Hampshire will have to pass a lie-detector test before claiming any prizes.
By Tracy Connor, Staff Writer, NBC News
There will be no fish stories at this year's Winni Derby in New Hampshire.
Organizers of the annual landlocked salmon-fishing contest will force the winner to take a polygraph exam to ensure the grand-prize specimen isn't imported from another lake or caught earlier.
"It's something that's always been in our rules, but it was never done before," derby chair Diane LaBrie said Thursday, the eve of the three-day competition.
She said no one has been caught cheating, but "there's a lot of rumors."
"People talk. Fish and Game hears things. We just feel it's necessary to do."
The derby costs $40 to enter and the grand prize is $12,500. The rules say that the salmon and lake trout must be caught on Lake Winnipesaukee in central New Hampshire.
LaBrie said over-eager anglers could be tempted to take their boats out on smaller lakes that might have bigger salmon because they're less fished and then bring them to the derby weigh station.
It's even possible someone could land a big fish before the derby and then keep it alive until the weigh-in.
So to make sure the scales of justice are not compromised, this year's winner will have to submit to a lie-detector exam within a week, as first reported by the New Hampshire Union Leader. If they flunk, the title will be stripped.
Last year's top winner weighed 5.4 pounds and was almost 25 inches long.
Please welcome to my blog Kristi Carter, co-author of the wonderful book?Guerrilla Marketing to Baby Boomers. She has some wonderful tips, so be sure to check out her book AND enter to win a copy! To be entered, simply leave a comment on this post with your name and email address. I?ll announce the winner next Friday!
In my book I show how large and small businesses can optimize their marketing effort to the targeted audience of baby boomers. I teamed up with Jay Conrad Levinson, the father and originator of Guerrilla Marketing, on this book. It was a joy and an honor to work with him. Many businesses are realizing that baby boomers are buying for three generations; their children, themselves and their aging parents. The baby boomers are the biggest sector of consumers with disposable income, and they demand high standards in the products they purchase. Baby boomers have a consciousness that past generations were not as concerned about. Boomers have actually helped our society raise the bar for more sustainable items and environmentally sound products. They care about the world around them and what they will be leaving as a legacy to their children. In Guerrilla Marketing to Baby Boomers, I discuss the boomers? perception of the world. It is crucial for marketers to use the right language and method to activate interest in their prospects? mind. It is important to know that boomers are changing the world for a better and simpler place.
In my book I show several marketing methods that help simplify our marketing plans ranging from using social media to delegating certain tasks to professional services such as Odesk. Working efficiently is the key here. For the entrepreneur, my book shows how to set up and use autoresponders, viral marketing, and landing pages to drive traffic to their product or services. More and more people are preferring the ?work at home online? model of business so they can spend more time at home with their families. This book speaks to them and points the way. Family values and time freedom are the buzzwords that so many entrepreneurs use to propel themselves onto great success both personally and professionally as they work at home online.
In this book you will learn:
* The basic principles of marketing online * How to get an audience of people begging to buy your product * Why and what baby boomers are buying * How to automate your business so you can spend more time with the family * The importance and influence of social media * Secrets that baby boomers don?t want you to know * Developing and sustaining your marketing plan
There are resources throughout each paragraph of the book to educate and help marketers reach their goals. In chapter seven, ?Secrets for Selecting the Best Marketing Methods,? there are links to demographic studies, e-media, and info-media. If you have the Kindle version, you can simply click and go to that link immediately. Plus there is a number of case scenarios that shows the cost and time frame for running ads in the Yellow Pages, television ads, and radio ads. This book provides 150 ways to reach your audience through mini and maxi marketing methods. Chapter nineteen disusses using Skymall as a resource to promote your business. The later chapters show how to put all of these methods into action. This book is a hands-on marketing tool that is up-to-date with the current methods of marketing online and offline. Using a few different marketing methods, both online and offline, will your heighten your exposure to the baby boomer customer. I wish you all much success, happiness, and lots of family time.
You can purchase the book, Guerrilla Marketing to Baby Boomers, by clicking here. You can also contact me by emailing?kristiacarter@gmail. Or visit me on Facebook here and here.
BEIJING (Reuters) - China has begun a crackdown on the sales of fake, diseased and tainted meat products after a series of scandals that have further dented public confidence in the food industry, the official Xinhua news agency said on Thursday.
It said the State Council, China's cabinet, recently ordered local government departments to step up checks on meat and processed meat products, and carry out detailed inspections of rural factories, workshops and warehouses as well as private slaughterhouses.
"The current water-injected meat, fake beef and mutton, dead livestock and other types of toxic and hazardous meat has aroused widespread concern," said the report.
"Local governments at all levels should strengthen their organization and leadership, to severely crack down on fake beef and mutton and other illegal and criminal activities."
Pork and poultry prices have suffered this year as a result of a series of food safety scandals, a bird flu outbreak and crackdown on expensive government banquets.
China has long been plagued by poor food safety standards, but many of the recent scares have involved its meat trade.
Earlier this month, the police said it had uncovered a crime ring that passed off more than $1 million in rat and small mammal meat as mutton.
It came after pictures of thousands of dead pigs dumped in rivers supplying Shanghai caused widespread outrage.
A media report last year uncovered excessive levels of hormones and antiviral drugs in chicken meat supplied to KFC, whose parent company is Yum Brands, and McDonald's.
Beijing has repeatedly called for greater inspection of food processing facilities to tackle food safety problems, but such actions appear to have done little to improve standards.
The latest clampdown will encourages local governments to offer rewards to people who inform on illegal activities.
The government also called for implementation of measures for the proper disposal of livestock that had died from disease.
(Reporting By Dominique Patton; Editing by Ron Popeski)
Let?s stipulate that the scandal involving the Internal Revenue Service?s targeting of conservative nonprofit groups portrays government as if drawn in caricature ? an almost Keystone Kops-style comedy of errors on the part of low-level staffers, with a vein of possible political bias.
Of course, the matter needs to be fully investigated, those responsible need to be held accountable and procedures need to be put in place to ensure that nothing like this can happen again.
But let?s also remember what the I.R.S. brouhaha is not. Unlike the abuse of the I.R.S. by President Richard M. Nixon, in this case there?s no evidence that anyone in the White House had any involvement in ? nor even any knowledge of ? what was going on within the agency?s Tax Exempt and Government Entities Division.
In the post-Watergate years, legislation was passed to protect the I.R.S. against political meddling from the executive branch. That included ? unusually ? a five-year term for the I.R.S. commissioner.
Until his departure in November 2012, the I.R.S. commissioner was Douglas Shulman, an appointee of President George W. Bush. (Yesterday, the acting commissioner, Steven Miller, who was a career civil servant, resigned under pressure.)
And finally, note that when Lois Lerner, the head of the Tax Exempt and Government Entities Division, learned that applications were being singled out if they contained words like ?Tea Party? in their names, she ordered that the practice be stopped. Regrettably, a bureaucratic ant colony succeeded in circumventing her instruction for several months.
By way of background, the decision in 2010 to target groups with certain words in their names did not come out of nowhere. That same year, the Supreme Court decision in the Citizens United case substantially liberalized rules around political contributions, stimulating the formation of many activist groups.
In the year ended Sept. 30, 2010, the division received 1,741 applications from ?social welfare organizations? requesting tax-exempt status. Two years later, the figure was 2,774. Meanwhile, the staff of the division tasked with reviewing these applications was reduced as part of a series of budget reductions imposed on the I.R.S. by anti-tax forces.
A far higher proportion of the new applicants wanted to pursue a conservative agenda than a liberal agenda. So without trying to defend the indefensible profiling, it wouldn?t be that shocking if low-level staff members were simply, but stupidly, trying to find an efficient way to sift through the avalanche of applications.
One of the bigger ironies about the I.R.S. imbroglio is that it had nothing to do with taxes. These newly formed entities didn?t seek 501(c)(4) status to avoid taxes ? these groups don?t earn profits and therefore don?t pay any taxes, regardless of their status. The important benefit that came from achieving 501(c)(4) status was freedom from having to disclose the names of any of their donors.
That?s right, what the I.R.S. was really deciding in these cases is which organizations have to disclose their funders and which don?t. And what it was trying to do ? however dumbly it went about it ? was to reduce the abuse of the campaign-finance rules, not the tax laws.
Without 501(c)(4) status, these groups would have had to organize as what are known colloquially as ?super PACs.? While this would have afforded them greater flexibility to overtly support candidates, the names of their donors would have to be made public.
In theory, 501(c)(4)?s are supposed to be social welfare organizations. But the rules are vague and are often stretched.
Some groups have interpreted the regulations as permitting them to spend as much as 49 percent of their funds directly advocating for or attacking the election of candidates, maintaining all the while the secrecy of their donors? names.
Perhaps most incredibly, a 501(c)(4) can even transfer a portion of its funds to a super PAC, which can ? thanks in part to the Citizens United decision ? freely support candidates for office
Karl Rove established just such a structure by pairing a 501(c)(4) organization (Crossroads GPS) with a super PAC (American Crossroads). By some accounts he raised as much as $300 million for these entities. And yet there?s no evidence that the I.R.S. ever questioned the 501(c)(4) status granted to Crossroads GPS.
So let?s, by all means, find the wrongdoers at the I.R.S. and punish them. But the biggest take-away from the I.R.S. mess should be that our campaign-finance system is in desperate need of overhaul.
iOS (Jailbroken): Velox is a new tweak for jailbroken iPhone's that completely changes how you view notifications and apps. It's one of those rare apps that overhauls iOS in a way that truly changes the way you use your iPhone. The app itself is great, but you can also tap into it with a handful of useful add-ons that add to the experience.
What Is Velox?
Velox is a $1.99 jailbreak app that changes how you interact with notifications. When you get a new notification in any app, you can swipe the app's icon, and Velox pulls up a folder with the notification right on the home screen. From there, you can swipe to dismiss them, clear them, or open up the app. This makes it so you can check in on notifications without wasting the time to open the app itself.
Velox also adds functionality into a few of the native apps and with a swipe of the icon you can invoke all kinds of cool features without ever leaving the home screen. The full list is pretty big, but here are a few of our favorites that come packed in with the app:
Camera: You can swipe the camera icon (or Camera+ icon) to quickly bring up your camera for those times when you need a quick shot.
Settings: You get instant access to toggles for Bluetooth, WiFi, Airplane mode, and more.
Music (works with any app that plays music, like Spotify or Pandora): You can skip tracks, pause, and scrub through songs.
Weather: With a swipe you'll get an instant look at the weather for the week.
Calendar: Shows you everything in your calendar for the upcoming week.
Mail: You'll see all your unread mail, and you can swipe to dismiss or even send a quick reply right from the home screen.
Out of the box you already get some great functionality, but the interesting part about Velox is that the developer also allows for add-ons. This means people can write their own extensions that add specific Velox functionality to apps Velox doesn't support. Here are a few of our favorites.
Addial for Velox
Addial adds a simple function to the Contacts app where you can instantly pull up a menu to add a new contact, dial a number, or call a contact. It's especially helpful when you just want to quickly add someone to your phone or get to the dialer without futzing about in menus.
AppLook for Velox
Instead of opening up the App Store and then tapping over to the search menu, AppLook for Velox allows you to instantly search right from the home screen. Just swipe down, type your search query, and you're all set. It seems simple, but it's actually surprisingly helpful to quickly get to the app you want.
Calculator for Velox
As you'd expect, Calculator for Velox pulls up the calculator so you can instantly perform calculations on the fly. It's a little quirky in its design and doesn't always work perfectly, but it's helpful when you just need to quickly make a calculation and don't feel like opening the full app.
Carrox or Things for Velox
One of the problems with to-do apps on the iPhone is the fact that in most cases you have to actually open the app to see what's on your list. Velox gets rid of this problem. If you're using Carrot or Things, you can download add-ons that make it so a swipe will reveal everything on your to-do list. It's helpful, and hopefully support for more to-do apps is on the way.
Stopwatch for Velox
You probably don't really need the stopwatch app very often, and if you're anything like me you kind of forget it's even there most of the time. What's handy about Stopwatch for Velox is that it packs it right into your home screen so you can get access to it immediately and instantly start timing whatever you need.
Velox was just released last week, so inevitably more add-ons are the way. If your favorite app doesn't have an add-on yet, chances are it will soon.
Jailbreaking is a process that changes little by little with each iOS upgrade. Rather than always? Read?
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Public release date: 20-May-2013
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